How Does the Buccal Fat Pad Age and How Can it Be Managed in Facelift Surgery? A Scoping Review of the Literature and...

The buccal fat pad tends to sag and herniate with age, creating an unnatural bulge in the perioral area. Failure to address this during a facelift can be a source of postoperative dissatisfaction.

To perform a scoping review of the literature on the aging of the buccal fat pad, to summarize published studies on its management during facelift surgery and to propose an algorithm for the diagnosis and management of the buccal fat pad during facelift surgery.

PubMed, Cochrane Library and Google Scholar databases were searched for published studies that included anatomic data on the aging of the buccal fat pad and surgical procedures involving the buccal fat pad during associated facelift surgery.

Of the 188 articles initially identified by the search, 23 were finally selected. 10 were anatomic studies addressing buccal fat pad aging and 13 studies were therapeutic studies addressing buccal fat pad management during facelift surgery. BFP is likely to increase between childhood and adulthood and may not begin to decrease until after the age of 60 or 70. Vertical descent of the BFP and pseudo-herniation of the buccal extension is the natural progression of aging, making BFP reduction the most common procedure performed during facelift surgery.

Depending on the surgeon's preference, BFP reduction can be performed through a facelift or an intraoral approach. The facelift approach should be preferred when a transposition is indicated. Patients should be informed of the risks of buccal branch injury and hematoma in the buccal space.

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