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External Approach to Buccal Fat Excision in Facelift: Anatomy & Technique
Christopher C. Surek
Sayf Said
Kihyun Cho
Marco Swanson
Eliana Duraes
Jennifer McBride
Richard L. Drake
James E. Zins
Cleveland Clinic
2018-02-14
Presenter: Sayf Said
Affidavit:
Dr. Surek has assembled the design, execution and write-up of this study under my mentorship. Data collection and interpretation was assisted by the other authors on this paper.
Director Name: James Zins
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
Purpose: The intraoral approach has been the most commonly described technique for direct excision of buccal fat. The purpose of this study was to examine the anatomy of a prominent buccal fat pad (BFP) in the aging patient and to describe an external approach to buccal fat excision during facelift surgery.
Methods: 18 hemifacial fresh cadaveric dissections were performed. The location of the buccal extension (BE) of the BFP was identified and measured from known surgical landmarks. Vascular pedicle position and the location of the parotid duct relative to the BFP was recorded. An operative technique video was created.
Results: The pedicle to the buccal extension was a branch off the middle facial artery and entered the fat on the inferior-lateral quadrant in 61% and the inferior-medial quadrant in 39% of specimens. The parotid duct traversed on the superior aspect of the buccal extension and buccal facial nerve branches traversed on the superficial surface of the capsule. The buccal extension was located 7.5 cm anterior the tragus, 4.5 cm from the gonial angle and 4.1 cm inferior to the zygomatic arch. Case examples are provided.
Conclusion: The BFP can demonstrate pseudoherniation in the aging face. In select cases, excision of buccal fat may improve lower facial contour. This study provides triangulation measurements to help surgeons identify the BFP intraoperatively. When excising from an external approach the surgeon must be cognizant of vascular pedicle location and the relationship of the fat pad to the parotid duct and buccal facial nerve branches.
