Diagnosis and Management of ‘Buccal Bulge’ Deformity After Facialplasty or Liposculpture

Background: Secondary hollowness and accelerated facial aging are reasons surgeons remain judicious or avoid buccal fat pad removal in the aging face. Yet, the buccal fat pad can be unattractive when visualized through skin or prolapsing. Unrecognized pseudoherniation of the buccal fat pad can lead to visible deformity after facialplasty or liposculpture. True herniation can also occur. Etiology and treatment strategies for both are explored. Methods: Nine patients with buccal bulge deformity were identified after facelift (8 cases) and facial liposuction alone (1 cases). Hallmark features of the deformity include a reducible convexity anterior to the masseter and 1 cm cephalad to the mandible border. Patients were treated with buccal fat removal through an intraoral or facelift approach, or with fillers to mask the contour deformity. Results: Buccal bulge deformity improved in all cases. At 1 year postoperatively, partial correction was observed in 5 cases and there was complete correction in 4 cases. Conclusions: Buccal bulge deformity can occur after facialplasty, liposculpture or both. Buccal fat removal effectively corrects the deformity, which can also be concealed with injectable fillers.