If you find that your
cheeks are round and look as if you've had your wisdom teeth removed
recently or if you appear to have the mumps or food stored
between your cheeks and teeth and you do not
appreciate this look, you may wish to
consider this procedure. It is not a rather invasive procedure but it
will cause discomfort and swelling and you will have to take it easy for
a proper result so consider all of the above before deciding if this may
be a viable option.
What To Expect At Your
After checking a few
surgeons' backgrounds and credentials, you will make some consultation appointments.
It is best to get at least 3 opinions. You will meet with these surgeons and discuss your goals
and you will disclose all information regarding your health; if you
smoke, what medications or vitamins you presently take, etc. -- this is
very important. See the Medication &
Supplements List for more information.
You will discuss your
complaints and concerns and discuss the various looks one can achieve,
the amount that can and should be removed, etc. Your surgeon will
explain the technique and incision placements or methods that may be
most appropriate for you and should discuss the risks associated
with buccal fat extraction with you, as well.
also discuss the available anesthesia that will be used for your
procedure. Most buccal fat extraction procedures are performed under
Light Sleep Sedation, Twilight or regional - sometimes even local with
oral sedation. However, some docs may use General IV Sedation.
Either way, discuss this beforehand as many people are not aware of the
risks of Anesthesia. If you do go under Deep General, ascertain that the
anesthesiologist is certified. Please
read the All About Anesthesia Page - the risks regarding anesthesia
should be considered for a fully informed choice. You will of course not
have General Gas Sedation as your procedure is performed intra-orally (through
also discuss your pre-operative instructions and speak about the
recovery period instructions and what to expect in the months ahead.
will be given prescriptions for antibiotics, pain relievers, perhaps
blood pressure medicines, prescription anti-inflammatory drugs and perhaps a box or
directions for gaining a bottle of Arnica montana. Perhaps
you will be instructed to obtain Bromelain or other types of remedies,
although many surgeons would rather have you not take ANYTHING other
than your prescription medications, please do not go against your
Would like to know more on the
benefits of Arnica montana? Or Bromelain?
If you would like more information on Consultations or a list of
questions to ask your surgeon please visit the Consultation
For Your Surgery
You should be given a pre-operative
information packet that explains everything you should do and know
before your surgery date. The packet should include a list of all
the medications you should not take starting usually at 2 weeks
before your surgery. These medications will include, but are not limited
to, aspirin containing products, stimulants, seratonin supplements, etc.
Would you like to view a typical Medication
& Supplements List? We have a printer-friendly
version as well. Also, if your surgeon advised that you may take
Arnica montana, Bromelain, Vitamin K, etc. for swelling and bruising you
should either have this in your packet or begin shopping for your
It is quite possible that you
will have preliminary blood work performed. This is normally an extra
out-of-pocket expense that the patient must participate in to check your
white and red blood cell count (CBC, complete blood count) which can
ultimately clue them in to disease or disorders
beforehand. If you are a female they may take an extra vial for a
pregnancy test. Some surgeons ask that you have physical. This can be
yet another out of pocket expense so ask at your consultation what will
be needed when you are quoted a price.
So many things to do...
so little time. Surgery will be here before you know it so visit the Preparing
For Surgery page and relax. This section contains, printer-friendly
pre-op lists, tips and advice as well as things you must do to prepare
for your big day.
Fat Pad Extraction Procedure
A buccal fat
extraction normally takes about an hour to perform. First,
you will be given your choice or your surgeon's preference in anesthesia
as discussed prior to your surgery date. If you had been given an oral
sedative or valium prior you usually could care less what they are
sticking in you. They will more
than likely insert an IV for a saline drip to keep you hydrated and have
a vascular doorway should the need arise. If you haven't
been given a sedative, it is more stressful for some patients. Having an
IV inserted feels sort of like blood being drawn, but for a shorter
period of time. It's the initial placement of the IV that may
sting a bit. After the needle is injected into the vein it is pulled out
and a little plastic tube is left in your vein. This is called a catheter, which is taped to your skin so it is not knocked
out and is ready to be used as a sort of entryway for anything the
surgical team deems
suitable for your body. This is usually done before you get into the
actual O.R. -- by a nurse -- and you have a saline bag hooked up to you.
The medications will usually be given with a drip system with this saline.
I said, the saline will keep you hydrated both during and
Some people get their
IV placed in the
crook of the elbow, some the hand. I dislike the hand ones as it's a
nasty place for a bruise to be, at least with the arm you can hide it --
it all depends upon your veins though. So if your veins are not
very prominent this can be a problem. You
are then brought to the O.R. if you aren't on the table yet.
have chosen an IV Liquid Sedative, they will insert a hypodermic
into your tube that you are attached to or they attach the bag of it
with a drip system to add a few drops every few seconds and when they
spring open the stopper and it starts heading towards your body. The
effects of the anesthesia are felt soon after injection or opening the
stopper -- a few seconds in fact. It feels like heat
going into you veins then creeping up your arm -- then it jumps from your shoulder to a metallic-like taste under your
tongue and then you are blissfully anesthetized.
"The buccal fat pad has a main
body with 4 extensions. The most clinically significant is the largest and most superficial (buccal extension). It accounts for 30-40% of the total weight of the fat pad and imparts cheek fullness. It is excised through an intraoral approach."
(Yale Medical Core Curriculum)
Your surgeon will make an
incision about 2 to 4 cm long between the cheek and gums (maxillary
vestibule), starting above the second upper molar towards the back
of the mouth. The surgeon uses blunt dissection to expose the fascia and
fibers of the buccinator muscle. Your surgeon will then use the pressure
of his thumb externally against your cheek right under your cheek bone
causing the buccal fat to protrude through the incision. He or she will
then tease the fat out with forceps or surgical tweezers, a little bit at a
time. Sometimes a collective amount of a golfball is removed,
sometimes more. Whatever your desires, just remember if you are in your
twenties this may not be a good idea. Although removal of this fat pad
may look good now, when you begin losing this fat naturally -- your face
will look gaunt and haggard if you have removed too much prior. Unless
of course, your genetics program you to always have chubby
surgical team then performs a sponge and instrument count and your
surgeon then closes your incisions with, more than likely, a non-dissolvable
type suture. You may have an antibiotic-soaked piece of gauze placed
between your upper molars and your gums and
perhaps a pressure dressing placed around your head such as you would
see in a face lift patient or a neck liposuction patient. If you are not
familiar with this look it involves wrapping a dressing
around the top of your head to underneath your chin, sometimes slightly
over your ears. Of course there may be differences in surgical technique
depending upon the preference of your surgeon.
You are then
wakened gently and brought into the recovery room where the recovery
nurse will monitor your vital stats until you are ready to be released.
This is dependent upon the individual but may take up to two hours.
face may feel tight and quite tender as the anesthesia wears
off. You may even feel emotional or upset -- this will depend upon your
body's reaction to anesthesia. You may also experience rigors, or shivering. This may feel uncontrollable and
is usually from the medications -- more than likely epinephrine that is
used as a vasoconstrictor. The recovery nurse usually has wrapped you in
a warm blanket but if not, request one. It certainly makes things more
patients feel nothing different although if you have had General you may
feel a little sick -- hopefully your surgeon gave you something to lessen
this. Your prescribed medication should alleviate this pain and
discomfort. However, if you believe your pain to be out of the ordinary
once you get home, call your surgeon or the on call staff immediately.
You will be driven home by your spouse, significant other or friend as
you will not be able to see, much less drive yourself home.
The Road To Recovery
You may be groggy from the anesthetic
and or oral medications and probably won't remember much of the first
day or two. You will have to take it easy and sleep on two pillows to
keep your head elevated for 7 to 14 days -- or however long your surgeon
suggests. When you wake up you will notice that your face will look even
more swollen in the first 3 days. But, as the days go on the swelling
will dissipate. There may be bruising, but this will go away, as well.
So make a mental note of this or you may be shocked into a depression. Bruising
and swelling are a normal occurrence in most surgeries.
more than likely experience some discomfort for several weeks -- having
had intraoral incisions your diet may be restricted. You should
ascertain all fresh fruits and vegetables have been washed, no raw fish
(sushi), very rare meat or other types of foods that may contain high
amounts of bacteria. Eating foods such as this may increase your risk of
infection due to the incisions being in the mouth. You may be instructed
to rinse with Listerine several times a day. DO NOT PICK or tongue your incisions or sutures!
discomfort should be alleviated by your prescribed pain medication if
you have excessive pain, redness, pus or other symptoms that do not
appear normal, contact your surgeon immediately! Take your
temperature regularly. An elevated temperature could mean an
infection. Take those antibiotics on time. Also, don't forget if
you are a female taking birth control pills that some antibiotics can
interfere so in the event that you do have relations, use another form
of protection as well.
will more than likely be taken out by your surgeon at a week to 10 days
postoperatively. Even though you may feel better, you must take it easy
for the first 3 weeks. Be careful not to bend over or lift heavy
objects. And be careful not to raise the blood pressure for at least 3
weeks as this could cause internal bleeding at your treatment area.
blood vessels dilate to allow increased blood flow when you raise your
heart rate. This may cause problems at internal wound sites. Do
not participate in contact sports for at least 6 to 8 weeks -- although ask
your surgeon what he recommends specifically.
swelling will subside within a few weeks, defining even more as the
months go by, revealing a more defined facial structure. You
may notice a change in your smile, odd sensations of hollowness, tingling, the sporadic sharp pain, or
pulling, burning, and cold sensations. These usually subside
within the first few weeks.
Risks & Complications
Of Buccal Fat Pad Extraction
Unfortunately, All surgery has risks and
complications. With buccal fat extraction, these include allergic
reaction to the anesthetic used and infection. There could be asymmetry,
general dissatisfaction, hematoma or seroma.
is possible, it usually subsides within the first few weeks but it may
become a permanent issue. Puckering of the skin may occur and deeper
than desired depressions may result. Excess scar tissue and lumps are possible
not least, it is possible to appear gaunt if too much was taken out, or
the procedure was performed before you lost much of your facial fat.
This fat decreases with age and you may notice that you appear hollow
about the cheeks in later years. Please consider this before you commit.
Although facial fat grafting is becoming
very popular and proving to have quite wonderful results!
However buccal fat is contained within membranes and once you take these
out you can't replace these.
The Least You Need To
buccal (pronounced like
buckle) fat extraction
to aid in defining an overly fatty lower cheek area sometimes
referred as "chipmunk cheeks"
from mid to late 20's
to usually 40's. Earlier than that is not recommend and later than
this is usually not needed.
skilled cosmetic or plastic surgeon with a good background and
experience in performing this operation.
Accredited Surgical Suite
Light Sleep IV
Sedation or General IV - possibly oral sedation with regional/local.
Read All About Anesthesia
1 hour, depending upon extent of work to be done.
Factor: mild to moderate,
pain meds should alleviate any discomfort. If not, call your surgeon
Mild to moderate -
depending upon individual's health, and habits such as smoking,
protein consumption, iron level, etc.
mild, depending upon
someone there to help care for you during your recovery, keep
elevated -- even when sleeping. A recliner works best.
usually to remove sutures at 7 to 10 days post, sometimes
Post-op visit: check up usually at 3 weeks for exercise/activity
to work: usually
within 3-5 days - but depends upon type of wok. Sedentary (desk job)
with little or no amount of talking. If your job requires high
impact activity you may need more time off, please ask your surgeon.
No exercise until at
least 3 weeks post-operative. Be careful not to raise your blood
pressure for several weeks, you don't want to inhibit proper
healing. Check with your surgeon.
result: usually can be seen within 4 months
of Sensitivity: It is
possible to lose sensation along the incision lines, on the central
cheeks and jawline. Long term or permanent loss of sensitivity is
eyebrow and eyelash loss from medications. Possible asymmetry as
Disclose all your medical background. If you are a smoker, if you
are taking medications, or if you have any other medical concerns.
Be realistic in your expectations. No plastic surgeon can perform
miracles, he or she can only try and improve upon what you have
average prices for: buccal fat extraction may be from
$2000 to 5000US and depends upon the surgeon and region as well as if
the surgeon has his or her own surgical suite. With procedures
performed in a hospital or under General with a certified
anesthesiologist, prices are usually be higher.
Yale Medical Core Curriculum
Ramirez, Oscar M,. M.D.
"Buccal Fat Pad Pedicle Flap for Midface Augmentation" Annals of Plastic
Surgery- August 1999, Volume 43, Number 2