Bulges and bumps after facelift explained | Can facelift make buccal fat pads more noticeable?

In this video, Dr. Zelken discusses a developing topic: Secondary Buccal Fat Pad Prolapse.

Hallmarks of secondary buccal fat prolapse include a bulge and shadow a finger breadth above the mandibular border and anterior to the masseter.

Dr. Zelken imagines that buccal fat removal is seldom performed during primary facelift surgery. But more and more, patients are presenting with unusual bulges after facelift surgery.

Fortunately, secondary buccal fat pad irregularities are both preventable and treatable. Prevention of secondary buccal fat pad herniation or pseudo-herniation may be achievable by resecting bulging buccal fat when it is seen in the deep plane during facelift. This may be planned when buccal fat ptosis or excess is observed in the preoperative period. Alternatively, this may be a “game time decision”, wherein buccal fat is judiciously reduced during deep plane dissection.

Secondary deformities present as either bulging perioral masses or shadows along the anterior border of the masseter and above the mandible. A history of skin only (“mini”) facelift or facial liposculpture may expose existing pseudo-herniation of the fat pad. A history of facelift with or without deep plane dissection and including SMAS advancement and resuspension should increase suspicion for secondary (iatrogenic) herniation of the buccal fat pad. Regardless of etiology, the excess buccal fat can be addressed through an intraoral approach or accessed through pre-existing facelift scars. Dr. Zelken has yet to determine if repair of the SMAS defect is more effective at eliminating versus reducing visible shadows and contour deformity.


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