Medical Care , Health & Wellness , Aesthetics
Permanent surgeries are irreversible. To prevent disappointing results, patients need to have specific reasons for undergoing the surgery, and not be carried away by the trends.
Recently, buccal fat pad removal surgery has taken social media by storm. On platforms such as TikTok, Snapchat and Instagram, young women and men engage in social conversations surrounding turning to this surgery as a "shortcut" for a more sculpted and defined cheekbone.
Buccal fat pad removal surgery is designed to "thin" the cheeks for those who want to get rid of round cheeks for a more sculpted, "chiselled", and modelesque appearance. Interest in this surgery has significantly increased among the younger population, largely influenced by the "snatched look" of social influencers and celebrities they follow. Chrissy Teigen, a Hollywood actress and model, publicly shared that she had the surgery.
"Buccal fat pad removal surgically removes the buccal fat pad (Bichat's fat pad), an encapsulated fat mass in the cheek to create more definition and angularity in the face. Bichat's fat pad is an important anatomical structure that affects facial aesthetics and facilitates muscle movement. Buccal fat pad develops significantly between ages 10 and 20. However, it gradually shrinks in size over the next 30 years as we age," explains Dr Ivan Puah, an aesthetics and liposuction doctor of Amaris B. Clinic in Singapore with over 17 years of facial and body sculpting experience.
Buccal fat pad removal is not a new procedure. Historically, it is performed in tandem with other facial rejuvenation surgeries. However, with the continued craze around the "snatched" look, the demand is picking up amongst patients in their 20s and 30s, who don't necessarily have extensive buccal fat but want to achieve the same chiselled look as that of their favourite celebrity or social influencer who had it done.
"The ideal candidate has prominent cheekbones that are obscured due to prominent cheeks. Buccal fat pad removal reduces cheek fullness and, in turn, highlights the cheekbones. However, it is not suitable for all patients," explains Dr Ivan Puah.
Patients with malar hypoplasia (underdevelopment of cheekbones) or those with gaunt faces are unsuitable for the surgery, as it will result in a hollowed appearance of their cheeks or further exaggerate the "already-sunken-in" cheeks, making them look more mature and older than their peers.
The buccal fat pad is removed permanently during the surgery, and the effect is irreversible. Over-resection may occur when the plastic surgeon is overzealous or is not skilled or precise. A study has also concluded that there is a 26.3% chance of injury to the buccal branch.
"I have seen patients who had this form of facial plastic surgery done by other doctors and regretted it as they grew older. They requested treatments to replace the facial volume loss. What looked good then has led to an overly hollow appearance as time passed. Their objective has now shifted from looking chiselled and modelesque to desperately wanting to "reverse" the effects of the worn-out look. In such cases, dermal fillers or facial fat grafting may help to restore facial volume loss to the cheeks area," explains Dr Ivan Puah.
Dr Puah begs to differ, "An overactive masseter muscle may lead to jawbone elevation and protraction, and injectable neurotoxins can easily rectify this. I would perform facial liposuction for patients with excessive fullness in the lower face and cheeks. This not only addresses the issue of excess facial fat, but it also can effectively sculpt the jawline and lift and tighten saggy skin. Facial liposuction targets localised superficial fat while leaving the buccal fat pad untouched, a critical support structure for the face."
The buccal fat pad is a unique and essential facial structure. It fills the deep tissue spaces, acts as a gliding pad when masticatory and mimetic muscles contract, and profoundly impacts the look and shape of the face.
It is easy to be carried away by the hottest trends and follow suit because everyone wants to look good. Believing too profoundly in an unrealistic view of ideals, in this case of one's appearance, can adversely affect an individual. Once the buccal fat pad is removed, it is permanent and irreversible. Therefore, you should have very specific reasons to remove the tissue, and it shouldn't be done just to look good on social media.
 Benjamin M, Reish RG. Buccal Fat Pad Excision: Proceed with Caution. Plast Reconstr Surg Glob Open. 2018 Oct 16;6(10):e1970. DOI: 10.1097/GOX.0000000000001970. PMID: 30534506; PMCID: PMC6250453.
 Schultz, K. P., Raghuram, A., Davis, M. J., Abu-Ghname, A., Chamata, E., & Rohrich, R. J. (2020). Fat Grafting in Plastic Surgery: Fat Grafting for Facial Rejuvenation. Seminars in Plastic Surgery, 34(1), 30-37. https://doi.org/10.1055/s-0039-3402767
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