The Importance of the Buccal Zone: Joining the Mid to Lower Face

The buccal area is defined as the part of the face where if you sucked in your cheeks they would suck inward.  It is the area that in a very skinny person can make one look gaunt, and the buccal area resides in the region below the cheekbone.  When someone starts to get older from say late 30s and beyond, the buccal area is one of the prime zones that can be affected with hollowing.  In overweight people, the buccal area can be plumply filled out and would not need to be filled.  However, in the great majority of individuals of normal weight, the buccal area tends to hollow out.

When looking at an individual from the oblique, ¾ view, you can see 2 to 3 little circular dips in the skin.  The area that is most typically affected is the central area right in the middle of the cheek.  The second most commonly affected portion of the buccal area is the area in front of the ear and below the bony cheek area that causes a dip appearance near the ear just below the bony protuberance of the cheekbone when someone is viewed from the front.  The final, circular, buccal hollow is not always present, being situated near the lips and occurring more in advanced aging, especially when there has been resorption of bone from bad dental care.

This woman is shown before and 2 years after a single session of fat transfer with a good aesthetic outcome. As one can see, the buccal area is entirely hollow from front to back and filling this area was critical to soften the transition from the mid- to the lower face.

Many times the buccal area is entirely ignored during a fat transfer by many practitioners who may focus just on the hollow lower eyelids or the central cheek area.  I think that the buccal area should be considered an important bridge area from the central midface to the lower face.  Why is softening the transition from one part of the face over to another so important?  There are a few reasons.  First, if the central cheek is augmented by itself it can look too big because it is not properly blended into the buccal area.  Second, the already gaunt buccal area can now look even gaunter vis-à-vis the augmented cheek, which can in turn further exacerbate the effect of aging.  Third, one reason to perform fat transfer is to soften the many shadows of the face, and the buccal area can be an important part of this overall strategy.

Not everyone needs to have their buccal area filled and when doing so it is important to know just how much and in what distribution to create the most aesthetically pleasing results.  Filling too much in the buccal area can make one look overweight or disproportionate.  Filling just the right amount in the appropriate combination of central, lateral, and medial buccal areas can lead to the most balanced rejuvenation for the face possible.  Focusing on the artistic side of fat transfer is a critical element in creating natural and aesthetically pleasing results for the aging face.

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