Why I Stopped doing Buccal Fat Removal Surgery...

Summary

In this video, Dr. Gary, a double board-certified facial plastic surgeon, discusses why he stopped performing buccal fat removal surgery. He covers the procedure's goals, anatomy, and surgical steps, emphasizing the significant risks involved, such as patient discomfort, potential nerve and blood vessel damage, and unsatisfactory aesthetic results. Dr. Gary also shares a personal patient case and highlights the lack of long-term studies on the effects of this surgery. While he acknowledges that some surgeons achieve consistent results, he believes the procedure isn't suitable for his practice, except in specific cases involving older patients with pseudo-herniation.

Takeaways

• 👨‍⚕️ Dr. Gary, a double board-certified facial plastic surgeon, explains his decision to stop performing buccal fat removal surgery.
• 🔍 The procedural goals of buccal fat removal include reducing mid-face fullness, highlighting zygomatic prominence, and correcting soft tissue asymmetries.
• 📚 The buccal fat pad is a deep fat pad located between the buccinator muscle and other superficial muscles, intertwined with important structures like the parotid duct and facial nerve.
• ⚠️ The surgery carries risks of damaging the facial nerve, blood vessels, and parotid duct, which can lead to complications such as temporary facial muscle weakness or difficulty in saliva production.
• 😖 Patient discomfort is common during the procedure, especially when performed under local anesthesia, due to the inability to numb deeper structures where the fat pad is located.
• 🤔 Dr. Gary found that the surgery often did not achieve the desired aesthetic outcome, with patients either being dissatisfied with the results or ending up with an unnaturally hollow appearance if too much fat was removed.
• 🧐 There is anxiety and uncertainty for the surgeon in locating and evenly removing the buccal fat pads, which can lead to post-operative asymmetries.
• 👵 Long-term effects of the procedure on facial aging are not well understood, with concerns that removing the buccal fat pad early in life may contribute to premature facial aging.
• 💼 Many senior surgeons have stopped performing buccal fat removal surgery, which influenced Dr. Gary's decision to cease offering the procedure.
• 👵‍🦳 An exception to Dr. Gary's practice is the removal of the buccal fat pad in cases of pseudo-herniation, typically during a facelift or other facial surgery under general anesthesia in older patients.
• 📖 Dr. Gary emphasizes that his experience and opinion should not discourage others from considering the surgery, but he aims to provide transparency about his personal practice and reasons for discontinuing it.

Q & A

Why do people opt for buccal fat removal surgery?

People opt for buccal fat removal surgery to reduce mid-face fullness, highlight the zygomatic prominence, and improve soft tissue asymmetries in the face.

What is the buccal fat pad and where is it located?

The buccal fat pad is a deep fat pad located on either side of the face, between the buccinator muscle and several more superficial muscles like the masseter, zygomaticus major, and zygomaticus minor.

Which important structures are intertwined with the buccal fat pad?

Important structures intertwined with the buccal fat pad include the parotid duct, the buccal branch of the facial nerve, and significant blood vessels.

What are the main surgical steps involved in buccal fat removal?

The main surgical steps include marking the parotid duct and incision area, infiltrating local anesthesia, making an incision inside the mouth, spreading through the buccinator muscle to find the buccal fat pad, teasing it out, and closing the incision with dissolvable sutures.

Why did Dr. Gary stop performing buccal fat removal surgery under local anesthesia?

Dr. Gary stopped performing the surgery under local anesthesia due to excessive patient discomfort, risks to important structures, dissatisfaction with results, personal anxiety about finding and removing the fat pads equally, and concerns about long-term facial aging effects.

What complications did Dr. Gary encounter that influenced his decision to stop performing buccal fat removal surgery?

Dr. Gary encountered complications like patient discomfort during surgery, difficulty finding the buccal fat pad, potential nerve damage, risk of significant blood loss, and dissatisfaction with aesthetic outcomes.

What are the potential long-term effects of buccal fat removal surgery?

The potential long-term effects include premature facial aging due to the depletion of the buccal fat pad, which remains constant over time while other facial fat compartments atrophy and sag.

What did Dr. Gary find when consulting senior surgeons about buccal fat removal surgery?

Dr. Gary found that many senior surgeons had stopped performing buccal fat removal surgery long ago, which influenced his decision to stop offering the procedure.

In which specific cases does Dr. Gary still consider performing buccal fat removal surgery?

Dr. Gary considers performing the surgery in cases of pseudo-herniation due to buccal fat pad fascia weakening, especially in older patients undergoing a facelift or other related surgery under general anesthesia.

What other procedures has Dr. Gary decided not to offer in his practice?

In addition to buccal fat removal surgery, Dr. Gary has decided not to offer Kybella and thread lifting procedures in his practice.