Buccal fat pad removal, also known as #bichectomy, is an increasingly popular minimally-invasive surgical procedure wherein a fat pad inside the cheek is removed or reduced through a small incision inside the mouth. The procedure is well-tolerated, typically performed awake, and provides a subtle but observable #contour improvement in the #midface. Perhaps more than other procedures, individual results may vary, but overall, they are subtle. Patient satisfaction remains very high and Dr. Zelken has yet to encounter a patient he treated that wishes to have the procedure reversed. See Gallery at the [ Ссылка ] and navigate to face, then cheek reduction.
Still, one of the most challenging aspects of buccal fat pad removal is its unpredictability in cosmetic impact and recovery time. Because Dr. #Zelken does not require a CT scan or MRI of the head, there is some element of surprise as to how big each patients’ fat pads are, and there is often a volume difference from one side to the other. But overall, buccal fat pads are surprisingly consistent in volume across genders, races, age groups and BMI categories.
The average resection specimen is 4-5 cc, but ranges from 3-8 cc in the past 200 patients treated at the Zelken Institute for Aesthetic Medicine. Still, Dr. Zelken believe size does not necessarily matter. It seems that the volume of the buccal fat pad specimen is not the best predictor of the effect of #buccalfatremoval #surgery. Dr. Zelken believes that the position and mobility of the fat pad with the cheek has greater bearing on its cosmetic impact than its volume. Size also does not seem to impact when the final result can be expected after surgery.
If volume is not the only factor or even the main factor, then how do we answer the age-old question: “how long until I see my final result?” Of course, the answer varies as much as the patient, his or her expectations, and the operation. After all, surgery causes swelling; excessive bleeding, prolonged operative time, a history of prior surgery, and patient tendencies to bruise or swell are expected to impact how quickly (A) one looks normal, and (B) one looks great after bichectomy.
To answer this question more thoughtfully and systematically than the knee-jerk “6 months”, Dr. Zelken evaluated a series of patients who underwent buccal fat pad removal as a standalone procedure with a 3D camera (#Vectra H2) and software capable of measuring and tracking volumetric changes. In this informal study, Dr. Zelken observed 3 broad recovery patterns:
1) The “Wolverine”. Wolverines recovered very quickly, and volumetric changes seen at one month did not change drastically thereafter. These patients typically had thin skin, a technically straightforward operation, and followed postoperative instructions religiously. About 40% of patients fell into this category.
2) The “Late Bloomer”. Late bloomers may have recovered quickly, but volumetric changes were not so evident at the one-month follow-up appointment; by 2-3 months, changes began to become more evident in two-dimensional and three-dimensional photos. Between 3 and 6 months, there was a significant improvement in this group of patients. Late bloomers tend to have thicker or oily, acne-prone skin, broader cheeks, lead active lifestyles or underwent a technically challenging operation. About 40% of patients are late bloomers.
3) The “Splitter”. Some patients were Wolverines on one side and late bloomers on the other. Discrepancies may be explained due to one side being more difficult than the other, existing facial asymmetries, or postoperative conditions such as sleeping on one side habitually. By 6 months, volume reduction was symmetric on both sides. About 20% of patients demonstrated asymmetric recoveries.
In other words, despite a more systematic review, the answer remains the same: 6 months. By six months, there is a measurable reduction in volume in the midface in most patients undergoing buccal fat pad removal at the Zelken Institute for Aesthetic Medicine. It is possible that further change may occur after 6 months, and Dr. Zelken will continue to study this. Of course, weight change, fillers, organic facial aging, and other facial surgical procedures are expected to impact recovery and long-term results.
Please note: This informal study is not peer-reviewed and represents the opinion of Dr. Zelken. Many patients travel to the Zelken Institute for surgery, lack long-term follow-up, and these preliminary findings represent a small subset of a larger population. Indeed, there is no long-term data that exists to Dr. Zelken’s knowledge, but he firmly maintains that buccal fat pad removal should not accelerate facial #aging.
