Can The Buccal Fat Pad Be Restored By Solid Fat Grafting?

Q: Dr. Eppley, I underwent a buccal fat pad removal surgery, during which approximately 5.0 ml of tissue was removed from each side. Unfortunately, I have since developed very significant adverse effects, including severe cheek hollowing, noticeable facial sagging, and what appears to be a collapse of the facial support structure. This has also led to concerning issues around my orbital area, such as a sensation of eyelid dragging downwards, potentially due to the loss of support. I learned that BFP is a structured, triangular fat compartment that provides essential upward and outward support to the midface. I am now desperately seeking a method to restore this foundational support as much as possible. I have consulted other surgeons, however, I was advised that standard particulate fat injection may not be a sufficient solution because it would be injected into the superficial or middle layers and cannot restore the deep structural support that the BFP provided. It would add soft volume but not stop the sagging, and may migrate downward over time. In my research for a lasting solution, I was profoundly impressed to learn about your advice in reserve BFP removal using en bloc fat grafting.This gives me much hope. Therefore, I would be incredibly grateful to know if you believe a revision procedure might be possible in my case. I am wondering is it possible to graft pedicled en bloc fat to the original compartment where BFP was in, potentially secured with material like fibrin net, to restore support? I seek your expertise with much respect and am available to consult. Thank you so much.

A: As most buccal fat pads are in the 3cc range it would be fair to say that at 5.2ccs a substantial fat pad removal was done. I have done several buccal liecptomy reversals where a solid or dermal-fat graft is placed back into the contracted and empty buccal space. To get it back in place (back as far as possible) a threaded suture technique is used to pull it in.  The fate of all fat grafts is unpredictable but dermal-fat grafts usually fare better than injected fat.

One element of the success of the procedure is how well the graft can be placed into the original buccal space. That is partially influenced by the time between the removal and the attempted graft implantation.

Dr.Barry Eppley

World Renowned Plastic Surgeon