What is The Risk Of Facial Nerve Injury During A Buccal Lipectomy?

Q: Dr. Eppley, I would be very grateful if you could answer some questions about the removal of the buccal fat pad. What is the level of risks of sustaining damage to the buccal nerve branch of the facial nerve? Approximately how long does it take to recovery and when to expect the end result?

A: The buccal fat pad is an encapsulated fat mass in the cheek which is located between the buccinator muscle and the masseter and zygomatic muscles and largely lies underneath the zygomatic arch.  It is deep to the malar fat pad which lies directly under the skin and the jowl fat pad which is situated much lower near the jawline and should not be confused with these two regionally close fat collections. The buccal fat has one large body and usually four processes like fingers which extend outward from it. The part that is removed in a cosmetic buccal lipectomy is part of the main body. The biggest risk in buccal lipectomy is transection of its blood supply,  the buccal artery or vein during its removal. This can result in bleeding and a hematoma afterwards. The key to avoiding this complication is gentle dissection of the main body outward and cauterizing attached blood vessels under direct vision. The buccal branches of the facial nerve are in close proximity to the main body but usually cross over top of it. Staying inside the buccal fat pad capsule and not being too aggressive with removal are the keys to avoiding a traction nerve injury. It is not a complication that I have ever seen. Trying to pull too much fat out runs the risks of pulling the nerve branches into the field of removal/cautery.

Buccal lipectomies will cause some swelling but most of that is gone after about three weeks from the procedure. The final result can be judged six weeks from surgery although some continuing fat atrophy may be ongoing based on how the fat pad was removed.

Dr. Barry Eppley

Indianapolis, Indiana