Buccal fat removal (BFRE) permanently excises a portion of the Bichat fat pad, a naturally occurring fat pocket deep within the cheeks. While the original tissue removal cannot be literally undone, the resulting volume deficit can be corrected. Patients who experience dissatisfaction or premature aging following the initial surgery have options to restore volume to the mid-face. Corrective procedures use different materials and techniques to effectively reverse the aesthetic outcome by reintroducing lost volume to the area where the buccal fat pad once resided.
Why Patients Seek Volume Restoration
The primary motivation for seeking volume restoration is the unintended aesthetic consequence of the original procedure, which often becomes more pronounced over time. Removing the youthful convexity of the lower cheek can lead to a gaunt or overly hollowed appearance, which many patients perceive as prematurely aging. This loss of fullness creates harsh shadows and exaggerated facial contours.
The face naturally loses volume as part of the aging process, which is compounded by the earlier surgical removal of the buccal fat pad. This often results in a visible transition line between the cheekbone area and the hollowed lower cheek. Patients who were initially satisfied may find their results worsen as they move into their 30s and 40s, prompting them to seek restoration of a softer, more youthful facial structure.
Methods for Reversing Volume Loss
Volume restoration after buccal fat removal focuses on replacing the lost tissue with materials that mimic the natural fullness of the original fat pad. The two main solutions utilized are autologous fat grafting and temporary dermal fillers. The choice between these methods depends on the patient’s preference for permanence, recovery time, and invasiveness.
Autologous Fat Grafting
Autologous fat grafting, also known as fat transfer, is considered the most natural method for restoring volume, as it uses the patient’s own tissue. The process begins by harvesting fat cells through liposuction from a donor site, commonly the abdomen or thighs. The collected fat is then processed to separate viable cells from blood and fluid before being strategically injected into the hollowed cheek area.
This technique is favored because the transferred fat integrates with the surrounding tissue, offering a lasting correction. The goal is to recreate the support and contour previously provided by the Bichat fat pad. Placing the fat deep within the cheek, often through an intraoral approach, allows for a smooth, anatomically appropriate restoration of the lost volume.
Dermal Fillers
Dermal fillers, most commonly composed of hyaluronic acid (HA), offer a less invasive and temporary alternative for volume replacement. These gels are injected directly into the buccal space to instantly plump the area and soften the hollowed contours. An advantage of using fillers is the minimal downtime and the immediate visibility of the results.
However, the buccal hollow lacks the bony support found in other facial areas, making it a challenging location for filler placement. The constant movement of the cheek muscles during speech and expression can cause HA fillers to metabolize quicker than in other areas. If not injected precisely, fillers can lead to a slightly bulky or unnatural appearance. Fillers also require repeat treatments to maintain the effect, as they are gradually absorbed by the body over time.
Recovery and Longevity of Results
The recovery and long-term sustainability of the volume correction differ significantly between fat grafting and dermal filler treatments. Patients undergoing autologous fat grafting should anticipate a recovery period involving swelling and bruising that can last for several weeks. The final aesthetic outcome is not immediately apparent, as the body will naturally absorb a portion of the transferred fat cells over the first few months.
The surviving fat cells after this initial period are considered permanent; they will live and behave like any other fat cell in the body, fluctuating with weight gain or loss. While fat grafting offers a long-term solution, it may sometimes require a touch-up session to achieve the full desired volume due to the unpredictable rate of initial fat survival.
In contrast, recovery from dermal filler injections is typically quick, often involving minimal swelling that resolves within a few days. The longevity of hyaluronic acid fillers in the mobile cheek area generally ranges from six to twelve months, though this can vary based on the specific product used and the individual’s metabolism. Maintaining the corrected volume requires a commitment to a maintenance schedule, with repeat injection sessions necessary once the body has broken down the filler material.