Overview
The senior author combines buccal fat suspension with facelift to restore cheek volume and contour, and has seen that it softens the nasolabial fold. No anatomic model explained this effect. The authors reproduced the suspension on fresh cadavers, identified four consistent effects on the middle cheek, and answered four anatomic questions through layered and cross-sectional dissection of 20 hemifaces from 10 cadavers (mean age 68.2 years).
Findings
- 20 hemifaces from 10 fresh cadavers; mean age 68.2 years.
- Four consistent effects on the middle third of the cheek were identified.
- The study identified a functional "buccal sling."
- Traction on the buccal fat and its capsule passes tension to the transverse facial septum.
- This tension moves the deep medial cheek fat toward the midline, softening the nasolabial fold.
- The authors propose the "Buccal Cascade," a bottom-up model of midface aging in which the buccal capsule weakens over time, leading to displaced deep medial cheek fat and pseudoatrophy.
What it means for a patient
- Lifting the buccal fat during a facelift may soften the nasolabial fold, and this study gives an anatomic reason why.
- The authors see the procedure as restoring cheek structure, not only lifting.
- Limits: a cadaver study. It explains a mechanism but reports no patient outcomes, measured fold change or complication rates.
Why this paper matters
It offers an anatomic explanation, the buccal sling, for nasolabial fold softening after buccal fat suspension. It also proposes a model of midface aging that starts with weakening of the buccal capsule.
Terms
- Buccal fat pad: a deep fat pad in the cheek.
- Buccal fat suspension: lifting and fixing the buccal fat in a higher position during surgery.
- Buccal capsule: the thin tissue envelope around the buccal fat pad.
- Nasolabial fold: the crease from the side of the nose to the corner of the mouth.
- Deep medial cheek fat: a deep fat compartment in the inner cheek.
- Transverse facial septum: a fibrous partition that crosses the cheek.
- Pseudoatrophy: an appearance of volume loss caused by fat moving out of place rather than disappearing.
- Hemiface: one side of the face.