Hubbub About the Buccal Fat Pad

PA_43 Decade Twenties.txt
Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Doreen Wu, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator, and technology innovator. The title of today's episode is Hubub about the buccal fat pad. Okay, Dr. Bass, you've piqued my curiosity. What is the buccal fat pad and why is there so much hubub about it?

Dr. Lawrence Bass (00:33):
I promise to answer that question, but let me give you a little background first so our listeners can understand the issues. A lot of the shape of our face is formed by fat pads in the face. We start with our bone and muscle, but on top of that we have multiple fat pads and not just multiple fat pads, but but more than one layer of fat pads. So we've understood that that's part of face shape and we kind of know that our cheeks and other parts of our face have some fat in there that gives shape. But we learned more and more about this anatomy over time. And in particular, a plastic surgeon in Texas named Dr. Joel Pessa did a lot of facial dissections in cadavers to really outline exactly which fat pads, how they're compartmented so that we understand what building blocks go into forming facial shape.

(01:41):
Now, of course, everything changes with aging and what changes in these fat pads is that they shrink. We get volume loss and they descend. But all of the fat pads will do that differential. They don't shrink the same amount and they don't descend the same amount. So when we're young, even though we have all of these different little building blocks making up the shape of our face that looks confluent and smooth as we age and they shrink in a variable fashion and descend in a variable fashion, we now get sags and bags and lumps and bumps. And so we now see more of the shape of those fat pads and more unevenness and irregularity.

Doreen Wu (02:40):
Thank you for the explanation of the important role that fat can play in facial shape. Now I'm wondering how is fat modified by plastic surgeons?

Dr. Lawrence Bass (02:51):
Well, really in two ways and we can either increase it or decrease it. And of course it's very important how much and exactly where you do those things. You need control over all of that. So we, we take rounded facial shapes, basically convexity, and we can sculpt and sharpened some of those shapes. And we mostly do not do that with liposuction. We certainly liposuction the neck that's frequently done and works very well, and we occasionally minimally do it in the gel. But separate from that, we're often building back a shape that has flattened out lost projection with aging. The example of the buccal fat pad though, is where we get chipmunk cheeks. If the fat pad is too big and we typically like to see some hollowing, we want underneath the cheek mound, we want that area to be relatively flat or just slightly concave. We don't want it to be convex because that's chipmunk cheeks. And so by doing a buccal fat pad excision, we can take somebody who is too rounded in that area under the the cheek itself and we can flatten them.

Doreen Wu (04:30):
How is the buccal fat pad excision done? Can you break it down for the average layperson?

Dr. Lawrence Bass (04:37):
Make an incision about as wide as somebody's fingernail inside the mouth just by the molars in the back. And through that incision we can access the buccal fat pad. The buccal fat pad is not accessible for liposuctioning. It's not a superficial fat pad right under the skin. It's a deeper fat pad. So from inside the mouth through that small incision, we can access the fat pad. Then we grab some of the fat and gently tease it out, trim a little bit of that fat off and look at what kind of contour we've got, and then we can trim a little more. So it's good to do this incrementally, not take a huge amount at once, assess the effects so that you know, it's like Goldilocks and the three bears. So not too much, not too little, just right. And by doing it a little bit at a time, we can get to that endpoint.

Doreen Wu (05:41):
Okay, so I now have a clearer picture of the process and what the results should look like. But can you explain why this has been in social media a lot lately and what the controversy surrounding buccal fat removal is?

Dr. Lawrence Bass (05:55):
The issue discussed in social media revolves around the unnatural look that some celebrities and some other folks have obtained after buccal fat pad excision. And basically it's the result of over hollowing. If a little is good, more must be better, not necessarily true. And some people have been over hollowed or may not have been particularly con convex to begin with, and maybe were not a good candidate for buccal fat pad removal. And this is a modern version of the mistake that was made decades ago with liposuction in the face. We learned in the 1980s, which sort of predates me as a plastic surgeon that liposuctioning the face was a bad idea, created an unnatural look, an over hollowed look. And sometimes you see that immediately and sometimes it's something that shows up a decade or more later as you slowly age. But the idea is just like what I said about the Goldilocks principle, that we want a certain contour and ramping that contour to an extreme degree creates an unnatural look and is a mistake.

Doreen Wu (07:14):
What's your take on this procedure, Dr. Bass? Is it good or bad? Is it something to be pursued or avoided?

Dr. Lawrence Bass (07:22):
So like everything we do in plastic surgery, it's about balance and harmony and some sense of planning for the future. You know, we don't want to burn our bridges in the future. We look good right now, but we look like a rack down the line. That's not a good trade off. So this is the classic Goldilocks principle. Not too much, not too little, just right. And the amount that we're typically excising in a buccal fat pad excision is a tablespoon or at most two tablespoons. It's not a good idea to go in there and get a big clean out of fat because that's going to look unnatural over hollowed or even pinched in early in the game, not even with aging.

Doreen Wu (08:14):
That makes a lot of sense. Balance is always key. All right. So we've reached the takeaways portion of the episode. Can you bottom line it for me? What is some good advice for our listeners in regard to this area of the face?

Dr. Lawrence Bass (08:27):
So buccal fat pad excision is a very useful and powerful tool for facial shaping and something we use mostly in young adults. The typical results are passing you in the street in a city like New York every day and look perfectly natural. Any kind of extreme or overdone surgery, and this is true in buccal fat pad surgery as well as in all of plastic surgery, that kind of overdone look is a bad idea both in terms of the immediate appearance and the late appearance as well. So it's always a good idea to work with an experienced plastic surgeon who can analyze your face, look at the shape, create something that harmonizes with your other features rather than something that clashes with your existing features. So this accents your appearance softens some discordant or over obvious facial attributes blending undesirable ones.

Doreen Wu (09:42):
Thank you Dr. Bass. After this discussion, I now realize how big of an impact a single small component of facial anatomy can have on our appearance. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review, and share the show with your friends. Be sure to join us next time to avoid missing all the great content that's coming your way. If you want to contact us with comments or questions, we'd love to hear from you. Send us an email at podcast@drbass.net or DM us on Instagram, @drbassnyc.