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Efficacy of the Buccal Fat Pad Graft in Facial Reconstruction and Aesthetic Augmentation

Kim, Jeong Tae M.D., Ph.D.; Ho, Samuel Yew Ming M.B.B.S.(Sing.); Hwang, Jin Hee M.D.; Sung, Kun Yong M.D.

Plastic and Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 83e–85e
doi: 10.1097/01.prs.0000436800.27670.dd
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Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea

Section of Plastic Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, Singapore

Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea

Department of Plastic and Reconstructive Surgery, Kangwon National University Hospital, Chuncheon City, Korea

Correspondence to Dr. Ho, Section of Plastic Reconstructive and Aesthetic Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng S308433, Singapore, lilming2000@gmail.com

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Sir:

Small facial soft-tissue contour deformities are usually corrected via the transfer of autogenous lipoaspirate, due to the small volumes and precision required. The popular use of lipoaspirate is not without complications, including volume resorption, difficulty in achieving a three-dimensional conformational shape, and the possibility of fat embolism.1 The main reason for delayed absorption of aspirate is well known to be trauma during the aspiration procedure.

In this article, we introduce the free buccal fat pad graft as an alternative to correct these small-volume facial deformities. Because the fat structure is well preserved, it is able to maintain its volume and consistency. The anatomy of the buccal fat pad should be well understood, in order to minimize donor-site complications and ensure minimal damage to the fine lobular architecture of the fat pad.

The buccal fat pad graft is harvested via a single, intraoral buccal incision. The opening of Stenson’s duct is identified, and the buccal incision is placed away from the duct orifice at the level of the mandibular occlusal line. The buccinator muscle is split using blunt dissection, and the encapsulated buccal fat pad is delivered, with external digital pressure. Care is taken to avoid damaging the capsule of the fat pad.

All 15 cases were performed by a single surgeon (Table 1). There were no donor-site complications. There were no cases of cheek contour deformity. All 15 patients reported excellent satisfaction with regard to contour deformity correction at 3-year follow-up.

The buccal fat pad has been a subject of analysis for a variety of procedures since 1998.2 Emphasis has been placed on its use in intraoral defects. It has also been removed for cosmetic purposes, used to soften bony contours,2,3 and used as an interpositional graft over the facial nerve to prevent Frey’s syndrome.4

There are many clinical applications of the buccal fat pad graft, such as the correction of periorbital contour depressions, volume replacement after eyelid or nasal tip operations, interpositional graft over the facial nerve, and shield graft in the nasal tip after implant placement, especially in revision cases. In cases of silicone implant exposure, the buccal fat pad graft serves as a barrier to prevent skin thinning (Fig. 1).

Fig. 1

Fig. 1

The main reason for fat resorption is known to be trauma during the fat aspiration. The buccal fat lobule, being well encapsulated in a multilobular form, maintains its structure and consistency, which helps to prevent its resorption.2,5 This allows it to be relatively robust in resisting fat resorption and to efficaciously restore volume in a three-dimensional conformation (Fig. 2); in contrast, lipoaspirate tends to conform to the soft-tissue pocket. It also obviates any possibility of fat embolism. Much attention has to be paid to surgical technique in harvesting the buccal fat pad. It is important that the capsule is not disrupted by poor surgical technique (Fig. 2). Damage to the capsule results in a higher rate of volume resorption after grafting.

Fig. 2

Fig. 2

In conclusion, the buccal fat pad graft represents an easy and convenient tool for the correction of small facial contour deformities, volume replacement, aesthetic nasal tip augmentation, and revision rhinoplasty with minimal donor-site morbidity.

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DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

Jeong Tae Kim, M.D., Ph.D.

Department of Plastic and Reconstructive Surgery

College of Medicine

Hanyang University

Seoul, Korea

Samuel Yew Ming Ho, M.B.B.S.(Sing.)

Section of Plastic Reconstructive and Aesthetic Surgery

Department of General Surgery

Tan Tock Seng Hospital

Singapore

Jin Hee Hwang, M.D.

Department of Plastic and Reconstructive Surgery

College of Medicine

Hanyang University

Seoul, Korea

Kun Yong Sung, M.D.

Department of Plastic and Reconstructive Surgery

Kangwon National University Hospital

Chuncheon City, Korea

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REFERENCES

1. Gir P, Brown SA, Oni G, Kashefi N, Mojallal A, Rohrich RJ. Fat grafting: Evidence-based review on autologous fat harvesting, processing, reinjection, and storage. Plast Reconstr Surg. 2012;130:249–258
2. Jackson IT. Anatomy of the buccal fat pad and its clinical significance. Plast Reconstr Surg. 1999;103:2059–20600; discussion 2061
3. Thomas MK, D’Silva JA, Borole AJ. Facial sculpting: Comprehensive approach for aesthetic correction of round face. Indian J Plast Surg. 2012;45:122–127
4. Kim JT, Naidu S, Kim YH. The buccal fat: A convenient and effective autologous option to prevent Frey syndrome and for facial contouring following parotidectomy. Plast Reconstr Surg. 2010;125:1706–1709
5. Meyer E, Liebenberg SJ, Fagan JJ. Buccal fat pad: A simple, underutilized flap. S Afr J Surg. 2012;50:47–49
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