Buccal Fat Extraction (Jowls), Bichat

​The buccal fat pad is responsible for the jowl and is not accessible by facial liposuction techniques. It has to be surgically extracted transorally or externally during a facelift operation. 

For patients with full cheeks, the hanging “jowly” appearance has always been a difficult problem in its surgical correction. In observing the aging patient, it became evident that the jowl is in fact the migration of the of the sagging buccal fat pad. Many years ago, when performing routine facelifts, we have noted that despite direct open liposuction of the jowl area, we still had in most cases a prominent jowl appearance. Later on, like many other facial surgeons I have also started to extract the buccal fat pad transorallly previous to surgery or during the face lift operation through the dissection of SMAS and undermining of the parotid gland.


There are two different times when the jowl is extracted: when the patients are not in need of a facelift and when they are in need of one. By means of buccal fat pad/jowl extraction with or without a facelift a facelift surgeon will achieve excellent aesthetic results and in most of the cases it has to be combined with an S-Lift surgery.


In most patients, an S-Lift combined with a buccal fat pad extraction is necessary. Through this very simplified technique the surgeon will be able to give patient more youthful look by eliminating the jowl appearance often associated with aging.


The Buccal fat pad may be too prominent, adding fullness to an already round or plump face. With the effects of aging, laxity of cheek soft tissue and gravity, the buccal fat pad slips inferiorly and produces the unattractive shape of the jowls. It is important to realize that during the aging process, the buccal fat pad assumes a more inferior and anterior position (prolapses) due to the forces of gravity.