Q: Dr. Eppley, I have a very prominent fat pad (?) on the left side of my face. I am 62 years of age and had a facelift eight years ago. I have a rather thin face which has lost with age some fat which I guess is expected. This lump has created a chipmunk effect like I have a big piece of bubblegum in my mouth all the time. What is the cause of this problem? Is it fat? What can be done about it? I have attached some pictures.
A: Thank you for sending your pictures. By your description and pictures, you have the classic findings of a ‘ptotic buccal fat pad’. Underneath the cheek bone sits the large cheek or buccal fat pad. With age, and sometimes after a facelift, this large pad can fall downward as the space in which it normally lives becomes loose and it leaves where it normally sits. This buccal fat prolapses or herniates outward, falling down to the level of the perioral (corner of the mouth) region. Patients will describe it as a wad of tissue that is inside the lower end of their cheek.
That being said, the question is what to do with it. There are two approaches, removal or resuspension of the buccal fat pad. While in some cases I would recommend resuspension, that may lead to some facial asymmetry as where it needs to go above is already symmetric to the other side. (usually done only when the problem exists on both sides) Therefore, removal would seem most judicious in your case. That could be done by small cannula liposuction from a small incision inside the corner of the mouth.
Dr. Barry Eppley