Pseudoherniation of the Buccal Fat Pad

Hi, I seem to be suffering from herniation of the buccal fat pad following an over-weakening of my left masseter muscle after I had 40 units of botox injected. I've read that I can either undergo a one-sided buccal lipectomy, or have the fat relocated to its previous position and sutured into place. Which do you think is the better option? I'm thinking the latter to retain cheek fullness. Can you please explain to me how this re-suturing is done? It's been like this for a month. Thanks so much.

Doctor Answers 7

The Buccal Fat Pad

At this point I would suggest waiting 3-6 months for the BOTOX to wear off.  After reviewing you photos, you have a slender face to begin with.  A buccal fat pad excision might solve this temporary situation caused by BOTOX, but after the effects of the BOTOX wear off, might leave you with a very skeletonized appearance of your cheeks. Good Luck, Dr. Corrado

Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 34 reviews

Please do not have surgery to address a temporary problem!


Please do not further victimize yourself.  The BOTOX will wear off.  Please let this happen before you decide on a surgery that is potentially going to skeletonize your very thin face.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

The BOTOX® will wear off

If your problem is related to treatment of the masseter with BOTOX®, you can expect that the problem will back off on its own as the BOTOX® wears off during the 3-6 months following your treatment. So, if I were you, I would certainly not be in any rush to do anything.

There are a variety of causes for what you have described. An ENT surgeon could probably work through the list. I would wait until the BOTOX® has worn off, then see an ENT surgeon if the problem persists.

Kevin C. Smith, MD
Niagara Falls Dermatologic Surgeon
4.7 out of 5 stars 4 reviews

Botox for cheeks

you didn't mention how long ago the botox was injected. If it is less than four to five months, you should not do anything other than await the pseudoherniation to resolve. Don't undergo a procedure now that you won't need in the future. If it has been six months since your botox, you should see a plastic surgeon for an in-person evaluation and examination and discussion of the treatment.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Botox injections and pseudo herniation of buccal fat pad

Answer: do not do anything! Just wait. 

Botox will wear off in about 4 months and your face will be as before. Doing any surgery now will create an issue when the Botox is gone. Just be patient and you will see that it will gradually get better over the next month or so. Removing fat from your cheek will create a hollowness that will be difficult to fix later on. 

Henri P. Gaboriau, MD, FACS
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 7 reviews

Buccal Fat Pad

Since it seems you are attributing your issue to Botox, then please do not rush into having any corrective surgery.  Botox ALWAYS goes away and you should give it time to wear off before jumping into any surgery.  Buccal fat pad excision can be very effective in the right patients.


Good Luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Botox and buccal fat pad herniation?

I do not think that Botox of the masseter would affect the buccal fat pad and cause herniation. Be that as it may, I would allow the botox to wear off and see how things respond. You seem to have a thin face in the photos and I would be reluctant to remove buccal fat which would make it look thinner.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

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