Buccal Fat Pad Excision: Hydrodissection Technique

Background: Buccal fat pad (BFP) excision is a procedure in which the fat pad is extracted in order to achieve a more youthful appearance. Objectives: The aim of this study was to describe an alternative technique that utilizes hydrodissection to extract the BFP. Methods: This is a controlled, prospective, randomized clinical study involving 2 groups. Group A (n = 27) underwent BFP excision with hydrodissection, during which 15 mL of a vasoconstricting anesthetic solution was injected into the BFP. Group B (n = 27) underwent BFP excision, during which 3 mL of lidocaine 2% with epinephrine was injected. All procedures were performed by the same surgeon. Variables analyzed were surgical time, intraoperative bleeding, and postoperative pain directly following surgery 2 hours after the procedure, as well as maximum pain within 72 hours of surgery and complications. Postoperative care was standardized, and patient follow-up extended over a 6-month period. Results: Pain scores for 54 patients were recorded on a visual analog scale (0-10). Mean +/- standard deviation transoperative pain scores were 0.5 +/- 0.8 for Group A and 1.3 +/- 1.3 for Group B (P = 0.01); 2 hours postoperation the scores were 1.2 +/- 0.7 for Group A and 2.6 +/- 1 for Group B (P < 0.0001). Maximum pain occurred within 72 hours, and scored 1.6 +/- 0.6 for Group A and 3.1 +/- 1 for Group B (P < 0.0001). Mean operative time was 8:18 +/- 0:47 minutes for Group A and 14:08 +/- 2:28 minutes for Group B (P < 0.0001). There was a positive correlation between operative time and pain. Overall, 5.5% of patients suffered postoperative complications. Conclusions: BFP excision by hydrodissection is an effective procedure that decreases surgical times by facilitating extraction of the BFP with less manipulation, thereby resulting in decreased postoperative pain and a more tolerable recovery.