1. Van Wicklin, Sharon Ann PhD, RN, CNOR, CRNFA(E), CPSN-R, PLNC, FAAN, ISPAN-F

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Plastic Surgical Nursing (PSN), the official journal of the International Society of Plastic and Aesthetic Nurses (ISPAN), publishes this column to provide information about current literature of relevance to plastic and aesthetic nurses.


Many individuals would take great pleasure in having a slim lower face and well-defined jawline. The idea that this can be achieved by removing the buccal fat pads during a simple intraoral procedure performed under local anesthesia is quite appealing. However, the evidence about whether or not this is an effective, long-term solution for improving facial contour is limited and the possibility that undergoing buccal fat pad removal might lead to premature aging and midface distortion is disconcerting. In a recent opinion piece, Rohrich et al. (2021) discuss the role of the buccal fat pad in facial aesthetic surgery.


Those who support buccal fat pad removal claim that the procedure provides improved definition and angularity to the face without causing midface distortion. However, there are no studies with long-term follow-up of patients who have undergone the procedure to support this claim.


Patients most likely to benefit from this procedure are individuals with round, heavy faces. To achieve an aesthetically pleasing appearance, the surgeon will need to excise a substantial amount of tissue. It is also important to note that the volume of the bilateral buccal fat pads is not symmetric; therefore, even if a surgeon removes the same amount of buccal tissue from both sides of the face, it is likely that one side will be overresected, resulting in midface asymmetry and distortion. For this reason, surgeons should conduct a thorough preoperative analysis of the patient's facial asymmetry.


Surgeons and plastic surgical nurses who assist with or perform buccal fat pad excision should be aware that aggressive dissection may accentuate submalar hollowing and lead to premature aging. Limiting the excision to the buccal extension of the buccal fat pad will help to mitigate the risk for premature aging.


Modern facial rejuvenation techniques often attempt to restore facial volume by targeting deflated facial fat compartments. However, in select patients, removal of the buccal fat pads through an intraoral incision can be used to achieve a slim lower face and defined jawline.


If you have read or know about an important study relevant to plastic and aesthetic nurses that you would like to write about or see presented in the Evidence Review column ofPSN, please contact Sharon Ann Van Wicklin, Editor-in-Chief,PSN, at




Rohrich R. J., Stuzin J. M., Savetsky I. L., Avashia Y. J., Agrawal N. A., Prada M. (2021). The role of the buccal fat pad in facial aesthetic surgery. Plastic and Reconstructive Surgery, 148(2), 334-3238.[Context Link]