Bichat’s Fat Pad Resection (Buccal-Cheek Fat Pad Removal)

An attractive feature of a woman’s face is the slight depression just underneath the cheekbones. The buccal fat pad described by Bichat, is a collection of fat that occupies a position in the middle third of the cheek, just below the cheek bone. It is more prominent in childhood. With aging it tends to shrink. When it persists, it can give a rounded, ‘heavy’ appearance to the cheek. The cheek fat-pad is usually diet and exercise resistant.

Improvement can be achieved by a relatively simple procedure called buccal or cheek fat-pad resection. The result is a contoured look with more definition of the cheek bone. The cheek can also be augmented at the same time with fat injections. The procedure is performed in the office under local anesthesia with conscious sedation. The cheek fat pad is removed through an incision inside the mouth. The cheek fat can be removed at the same time as a face-lift or when inserting cheek implants. 

Risks are rare and include facial nerve injury and bleeding.

The Mid-40’s Make-over

More recently Dr. Kirwan has combined this technique with a brow lift in patients in their mid-forties.

Many women at this age are already using regular maintenance treatments such as a Retinoid-based skin program with regular peels, Botulinum Toxin injections, fillers and other non-surgical treatments such as Thermage and Fraxel. And yet they still aren’t satisfied. They are usually beginning to see heaviness in the upper face, around the upper eyelids and the brows as well as loss of fat in the cheek bone and lower orbital region. Often they may have a round face which fails to respond to dieting.

Now Dr. Kirwan is recommending three treatments, separate or combined, to improve facial aesthetics and rejuvenate the face in a durable fashion until the inevitable face-lift at a later point.

The three-point program:
1. Endoscopic Brow Lift with the removal of the Corrugator and Procerus (frown) muscles.
2. Removal of Cheek Fat Pads to give some hollowing of the cheeks and definition of the cheek bones.
3. Fat Injection to replace fat into the cheek bone area and lower orbital area. This also markedly improves skin quality.

Obviously, a facelift is also an option but many women are not ready for this psychologically or physically in their fifth decade.

I call this program the ‘Mid-40’s Makeover.’

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