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External Approach to Buccal Fat Excision in Facelift: Anatomy and Technique
Andrew L Kochuba MD, Christopher C Surek DO, Sayf A Said MD, Eliana Duraes MD, and James E Zins MD FACS
Cleveland Clinic
2020-01-30
Presenter: Andrew Kochuba
Affidavit:
I agree
Director Name: Dr. James Zins
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
BACKGROUND: Masculinization of the face is a common finding in facelift patients. It is attributed to deflation and decent of the midface-jowls coupled with skin laxity. Fullness is evident lateral to the jowl in small percentage due to prominent buccal fat pad.
OBJECTIVES: To examine the anatomy of the buccal fat pad, triangulate the prominent BFP with surgical landmarks, and describe an external approach to excise the BFP during facelift surgery.
METHODS: 18 cadaveric dissections were performed. Facelift flap was elevated and the prominent buccal extension of the BFP protruding through the SMAS was identified. Measurements were taken from the BFP to surgical landmarks: zygomatic arch, tragus, gonial angle. The location of the facial nerve, parotid duct, and vascular pedicle relative to the BFP were calculated.
RESULTS: BFP was 4.1cm inferior the zygomatic arch, 7.5cm anterior the tragus, 4.5cm medial the gonial angle. The middle facial artery supplied the BFP on the inferior-lateral quadrant in 61% and inferior-medial quadrant in 39%. In all specimens, the parotid duct traversed the BFP superiorly and the buccal branches of the facial nerve traversed the capsule superficially.
CONCLUSIONS: The buccal extension of the BFP can pseudoherniate in the aging face. Excision may improve lower facial contour. Measurements from facial landmarks may help surgeons identify the buccal extension of the BFP intraoperatively. The surgeon must be careful of the vascular pedicle, parotid duct, and the facial nerve. The external approach safely excises buccal fat during facelift dissection while avoiding intraoral incisions and unnecessary contamination.
