Buccal fat pad herniation during mini facelift led to removal. What can be done nonsurgically to add some volume back? (Photos)

Question

Buccal fat pad herniation during mini facelift led to removal. Seems one side is a partial removal and the other is total as both sides are different. Additionally, I had this done solely to address neck laxity, which now is as it was before facelift which was 6 mos ago. What can be done non surgically to add some volume back?

Semih Yildiz, MD, FEPOBRAS · Answer

Your photos show lower cheek/submalar hollowing and some asymmetry, along with persistent neck laxity. Once buccal fat has been removed, it cannot truly be put back nonsurgically, but volume can sometimes be improved with carefully placed injectable treatments.
For the cheek hollowing, options include hyaluronic acid filler, calcium hydroxylapatite, or biostimulatory treatments such as Sculptra, depending on the depth and location of the hollow. The key is conservative placement by someone very experienced with facial anatomy, because the lower cheek and prejowl area can look heavy or irregular if overfilled. Often the best result comes from restoring support in the midface and lateral cheek rather than trying to fill only the deepest hollow.
Fat grafting is usually a more structural and longer-lasting way to replace lost volume, but it is surgical. For the neck, nonsurgical treatments such as skin tightening devices or injectables may give only modest improvement; if the neck laxity is similar to before surgery at 6 months, an in-person revision evaluation is reasonable. I would seek a second opinion from a facelift revision surgeon before adding volume so the cheek and neck are planned together.

Kyle Kimura, MD · Answer

Great question and photos. 
The area you are circling in the first photo looks like it may be a bit too far back from where the buccal fat is and may be fullness from the lift, though its hard to tell definitively. This can sometimes resolve with time or steroid injections. The third photo circled looks to be a common deformity that can occur after facelift where too much central fat is removed and not enough laterally, giving the impression of a hollow in this area. Unfortunately, this area is likely better addressed through a revision facelift or neck lift with particular attention to plicating or at least bringing some of the platsyma muscle back to the midline and lifting superior and laterally. I think your best bet is to discuss these areas with your surgeon or another plastic surgeon who specializes in facial rejuvenation procedures.
Hope this helps and best of luck

Jake Thayer, MD · Answer

You can try an HA filler product (temporary), fat transfer (permanent) or an alternative nonsurgical injection that consists of extracellular matrix (Renuva) that would attempt to add volume back to the buccal fat areas.
Thanks!

Michael P. Morrissette, DDS, FACS · Answer

The 2 areas that you circled can be addressed with the addition of your fat or "autologous fat grafting". It is the best filler for volume loss in my opinion. Unfortunately, you didn't achieve a long-term result for your neck, and this will have to be addressed with another surgery. Sometimes all it takes is a small revision from each side.

Catherine Weng, MD · Answer

Thank you for you question and photos.  Buccal fat pad removal can be done during a deep plane face lift if it is encountered and protruding.  When I perform deep plan face lift, I do occasionally remove fat from the buccal fat pad if necessary. This is usually planned based on assessing the preoperative anatomy and seeing if there is excess fullness in the lower cheeks.  This fullness can be asymmetric one side can be fuller than the other side.  This happens pretty commonly.

Looking at your post operative photographs, on the left side the area that is circled, the volume deficit appears posterior. this is typically where the parotid land and smas muscles are.  This is not the area of the buccal fat pad.  Volume loss in this area can be filled with fat or filler.  I would consider voluma in this area.

As for your concerns reguarding neck laxity, you mentioned you had a mini facelift.  Typically in a mini facelift, there is shorter incisions and limited dissection usually laterally around and below the ears.  The area under the chin is not always adressed.  I do not see a scar from an incision beneath your chin.  It appears you have platysmal bands.  The fan like muscle called the platysma in the neck has separateded, which causes you see the bands.  This can be repaired by a submental platysmaplasty - often included in a facelift surgery, but not necessarily done in every case (and less likely to be done in a mini facelift).

I hope this helps.

Zoran Potparic, MD · Answer

Residual deformities of the neck and face can only be corrected with suegical revision of neck bands and fat grafting of areas of scars and volume deficiencies. Person or teleconference second opinion consultation with an expert in facial rejuvenation is recommended. Good luck.

Albert Yang, MD · Answer

So from the picture, your left? cheek has a little protrusion. hard to tell but usually buccal fat is higher and more towards the mouth than that area. Was there fat graft done? or it could be your muscle.If that's truely your buccal fat though, a deep place facelift will be able to address that area. 
For the neck, it seems like the platysma muscle is sagging a little. I would recommend a deep plane necklift. this will create a "hammock" that will sling up the entire neck to give a better contour.

Buccal fat pad herniation during mini facelift led to removal. What can be done nonsurgically to add some volume back? (Photos)

Answers (7)

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