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Incision localization and buccal fat pad being removed. Note parotid duct on tip of Minnesota retractor
Source publication
Buccal fat pad removal or bichectomy is an esthetic surgical procedure that is gaining notoriety and increasing number worldwide. This paper aims to discuss the effectiveness of bandage in bichectomy postoperative concerning major complications like bleeding and subcutaneous emphysema. This is a retrospective case series according to PROCESS guidel...
Citations
... To avoid the appearance of premature aging by plastic surgery, a detailed anatomical knowledge of the buccal fat pad, of its relationship with surrounding anatomical structures, and an exhaustive preoperative facial analysis are fundamental to adequately planning buccal fat pad excision [11,72]. Furthermore, bichectomy has a low morbidity, and complications are rarely reported [8,[72][73][74][75][76]. ...
Buccal fat pads are biconvex adipose tissue bags that are uniquely found on both sides of the human face along the anterior border of the masseter muscles. Buccal fat pads are important determinants of facial appearance, facilitating gliding movements of facial masticatory and mimetic muscles. Buccal fad pad flaps are used for the repair of oral defects and as a rich and easily accessible source of mesenchymal stem cells. Here, we introduce the buccal fat pad anatomy and morphology and report its functions and applications for oral reconstructive surgery and for harvesting mesenchymal stem cells for clinical use. Future frontiers of buccal fat pad research are discussed. It is concluded that many biological and molecular aspects still need to be elucidated for the optimal application of buccal fat pad tissue in regenerative medicine.
... Our initial search yielded 590 results, after removing duplicates 205 studies were screened, leaving 13 studies that met our inclusion criteria for final analysis (Figure 2). 6,9,[22][23][24][25][26][27][28][29][30][31][32] The characteristics of the included studies are shown in Table 1. ...
Introduction
Buccal fat pad (BFP) excision (bichectomy) or lipolysis by injectable deoxycholic acid (brand name, Kybella) is increasingly used procedures for cheek contouring and facial slimming. However, the literature on their effectiveness and safety is inconsistent. The most recent review was published over 5 years ago; however, the study was limited, did not include injectable lipolysis, and available literature has doubled since its publication. Thus, an updated systematic review is needed to provide a comprehensive evaluation of these procedures.
Methods
Aligned with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, a literature review with pre-determined search terms was conducted with 5 major medical journal databases from 1975 to March 2023. We were unable to conduct a meta-analysis due to limited reporting.
Results
Our initial search yielded 590 results, with 13 studies meeting criteria for inclusion with a total of 883 patients. All studies performed surgical BFP excision with no studies performing injectable lipolysis. Seven (53%, n = 181) studies reported mean excised volume at 4.01 ± 1.19 grams per side. Two (15%, n = 61) studies assessed mouth opening, noting a combined mean decrease of 28.0 ± 1.93 mm 4 days post-operative and mean decrease of 1.36 ± 4.96 mm 1-month post-operative. Three studies (23%, n = 115) reported a combined mean increase in pain of 2.62 ± 1.63 on a 10-point scale at 72 hours post-operative. Eleven (85%, n = 883) studies reported complications following BFP excision showing complications in 6.8% of patients with 75% of those complications being swelling that resolved spontaneously.
Discussion
This review suggests initial patient satisfaction with BFP excision, with only a 6.8% complication rate, primarily consisting of edema that spontaneously resolves. However, concerns regarding bias were raised in 2 of the clinical trials included in this review. Although the original aim was to compare surgical excision to a dissolution technique using deoxycholic acid (DCA), no studies on the DCA were identified that met inclusion criteria. Some authors compared alternative techniques to standard excision, such as hydrodissection and laser-assisted techniques, noting benefits including faster procedures, less pain, and reduced inflammation. Patient age and BFP volume are crucial considerations for appropriate candidate selection, with over excision cautioned against due to natural aging effects.
Conclusion
As BFP contouring continues to gain popularity, it is important to continue to monitor outcomes of BFP reduction and its associated complications. It is apparent that more studies are needed in both surgical excision and injectable dissolution to accurately assess this novel procedure.
... There are cases of articles that have received few citations but have a substantially higher number, comparatively, of readings according to other indices. 47 The primary objective of the present study was to quantitatively assess the publications related to virtual surgical simulation in orthognathic surgery, with a view to predicting and anticipating trends in this field. ...
Purpose
Anticipating trends and pursuing innovative ideas are imperative for the advancement of science. The objective of this study was to conduct a bibliometric analysis of three-dimensional (3D) virtual simulation in orthognathic surgery, explore its implications for clinical practice, and identify future publication trends through digital tools.
Methods
This study employed a retrospective bibliometric analysis using data obtained from the Web of Science (WoS) database. The search strategy focused on articles related to orthognathic surgery and virtual simulation techniques. RStudio and bibliometrix tools were used to data mining. The independent variables retrieved from digital analysis were the emerging themes related to virtual planning in orthognathic surgery. The trends that we identified were facial aesthetics, digital workflow, personalized treatments, and complex cases. The primary outcome variable was the number of publications dedicated to virtual simulation in orthognathic surgery, along with secondary outcomes such as citation rates, language of publication, country of origin, institutional affiliations, and emerging research themes. Covariates included variables related to publication characteristics, author affiliations, and geographic distribution of publications. Publication analyses over time involved descriptive statistics, regression analysis, Pearson correlation tests, and graphical representation techniques. Statistical significance was set at a 95% confidence interval (P-value < 0.05).
Results
A comprehensive analysis of 987 articles reveals the impact of included authors, with a mean H-index of 62 (sd=18,4). The analysis further illuminates a discernible upward trend in publications on this subject, showcasing a linear pattern with a notable R2 value of 0.88 (p=0.021). English remains the predominant language of publication, accounting for 97.97% of articles, while contributions hailed from a diverse spectrum of 56 countries. Interestingly, a moderate correlation emerges between publication numbers and Gross Domestic Product (GDP) per capita (r=0.30, p=0.044) and total area (r=0.30, p=0.032), whereas a more substantial correlation is evident with total population (r=0.61, p=0.034). Notably, the most cited article amassed 254 citations. Furthermore, a Pearson correlation coefficient of 0.97 underscores the correlation between citation density and the year of publication.
Conclusion
The bibliometric indicators provided insights for evaluating research productivity and the quality of research output. Emerging themes included facial aesthetics, 3D printing, and the utilization of custom-made templates and implants. This study holds relevance for maxillofacial surgeons, academics, and researchers alike.
... The cheek, being bilateral, requires the search for symmetry between them, being limited in its upper part by the infraorbital groove and zygomatic arch and in the lower part by the lower edge of the mandible [3]. The midline is limited by the nasolabial and labiogenian folds, while laterally it is represented by the preauricular region [4][5][6]. ...
... Although there are reports of late postoperative monitoring and evaluation, none of the studies statistically evaluate tissue behavior. However, several studies have presented the importance of using Bichat's fat ball as an oral layer in the closure of fistulas and also to cover bone grafts in implant dentistry, as well as for the reconstruction of extensive defects caused by tumors in the maxillofacial region, aiming to avoid its removal [2][3][4][5]. ...
... In this sense, some authors described that the removal of the oral fat pad for aesthetic purposes highlights the superiority of results with associated procedures [2,4,6]. According to Jackson et al. (2003) ...
Introduction: According to the Brazilian Society of Plastic Surgery in 2016, 7,362 people underwent bichectomy (BC), which represents 0.5% of the total number of aesthetic surgeries. In an attempt to achieve facial harmonization, BC surgery presents little complexity and is based on some well-defined steps. Even when appropriately indicated, it is still a controversial procedure, as there is no surgical technique adequately systematized in current literature, aiming to make it safe and reproducible. Objective: It was to present the main aesthetic considerations and complications of bichectomy, as well as discuss its safe management to avoid and treat problems. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2023 to February 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 96 articles were found, 40 articles were evaluated in full and 28 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 10 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=67.9%>50%. It was concluded that on an aesthetic level, performing a bichectomy thins the middle third of the face, outlining and highlighting the bone angulations of the zygomatic region, contributing to a more pleasant facial aesthetics. Surgical removal of the Bichat ball induces a mild inflammatory process controlled by rescue medication, significantly reduces facial volume, and improves the quality of life and satisfaction with facial aesthetics 3 months postoperatively. Several studies have presented the importance of using the Bichat ball as an oral layer to close fistulas and also to cover bone grafts in implant dentistry.
... Although judging facial beauty is subjective, judging facial proportions is objective. Despite massive differences in cultural and ethnic features worldwide, facial harmony is a cornerstone [12,14,16,22,23,36,37]. Clinical facial analyses, complemented by imaging studies, are basilar to achieve a more proportionate face and achieve a more attractive face, without leaving aside functional outcomes [10,14]. ...
... Unusual orthognathic surgical steps could be added to achieve better facial aesthetics, such as malarplasty, mandibular angle reduction and corticectomy [13]. Several aesthetic procedures can be combined synergistically with orthognathic surgery to improve the end result, such as botulinum toxin, facial threads, filling, bichectomy, liposuction, and alloplastic implants [9][10][11]18,23,24,37]. An algorithm regarding indications and contraindications for both procedures was proposed according to the existing literature on the subject ( Table 2). ...
Objectives: The amount of dermal filler procedures is increasing. Some patients opt to undergo dermal fillers instead of orthognathic surgery to treat unesthetic complaints from dentofacial deformities. The aim of this work is to carry out a literature review with regard to a comparison of role and limitations between aesthetic indications of orthognathic surgery and dermal fillers. Methods: A scoping review was performed according to the PRISMA-ScR guidelines on Pubmed, Web of Science and Google Scholar. A second search was conducted to highlight topics very close subjects to the main subject: the importance of social media and measures to avoid litigation in facial aesthetics. Results: Literature on the subject is very rare. Clinical facial analysis is fundamental to both procedures. Although patients wishes are important issues, facial analysis cannot be neglected due to its objectivity. Body dysmorphic disorder is considered a contraindication for both procedures. Social media is important in patient decision-making, but should not influence treatment planning by experts. Preventing litigation or reducing financial and reputational damage can be accomplished with a few simple steps. Conclusions: A helpful list of indications and particularly contraindications for orthognathic surgery and dermal fillers was drawn up. Dermal fillers must not substitute orthognathic surgery. Further studies are urgently needed to discuss this contemporary issue.
... This retrospective study showed that the overall complication rate was significantly lower for patients who received compressive bandaging versus those who did not across 643 operations (P < 0.05). 19 Thus, considering the collective head and neck literature beyond rhinoplasty, there are no RCTs to inform strong recommendations on the use of postoperative compression therapy. Although it may be more beneficial after neck lifts and buccal fat pad removals than facelifts in reducing complications, further research is necessary to inform best practice. ...
This practical review critically evaluates the evidence behind the widespread use of postoperative compression therapy intended to improve surgical outcomes, such as reduced edema, ecchymosis, pain, and seroma formation. A literature search of PubMed was conducted to identify relevant studies concerning the use of compression garments after aesthetic surgery, including rhinoplasty, facelift, neck lift, mammoplasty, abdominoplasty, limb contouring, and others. Additionally, reconstructive and therapeutic procedures closely related in anatomy or technique to these cosmetic operations, such as breast reconstruction, mastectomy, and hernia repair, were also considered to provide further perspective. After study extraction, the volume, quality, and agreement of the evidence found was highly heterogenous depending on the context of specific operations and outcomes evaluated. The most well-supported indications for the use of postoperative compression garments are to mitigate edema and ecchymosis after rhinoplasty and to reduce postoperative pain after breast and abdominal procedures, although no effect on seroma rate was demonstrated. Any potential benefit must be balanced against the associated costs and possible complications of compression, including patient discomfort, increased venous stasis, and skin defects. Thus, we encourage surgeons to critically reassess their use of compression garments. In many settings, such as brachioplasty, there is limited high-quality evidence to inform best practice, and we urge the community to continue researching this important topic so that more definitive and comprehensive guidelines may be established.
... This fat pad is innervated by the buccal and zygomatic branches of the facial nerve, internally by the buccal nerve, and it is supplied by the superficial temporal arteries, the buccal branch of the maxillary artery and the facial artery [1]. The primary function of the buccal fat pad is to allow a smoother muscular gliding [2]. ...
Bichectomy is the partial removal of the Bichat’s fat pad for the aim of smoothing the facial contour. The complications of bichectomy include soft tissue infections, hematoma, facial paralysis (especially buccal branch paralysis), stenon canal injuries and related complications such as sialocele and sialoadenitis, however these are not common complications in clinical practice. Here we report a case of a 29-year-old white female with a right sided orbital abscess following bichectomy. Right sided orbital abscess and orbital cellulitis was managed with endoscopic decompression and drainage. The patient healed completely with no sequela. The frequency of major complications leading to moridity after bichectomy is rare in the literature. This is the first reported intraorbital complication of bichectomy.
... "In the case presented in this study, intraoral healing was observed within 15 days, mouth opening movements also returned within 15 days, and the end of facial edema after 4 weeks, the same as reported in the literature" [17]. ...
Aims: In recent years there has been an increasing number of procedures for removing the buccal fat pad, also known as cheek reduction or face thinning surgery. Bichat buccal fat can be used as part of the therapeutic procedure in several cases of oroantral communication and in other oral surgery procedures. The objective of this case report was to demonstrate the procedure for removing the buccal fat pad for aesthetic purposes. Study Design: Case report. Place and Duration of Study: Case carried out in 2021 in a private dental office in the city of Santos-SP- Brazil. Presentation of Case: After completing the anamnesis and oral clinical assessment, the patient underwent laboratory tests for preoperative evaluation and magnetic resonance imaging of the malar region. Buccal fat pad removal is a minor procedure, and the surgical technique is considered simple and safe if performed by trained and experienced professionals. The postoperative period requires rest in the first days and limited mouth opening is a common symptom, and the use of analgesics and anti-inflammatories adequately controls any painful symptoms. Results: The procedure can be performed by a dentist if the practitioner has a local anatomical knowledge, follows the indication for each case, and take all pre and postoperative care that is necessary to avoid complications. Conlusions: When we have the correct indication, preoperative exams that indicate that everything is correct in relation to the presence of buccal fat pad and their relationship with adjacent structures and the execution of the technique with postoperative control, there is no way that professionals and patients cannot be happy with the buccal fat pad removal results.
... Além disso, seu corpo apresenta quatro extensões: bucal, sublevadora, melolabial e pterigoide (Lin, 2022). O suprimento sanguíneo deriva de ramos das artérias maxilar, temporal superficial e facial (Grillo et al., 2021) e a drenagem venosa se faz pela veia facial; já a inervação é proveniente dos ramos zigomáticos e bucais do nervo facial e pelo nervo bucal do nervo trigêmeo (de Sena et al., 2022). ...
... De toda forma, apesar de dor leve e certa rigidez local serem esperadas no pós-operatório (Jackson, 2003), é imprescindível a execução de boa técnica cirúrgica aliada a medidas complementares (anti-inflamatórios, laser de baixa potência, crioterapia, bandagem), o que determina uma melhor e mais confortável recuperação (Grillo et al., 2021;Silva et al., 2020). ...
... Ademais, quando disponível, esta estrutura anatômica é amplamente utilizada em cirurgia bucomaxilofacial como enxerto ou retalho pediculado em procedimentos de reconstruções de defeitos intraorais das mais diversas naturezas (exemplos: comunicação buco-sinusal, problemas congênitos, ressecções oncológicas, osteonecrose) (Grillo et al., 2021;Traboulsi-Garet et al., 2021) e para a anquilose da articulação temporomandibular (Cardona-Gómez et al., 2022). ...
Localizado no terço médio da face, o corpo adiposo da bochecha é uma estrutura adiposa arredondada, biconvexa e delimitada por uma cápsula fina. Indivíduos com volume excessivo do corpo adiposo da bochecha podem apresentar uma aparência infantil ou de que estão em sobrepeso, porém a excisão cirúrgica é capaz de esculpir os ângulos faciais e melhorar a estética da face como um todo. Apesar deste procedimento (também conhecido como “bichectomia”) ter se tornado muito popular nos dias de hoje, as evidências e os estudos que fornecem detalhes técnicos são bastante limitados. Desta forma, a presente revisão narrativa da literatura teve como objetivo compilar o máximo de informações relativas à excisão do corpo adiposo da bochecha com finalidade de recontorno estético da face. De acordo com os estudos levantados, o manejo cirúrgico do corpo adiposo da bochecha pode ser considerado um procedimento relativamente simples e que apresenta ótimos resultados estéticos quando bem indicado e realizado por profissional experiente na técnica. Entretanto, considerando a carência de evidências científicas de alto nível principalmente relacionadas aos efeitos em longo prazo, estudos bem delineados e com seguimento apropriado são ainda necessários para maiores esclarecimentos e fundamentação da técnica no cotidiano clínico.
