Management of the Buccal Fat Pad During Deep-Plane Facelift: Technique, Safety, and Aesthetic Outcomes in 68 Patients.

BACKGROUND

Management of the buccal fat pad (BFP) has gained prominence in facial aesthetic surgery for refining mid and lower face contours. While intraoral excision is common, addressing the BFP during deep-plane facelift (DPFL) offers a direct, anatomically informed approach.

OBJECTIVES

To describe a surgical technique for BFP excision and suspension performed during DPFL and to evaluate its safety, effectiveness, and impact on lower facial contouring.

METHODS

This retrospective case series included 68 patients (aged 45-64 years) who underwent DPFL with BFP management between February 2023 and September 2024 by a single surgeon. Patients with prior hyaluronic filler, thread lift, or microneedling radiofrequency were included; those with permanent filler were excluded. BFP prolapse was directly visualized during DPFL dissection. Partial excision (1.5-2.5 cc/side) was performed, followed by suspension of residual fat to the SMAS when indicated. Outcomes assessed included contour improvement, complications, and follow-up up to 8 months.

RESULTS

All patients demonstrated improved lower facial and jowl contour. Mean excised volume was 1.5-2.5 cc per side. Complications included three hematomas (4.4%), one transient buccal nerve paresis (1.5%), and two transient marginal mandibular nerve injuries (2.9%). No long-term adverse sequelae or excessive hollowing were observed.

CONCLUSIONS

Concurrent BFP management during DPFL enables direct treatment of buccal fat prolapse, optimizes lower facial contour, and may reduce recurrence of jowling. This technique appears safe, effective, and enhances aesthetic outcomes with minimal morbidity.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .