Answer:
The buccal fat pad has a main body with 4 extensions. The most clinically significant is the largest and most superficial (buccal extension). It accounts for 30-40% of the total weight of the fat pad and imparts cheek fullness. It is excised through an intraoral approach. The incision is made in the maxillary vestibule, lingual to the parotid duct orifice, beginning above the second molar and extending posteriorly for 2 cm. The buccopharyngeal fascia and buccinator fibers are exposed by blunt dissection. External pressure is applied below the zygomatic arch. The herniated fat protrudes and is easily teased out.
Removal of the cheek fat tends to make patients look older. As a general rule, rejuvenation of the face involves redistribution, not removal of fat.