Article

Buccal Fat Pad Sculpting for Lower Facial Contouring With 3-Dimensional Volume Assessment

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Abstract

Buccal fat pad sculpting and removal (BFPS) can create narrowing of the lower 1/3rd of the face by selective removal and reduction of soft tissue volume. Three-dimensional (3D) imaging allows for quantitative and objective assessment of volume changes over traditional 2-dimensional photographs that has not been previously studied in BFPS. A prospective study was designed in consecutive subjects undergoing BFPS from April 2018 through March 2020. Only those patients that underwent solely BFPS were included. Vectra XT 3D imaging and software was used to compare preoperative and postoperative volume changes. Fifteen patients were enrolled in the study with 2 males and 13 females. The mean length of follow up was 7.7 months (range: 1-21 months). All patients were found to have volume reduction in the area evaluated. The mean volume reduction of the selected mid-lower face in the frontal view was 7.2 mL on the left side and 7.5 mL on the right side. There was no statistical difference between the volume change when the 2 sides were compared (P= 0.82). This study demonstrate the use of 3D photography to objectively and quantitatively assess volume change following BFPS and that the volume removed is significant enough to demonstrate favorable results using 3D imaging. Buccal fat pad sculpting is a safe and reliable option for creating a narrowed lower one-third of the face. This is accomplished by selective fat removal and cautery induced reduction of the lower one-third of the face soft tissue volume. Vectra XT 3D imaging and analysis is a powerful tool to objectively and quantitatively assess volume changes in BFPS.

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... An area of key interest is the buccal fat pad, a particularly novel fat source with favorable embryologic and histology properties that make it an ideal donor for facial fat grafting. 126,127 This fat is unique in its high concentration of adipose-derived stem cells and low levels of fibrous tissues and associated inflammatory factors. 128 In addition, the fat exists in a glide plane, and is therefore not reticular, globular in nature, and ideal for transplantation. ...
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The buccal space, with its fat pad, is a valuable, overlooked target in facial rejuvenation procedures. The authors identified a specific group of patients who have normal or prominent malar projection in the presence of atrophy of the buccal fat pad, with or without prominent gonial angles. Eight of 24 prospectively studied patients (Biomedical Research Institute of America) who had fat grafts and face lifts received an average of 2.7 ml of fat transferred into the buccal space. Immediate visual correction of the buccal depression was noted. No overcorrection was carried out. None of the eight patients suffered an adverse event from transoral buccal space fat grafting. Persistent facial volume in this area has been noted up to 24 months after treatment. In patients with buccal fat pad atrophy, fat grafting into the buccal space can be safely performed through an intraoral approach.
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Despite the prevalent use of hyaluronic acid-based filling materials for facial soft-tissue augmentation and favorable reports of durability in the infraorbital region, no quantitative data exist on the long-term durability of these products following injection. This study represents the first attempt to use three-dimensional imaging to quantify augmentation achieved and duration of effect with one hyaluronic acid product in the tear trough. The authors conducted a prospective, blinded case series in a clinical setting. One non-animal stabilized hyaluronic acid material was used to augment 20 tear troughs to address cosmetic deficiency in this region. Patients were followed long term with three-dimensional imaging. Posttreatment and pretreatment images were compared, volume change was calculated at each time point, and percentage change between immediate and long-term posttreatment was evaluated. All measurements and calculations were performed independent of the injector. Residual effect from the hyaluronic acid product was demonstrable on three-dimensional imaging in 100 percent of tear troughs augmented in this study at the final follow-up visit. Average follow-up was 14.4 months (range, 8.5 to 22.75 months). Average initial augmentation measured by three-dimensional imaging was 0.21 cc per site. Average maintenance of effect for patients at the final follow-up visit was 85 percent. The long-term durability of a small gel particle-based hyaluronic acid in the tear trough is substantiated for the first time in an objective, quantitative fashion using three-dimensional imaging for evaluation of volumetric facial rejuvenation. Three-dimensional photographic imaging offers clinicians a precise and expeditious method for quantitatively evaluating volumetric changes in the face, and represents a significant advance in technology for studying the effects of facial aging.
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The author performs buccal fat pad excision to improve facial contour in some patients with buccal lipodystrophy and to treat buccal fat pad pseudoherniation. He recommends an intraoral approach, taking care not to pull on the fat pad and resecting only that which protrudes easily with gentle pressure.
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All the MRI investigations were performed with the subject in the supine position in a 0.5 T MRI scanner (GE Medical Systems, Waukesha, Wisconsin). The subjects were advised not to swallow and not to move while assuming a neutral or nonsmiling posture. Of the 11 subjects, 4 consented to undergo a second MRI while assuming a smiling posture. A multiplanar localizing sequence, followed in sagittal and coronal orientation using a turbo spin echo sequence, was performed for determining structure volumes. The total acquisition time was 10 minutes. Volumetric calculations were performed using a 3-dimensional (3D) image analysis application (Dextroscope, Volume Interactions, Republic of Singapore) to circumscribe areas, orient dimensions, and calculate volumes of the MFP. The MRI data were imported into the virtual reality environment and rendered as a 3D object in a monoscopic or stereoscopic view using proprietary glasses. A line measurement tool was used to manually circumscribe the MFP in the sagittal plane per image slice. A volume tool automatically estimated the volume of the previously configured sagittal slices in cubic centimeters. The computation of the volume takes into account all voxels with a transparency value greater than 0.01 (transparency range, 0-1.0). The volume of the MFP per subject was calculated and compared across the case series in terms of sex, BMI, and differences between the right and left sides. The volumes in neutral position were compared with those in the smiling position per subject. The horizontal and vertical distances and anterior-posterior (A-P) depth of the MFP were compared in neutral and smiling positions.
Lower lateral cartilage repositioning: objective analysis using 3-dimensional imaging
  • A Bared
  • A Rashan
  • Caughlin
  • Bp
  • D M Toriumi
Anatomie generale, appliquee a la physiologie et a la medicine [General Anatomy, applied to physiology and medicine
  • F Bichat
World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects