Buccal (intraoral) fat pads are at deep tissues inside the oral cavity rather than at the superficial fat layer under the skin. They are less prone to change along with body weight and exist after the development of puberty. Anatomically, they are distributed between the masticatory muscle and mandible bone, namely the middle one-third portion of the lower face, and primarily serve to cushion the cheek and gingiva as well as protect the teeth from collision. Buccal fat pads protrude outward from the face due to obesity, excess mastication, aging, or fat pad looseness because of facial bone reduction and commonly manifest as buccal hypertrophy (commonly called chubby face or baby fat) or two protruding lumps at both sides of the mouth corner on smiling (also called circumoral fat), thus making the lower cheek appear sagged and bulging. Therefore, patients should consider undergoing buccal fat pad removal to alleviate weight loads inside the cheek and prevent the future probability of continuous buccal sagging.

This surgery involves creating a 1-cm incision at the buccal mucosa inside the oral cavity; via this incision, deep buccal tissues are separated with the assistance of a headlamp illumination, and buccal fats are identified near the masticatory muscle and removed in chunks. For patients with a relatively thin skin or mild circumoral fats, they consider preserving one-third portion of the fat pads to avoid future skin laxity or buccal depression.

Limited in distribution area, buccal fat pads differ from facial subcutaneous fat accumulation in skin hypertrophy as well as the treatment method, so the physician needs to conscientiously conclude the diagnosis before surgery. Based on Dr. Chuang’s experience, patients with a round face or an obese stature are prone to have concurrent extensive subcutaneous fat accumulation, so facial liposuction should be considered first; if the patient’s skin is normal but appears as regional fats protruding outward from both cheeks that become more obvious on making facial expressions or smiling, it is highly likely to be caused by buccal fat pad protrusion, so an intraoral incision should be made to remove the fat pad. In clinics, there are a minority of patients undergoing combined subcutaneous fat hypertrophy and intraoral fat pad protrusion, and the physician should notify the patient of the severity and treatment results before deciding to resolve such facial hypertrophies in sequence or at one time.