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Buccal fat pad removal is performed to close oroantral communications and for aesthetic recontouring of the face. This activity outlines and explains the role of the interprofessional team in evaluating and treating buccal fat pad removal patients. Objectives: Evaluate the anatomy and physiology of the buccal fat pad. Assess the indications for buccal fat pad removal. Identify the most common complications associated with buccal fat pad removal. Access free multiple choice questions on this topic.

The buccal fat pad, also known as Bichat’s fat pad, is an important anatomical structure that contributes to facial aesthetics and facilitates movement of the facial muscles (see Image. Buccal Fat Pad). Many studies have researched the utility of the buccal fat pad in oral defect repair and trauma, as the buccal fat pad may be utilized as a pedicled autogenous graft for oroantral fistula repair. However, the buccal fat pad plays an important role in facial aesthetics and may be modified to enhance facial contour.[1] When indicated, the buccal fat pad’s removal enhances the zygomatic prominences and overall contour of the face. This topic discusses the anatomy and physiology of the BFP and the indications, techniques, and complications associated with removing the BFP to enhance facial aesthetics.[2]

Buccal fat pad reduction is generally considered a safe and relatively simple procedure. Complications related to bichectomy are rare but are clinically significant when they do occur. The buccal fat pad is closely positioned to multiple vessels, the facial nerve, and the parotid duct. Removal of the BFP can result in damage to these vital structures. Complication rates are between 8.45% and 18%. Complications may result in parotid duct injury, hematoma, trismus, neuromotor deficits, and infection. A case presentation in The Journal of Craniofacial Surgery discussed 2 cases of complications after removing the buccal fat pad. The first case report describes a patient who presented to the emergency dept 5 days post-operatively with facial asymmetry. The patient was initially admitted and treated for an infection. However, the patient was re-presented with increasing pain and edema, requiring further investigation. The patient was found to have an accumulation of saliva in her buccal mucosa from obstruction of the Stenson duct due to iatrogenic damage of the duct. The patient was admitted for an additional 7 days. During admission, the patient received conservative therapy and multiple drainages of the right buccal mucosa. The patient re-established good salivary drainage and was discharged home.[14] The second case report describes a patient who presented hours after buccal fat pad removal with severe facial pain and edema. The patient also had significant ecchymosis of the infra and periorbital regions. The patient's clinical presentation was due to active bleeding from the sphenopalatine artery, and compression and attempts to locate and ligate the vessel were unsuccessful. The patient was emergently transported to the operating room, where the interventional radiology team performed angiographic embolization. Severe bleeding due to vessel damage during buccal fat pad removal is a rare complication likely resulting from either a vessel traction injury or deep dissection of the oral space. Knowledge of the buccal fat pad and its related vital structures is fundamental to mitigating complications associated with buccal fat pad reduction. Appropriate informed consent is critical as even when demonstrating sound surgical technique, complications can occur due to the intimate association of the buccal fat pad with vital structures.[15]

Clear communication among the team when performing procedures is key for the entire oral and maxillofacial surgery team. The buccal fat pad has long been considered a nuisance in many surgeries as its discovery is not usually intentional. Clear communication with surgical assistants is critical so as not to dislodge the buccal fat pad with overzealous suctioning high into the maxillary vestibule.[16]