整复双侧颊脂肪垫疝1例

患者某女,45岁,自30岁起两侧口角旁逐渐出现一突起,随年龄增长逐渐明显,立位口内用力时突出,卧位消失。自述其父双侧口角旁亦有明显突起。检查:患者双侧口角旁2.5cm处有对称性椭圆形肿物,触之软,无压痛,如李子大,平卧时肿物消失。该部皮肤薄,与皮下组织无密切联系,可触及指头大疝囊口。诊断:双侧颊脂肪垫疝。局麻下行双侧颊脂肪垫疝孔修补术。从患者某女,45岁,自30岁起两侧口角旁逐渐出现一突起,随年龄增长逐渐明显,立位口内用力时突出,卧位消失。自述其父双侧口角旁亦有明显突起。检查:患者双侧口角旁2.5cm处有对称性椭圆形肿物,触之软,无压痛,如李子大,平卧时肿物消失。该部皮肤薄,与皮下组织无密切联系,可触及指头大疝囊口。诊断:双侧颊脂肪垫疝。局麻下行双侧颊脂肪垫疝孔修补术。从疝的口内相对应处切开颊粘膜约1.0cm,分离粘膜下见黄色脂肪团突出约2.5×3.0cm,剪除突出的脂肪,将该处的肌间隙疝囊口缝合,最后缝合颊粘膜。术后5天拆线。讨论:颊脂肪垫在颊部位于颊肌与口腔粘膜之间,由“1体4突”组成。体部从咬肌内面延伸至翼突上颌裂,为一扁长形脂肪组织。其中翼腭突、颞突、翼突分别位于翼腭窝、颞肌前缘和翼突后下方,而颊突自体的前端发出,位于咬肌、笑肌和颧肌之间,表面被覆一层菲薄筋膜、腮腺导管横过其上方或浅面,面神经颊支在其附近通过。由咬肌、笑肌、颧肌及颊肌形成的肌间隙如果先天性联系松散,或因年龄增大肌肉萎缩而间隙加宽,口内压力增大时颊脂肪垫的部分体部及其颊突就会从肌间隙突出于肌肉表面至皮下形成颊脂肪垫疝。该病虽无其他临床症状,但由于其影响面容,增加老态,故患者愿手术治疗。经以上治疗效果满意见附图。     

眶上裂及其周围结构的显微解剖和手术学意义

目的研究眶上裂及其周围结构的显微解剖,并分析其手术学意义,以期为相关手术入路、病理解剖和影像学研究提供显微解剖学资料。方法利用8具经福尔马林固定的成人头颅湿标本和5具成人头颅干标本,在显微镜下对眶上裂及其周围的骨性结构、硬膜结构、韧带、神经和血管进行解剖,并进行多角度观察、拍摄和描述。结果眶上裂的空间分成外侧部、中间部和下部;动眼神经、滑车神经、展神经、眼神经和眼上静脉从眶上裂的外侧部或中间部穿过;神经血管与软组织共同封闭眶上裂;眶上裂外侧韧带和直肌间韧带是重要的解剖标志。结论只有经过精细的显微解剖操作和观察才能全面掌握眶上裂及其周围结构的解剖知识,进而有助于临床手术操作。     

衰老所致泪槽畸形和睑颊沟畸形发生机制的解剖学研究

目的 研究衰老所致泪槽畸形及脸颊沟畸形解剖学方面的形成机制.方法 对6具60岁以上泪槽畸形及睑颊沟畸形较明显的尸体标本(男性3具,女性3具,平均年龄67.2岁)的下睑及眶周区域做逐层解剖(12侧),观察眶部各层组织间的相互关系.结果 泪槽畸形及睑颊沟畸形处于眼睑较薄皮肤与颧颊部较厚皮肤的交界处,皮肤与眼轮匝肌附着较紧密;颧部脂肪上缘覆盖于眼轮匝肌睑部与眶部的结合部,并与泪槽及睑颊沟的位置相对应,颧部脂肪七缘不随颧脂肪垫下移;内侧眼轮匝肌眶部与提上唇鼻翼肌之间隙与泪槽位置不对应;眼轮匝肌限制韧带起于眶下缘并止于眼轮匝肌睑部与眶部的结合部,外宽内窄,在内侧1/3延续为内眦部深层眼轮匝肌,直接贴附于眶下缘骨面;眼轮匝肌下脂肪位于眶部外下方,薄且松弛;眶隔附着于眶下缘.眶脂肪向前下方膨出.结论 泪槽畸形和睑颊沟畸形形成是衰老所致各层组织松弛、萎缩和下移等综合因素共同作用的结果,其中眶隔及眼轮匝肌限制韧带限制组织下移的作用町能是眶下缘凹陷更加凸显的关键.     

眶颊沟老化特征的解剖学研究

目的通过对眶颊联合区域进行解剖学研究,探讨眶颊联合老化后形成眶颊沟的发生机制。方法选取13具（26侧）10％甲醛固定的成人尸头标本,其中男9具（18侧）,女4具（8侧）,年龄22～78岁。应用显微下术器械在10倍的解剖显微镜下逐层解剖眼周,重点解削下睑眶部和眶外侧,了解并描述各区的解削学层次,解剖显露眶外侧增厚区,认真记录眶外侧增厚区解剖学位置并照相保存。结果（1）眶外侧区层次：皮肤层、皮下脂肪层、眼轮匝肌层、眶外侧增厚区、颞中筋膜层、骨膜层。（2）眶外侧增厚区：起于眶外侧缘向外侧走行在颢中筋膜表面,成三角形,三角形的顶角距外眦角25．24～37．20mm。眶外侧增厚区与颞中筋膜紧密粘连区也成三角形,顶点距外眦角（9．28±0．45）mm。向内侧走行在眼轮匝肌下眶隔表面,分为上、下睑部,下睑部成横V形,V上臂与睑板前筋膜粘连,距外眦角21．69～37．2lmm。下臂与眶下缘粘连,距外眦角垂线（13．55±0．52）mm。V顶点距外眦角垂线（11．35±0．27）mm。结论眶颊联合老化后形成眶颊沟的主要原因是皮下脂肪层和颞中筋膜层的脂肪萎缩所致。     

从解剖学角度探讨应用锯齿线行面部提升术的可行性

目的:以解剖学研究为基础,探讨应用锯齿线行面部提升术的适应证、禁忌证与手术层次。方法:对10例(20侧)防腐人头标本进行头面部逐层解剖,观察面部脂肪分布与眶上血管神经、滑车上血管神经、面神经的走行特点。结果:额正中部皮肤与皮下组织的厚度(1.9±0.2)mm,颞部发际缘处皮肤与皮下组织的厚度(2.4±0.3)mm,面颊部颊脂肪垫处皮肤与皮下组织的厚度(3.1±0.4)mm。眶上血管神经分为内侧支和外侧支,分别穿过额肌、帽状腱膜进入头皮。滑车上血管神经穿过额肌分布于近中线的额部皮肤。面神经颞支向前上方走行于颞浅筋膜深面。面神经颊支出腮腺后走行于表浅肌肉腱膜系统(SMAS)的深面,其分支相互吻合呈立体网格状。结论:额部于额肌深面、颞部于颞浅筋膜浅面、面颊部于SMAS浅面,是锯齿线的安全植入层次。     

颧脂肪垫的解剖学研究与老化分析

目的 通过对颧脂肪垫的解剖学研究,探讨面中部老化机制.方法 选取10具甲醛固定后的成人尸头标本20侧,应用显微手术器械在10倍解剖显微镜下逐层解剖,仔细观察面中部纤维,区分不同区域皮肤与皮下脂肪层的结合方式,对其进行标记,注意其位置及范围,观察脂肪垫的范围、形状、位置,记录支持结构的解剖学位置并照相保存.结果 ①颧脂肪垫近似一个三角形,底部沿下睑眼轮匝肌支持韧带上层呈一弧线;内侧界为鼻唇沟和口下颌沟;外侧界从颧大肌在颧骨表面的止点区到达口角外下方或下颌缘.②颧脂肪垫系由较韧的纤维结缔组织组成的网状结构,其间有较大的脂肪颗粒;沿鼻唇沟水平方向牵拉,使颧脂肪垫纤维更加紧密,垂直方向牵拉,使颧脂肪垫纤维变得疏松,纤维之间距离增大.③在面部皮肤层和颧脂肪垫之间存在4个连接紧密的区域,从内向外分为Ⅰ区、Ⅱ区、Ⅲ区和Ⅳ区,Ⅰ、Ⅱ、Ⅲ区为与鼻唇沟平行的长条形,Ⅳ区为不规则的 四边形.④颧脂肪垫与深层组织固定的结构有6条韧带:眼轮匝肌支持韧带上、下层、颧弓韧带、颧骨皮韧带、颧骨下皮韧带、颈阔肌皮肤前韧带、颊上颌韧带.结论 颧脂肪垫与皮肤连接紧密,而与深层组织只有6条韧带相连接,随着时间的推移,颧脂肪垫支持韧带的松弛导致颧脂肪垫随着皮肤的老化下垂而下移,从而形成特征性的衰老面容.     

内窥镜辅助中面部提升术的颞区解剖学研究

目的:明确颞区的血管神经分布,为内窥镜辅助颞部切口中面部提升术提供详细的颞区解剖层次。方法:收集10具24h内死亡的新鲜尸体头标本,将标本随机分为2组,分别进行血管造影和神经解剖染色等处理。结果:颞区位于颅顶的两侧,为颞肌和颞筋膜在头部的分布区域。此部位的组织层次由浅入深有血管的层次可分为:颞浅筋膜、颞浅脂肪垫、颞肌、颅骨,共4层。无血管的层次为:皮肤、皮下组织、颞深筋膜深浅层、颞深脂肪垫、颅骨骨膜,共6层。颞浅筋膜层有颞浅动静脉、面神经的颞支、颧支和颞浅神经分布。颞深筋膜分为浅、深两层,两层之间有颞浅脂肪垫和颞中静脉。结论:颞部切口常被应用于颞部除皱术和面部提升术,较安全且有效的解剖层面需要分区描述。切口的分离层次在颞深筋膜深层;眶外缘注意哨兵静脉彻底止血;向下在融合线处走在颞脂肪垫的浅层,注意保护颞中动静脉;触及颧弓则进入骨膜下;穿过颧弓后面中部的分离层次在SMAS层深面,SMAS层深面剥离后,在颧弓处向浅层纵向分离保护面神经分支。为了确保手术的安全性,术中避免损伤面神经及血管,需要注意切口,融合线,颧弓位置的不同层次。     

眼轮匝肌下脂肪垫的解剖学及整形外科学的研究

目的：研究眼轮匝肌下脂肪垫的解剖结构,和相邻组织结构的关系,评价其在眼部年轻化手术中的应用效果。方法：对成人头颅部人体标本7具（14侧眼部标本）进行眶部解剖研究;对50例术前有明显面部老化征象患者进行了眼部手术,手术中将眼轮匝肌下脂肪垫部分去除。结果：在眼轮匝肌下和上颌骨、颧骨骨膜的浅面,存在有脂肪垫,其大部分分布在眼眶外围,并与周围脂肪垫相连续。50例眼袋患者,术后下睑区平展,眶隔脂肪袋消失,下眶缘沟消失,眶下外侧骨缘轮廓平和。其中19例伴有上睑臃肿下垂患者,术后眼裂增宽,眼睑变薄,无上睑外侧臃肿表现。结论：眼部年轻化手术适当去除眼轮匝肌下脂肪垫,可明显改善手术效果。     

汉族人眶脂肪之间相通性的断层解剖学研究

目的研究汉族人眶脂肪的分布及相互之间的交通情况,为眼眶部手术提供解剖学依据。方法选用12对以甲醛固定的眼眶标本及5对新鲜的眼眶标本。将12对固定的眼眶标本去除眶壁,保留完整的骨膜,取出眶组织,以3 mm厚度分别制成冠状位、矢状位和水平位的断层标本。其中各取2对断层标本制成组织切片,分别进行HE和Masson染色,并对断层标本和组织切片进行观察。分别向5对新鲜标本的上下睑内注射亚甲蓝和曙光红A染料,制成断层进行观察。结果在断层解剖和组织切片中发现眶隔脂肪之间有隔膜存在,将其分隔成大小不同的脂肪团,眶隔脂肪沿肌肉和骨膜之间的通道向后延续。眼外肌周围存在筋膜组织,其与骨膜和脂肪小叶之间有广泛的纤维连接,并不能形成完整的隔膜。肌肉内外的眶脂肪通过眼外肌间隙相互延续。在染料注射研究中发现,注入上睑和下睑的染料都可以向眶后部脂肪中渗透,且能渗入肌肉内的眶脂肪。结论眶脂肪自前向后是一个延续的整体,周围性眶脂肪是通过眼外肌间隙与中央性眶脂肪相互延续。肌肉周围的筋膜组织和眶脂肪维持着肌肉和眼球的位置。     

颞下窝咽旁间隙的显微外科解剖研究

目的 研究颞下窝、咽旁间隙的显微外科解剖，探讨该区域的解剖境界及临床意义。方法 选择经10％福尔马林固定成人头颈标本10具，显微镜下模拟耳前颞底，颞下窝入路的手术操作，逐层显露颞下窝和咽旁间隙，研究该区域肌肉、神经血管和骨性结构的相互及定位标志。结果 颞下窝内的主要结构有翼内肌、翼外肌、上颌动脉、翼静脉丛、下颌神经及其分支等。茎突隔膜将咽旁间隙分为茎突前区和茎突后区，颈内动脉、颈内静脉及Ⅸ、Ⅹ、Ⅺ、Ⅻ脑神经等重点结构位于茎突后区内。茎突隔膜由二腹肌后腹、茎突肌群、茎突舌骨韧带和茎突下颌韧带、茎突咽筋膜和由二腹肌延至胸锁乳突肌的筋膜构成。结论 颞下窝为下颌骨和翼内侧板之间的区域，咽旁间隙系颞下窝后方、鼻咽外侧及颈椎腹侧的区域；茎突隔膜包绕颈内动脉，为颞下窝咽旁间隙区域的重要解剖标志。     

颊脂垫瓣在口腔缺损修复中的应用

目的评价颊脂垫瓣在修复口腔黏膜缺损中的应用。方法1998年5月~2004年7月,收治42例各种原因致口腔缺损患者,其中男26例,女16例,年龄25~76岁。颊部鳞癌7例,颊部白斑5例,软腭部鳞癌7例,腭部腺样囊性癌8例,上颌窦癌6例,上颌齿槽突血管瘤5例,上颌骨角化囊肿4例。病程2个月~10年。缺损部位颊部12例,上颌骨切除导致颊部上分缺损6例,口腔上颌窦瘘17例,软腭部缺损7例。缺损范围3.0cm×3.0cm~6.5cm×4.0cm。均采用颊脂垫瓣修复缺损部位,切取的颊脂垫瓣为颊脂垫的颊突及部分体部。结果术后41例颊脂垫瓣与创面期愈合;1例因缺损大,瓣成形后较薄而期愈合。术后4周水肿消退逐渐上皮化,6周完全上皮化,颊部外观无明显影响。35例获随访3个月~5年,颊脂垫瓣修复区与附近正常黏膜的层次和颜色、弹性、光滑度、质地无明显差异,咀嚼摩擦和食物刺激无明显影响。2例磨牙后区缺损者有轻度张口受限,经过开口训练恢复张口度。结论颊脂垫瓣能较快而有效地修复直径6.5cm以下的黏膜缺损,取材方便,术后无明显的供区并发症,是修复颊部、软腭和牙槽等部位黏膜缺损的理想组织。其缺点为修复范围较局限。     

Microvasculature of the cruciate ligaments and its response to injury. An experimental study in dogs

The normal vascular anatomy of the cruciate ligaments was investigated in eight dogs by microangiography, histology, and tissue-clearing (Spalteholz) techniques. The vessels were found to originate predominantly from the soft tissues (infrapatellar fat pad and synovial membrane) of the joint. The vascular response to partial surgical transection of the anteromedial mid-portion of the anterior cruciate ligament was evaluated in twelve dogs. This response, which was vigorous and extensive, appeared to arise from the soft tissues. Resection of the infrapatellar fat pad and synovial membrane at the time of injury tended to decrease this response. Spontaneous healing of the defect had not occurred in either group by eight weeks. Clinical Relevance: The predominant soft-tissue, as opposed to osseous, origin of the blood supply to the cruciate ligaments may be an important consideration in the repair of these structures. The preservation and utilization of the infrapatellar fat pad and synovial envelope may optimize the vascular response and healing of the ligament.     

Surgical anatomy of the midface as applied to facial rejuvenation

Distinct anatomic structures provide attachments and support for the soft tissues of the central third of the face. Over time, laxity of these structures and descent of the malar fat pad contribute to the characteristic changes seen in the aging face. Mobilization of the midface soft tissues to allow reelevation of the malar fat pad is an effective method of rejuvenating the midface. A focused anatomic dissection of 8 fresh cadaver heads was performed to evaluate 4 soft-tissue structures that control mobilization of the malar fat pad. Specifically, the orbicularis retaining ligaments, the lateral orbital thickening, prezygomatic space, and zygomatic cutaneous ligaments were evaluated. The anatomic relationship of these structures explains the visible effect of aging in the central third of the face. In addition, it correlates with the outcomes of surgical rejuvenation as demonstrated in clinical cases. Effective repositioning of the malar fat pad was found to be reliably obtained by release of the lateral orbital thickening and the orbital retaining ligaments. Suspension of the malar soft tissue is in a cephalad direction after release of these structures recreates a youthful facial architecture. Motor nerve injury is less likely to occur with this technique than with traditional lateral facelift approaches. The conclusion reached is that ptosis of the malar fat pad can be corrected safely and effectively utilizing either the lower lid blepharoplasty approach or temporal prehairline incision. These findings were consistent with clinical data from facial rejuvenation procedures.     

Blood supply to the anterior cruciate ligament and supporting structures

The blood supply to the knee arises from a vascular plexus that surrounds the joint. The descending genicular artery, the medial and lateral inferior genicular arteries, the medial and lateral superior genicular arteries, the middle genicular artery, and the anterior and posterior tibial recurrent arteries contribute vessels that supply the various structures of the knee. The intra-articular soft tissues of the knee (the infrapatellar fat pad and synovium) mediate the blood supply to the cruciate ligaments, and preservation and utilization of these tissues should be considered when repair or reconstruction of the anterior cruciate ligament is being performed.     

Volumetric analysis of the buccal fat pad

There is still insufficient knowledge about the anatomical features of the buccal fat pad as well as its behavior in various clinical conditions. The aim of this study was to elucidate some of the anatomical features of the buccal fat pad using volumetric analysis. The volumes of the buccal fat pads were measured bilaterally in 106 individuals based on their 3-D CT scan images. There were five study groups. Twenty-eight individuals of various age groups were the controls while patients with congenital unilateral cleft (n=39), facial trauma (n=25), temporomandibular joint disease (n=7) and fibrous dysplasia (n=7) formed the groups with pathological conditions. Assessment of volume differences was performed between each side of the same individual, between males and females, and between the various age groups. Comparison of the pathologies with controls was done when necessary. The volume did not significantly differ between both sides of the same individual both in the control group, in the unilateral cleft group and in the fibrous dysplasia group (p>0.05), and between male and female, whereas significant differences appeared between the volumes of the both sides in trauma patients. The general volume of the buccal fat pad appeared to increase with growth. It appeared from this study that the buccal fat pad can be affected by clinical conditions and this fact should be kept in mind when planning its surgical use. Received: 29 July 1998 / Accepted: 28 September 1998     

Vascular assessment of the periarticular ligaments of the rabbit knee

While the rabbit is being extensively utilized in animal models for orthopaedic research, the vascular anatomy of the knee ligaments has not been thoroughly described in this species. This study demonstrates the blood supply to the infrapatellar fat pad, the cruciate ligaments, the medial collateral ligament (MCL), and the menisci, such that the effects of manipulating these tissues may be properly interpreted. Vascular injection with India ink and iodinated i.v. contrast dye was performed in 11 New Zealand white rabbits, and routine histology done on six. The large vessel anatomy is similar to that described for humans and dogs, with a descending geniculate artery, medial and lateral superior and inferior geniculate arteries, a posterior geniculate artery, and a recurrent anterior tibial artery. The microvascular anatomy is also similar in that the infrapatellar fat pad and synovial membrane are highly vascular, the menisci are vascularized from their periphery (being avascular centrally), and the medial collateral ligament is relatively well vascularized. A difference from dogs and humans is present in the anterior cruciate ligament (ACL), which is poorly vascularized, with a single artery on its anterior aspect. High magnification histologic evaluation reveals numerous capillaries in the substance of the MCL, while the ACL is nearly devoid of such vessels. The interspecies variation in vascular anatomy is a variable that must be taken into consideration in any surgical or traumatic animal model investigation of knee pathology.     

Facial fat: descriptive and functional anatomy, from a review of literature and dissections of 10 split-faces

The aim of this study is to describe the anatomy of the fat in the face, based on a review of the literature and dissections of 10 half-faces. The facial fat can be divided in two layers. The first-one is superficial, between the skin and the superficialis fascia. Its function is essentially protective and its morphological implications are major, especially according to the facial aging. The other layer is deep, under the superficialis fascia. Its principal function is mechanical and its morphological implications are less important. This layer is made of several fat pads in continuity, excepted the buccal fat pad which is separated from the others by its own capsula. The other fat pads are the intra orbialis fat pad, the sub orbicularis oculi fat pad (SOOF), the retro orbicularis oculi fat pad (ROOF), the galeal fat pad and the temporal fat pad.     

Buccal fat pad pedicle flap for midface augmentation.

Midface aging is characterized by soft-tissue ptosis with loss of cheek projection. Subperiosteal midface lifts may reposition the soft-tissue mounds and improve the tear trough, but may not fill the lateral cheeks in patients with significant jowls or poor bony support. Correction with alloplastic implants is helpful, but may not be accepted by many patients. During subperiosteal midface lifts, the author often excises Bichat's fat pad to decrease the jowl and to diminish face fullness. He has modified this approach and used a vascularized Bichat's fat flap to aid lateral cheek projection while still improving lower face fullness and the jowl. For the last 4 years, close to 150 patients undergoing subperiosteal midface lifts have had vascularized Bichat's fat pad flaps. The jowls were marked preoperatively. All patients had complete cheek undermining either through a buccal sulcus incision or through a crow's-foot incision, or through a muscle-sparing limited lower blepharoplasty incision. Bichat's fat pad is identified in its pocket medial to the masseter tendon. Mobilization of Bichat's fat pad is done by blunt dissection, preserving its thin fascial envelope. The "hernial saclike" pocket, excluding Stensen's duct and the buccal branches of the facial nerve, is identified and protected. Suspension is accomplished by fixation with 3-0 polydioxanone sutures either to the temporalis fascia (via the temporal incisions), to the arcus marginalis, or to the suborbicularis oculi fat pad. Fixation technique is dependent on where the fat pad is needed and the surgeon's preference. Fat pad repositioning is accomplished with a minor learning curve. The most common problems are tearing of the fat pad during fixation and temporary numbness of the long buccal nerve. Attention to leaving the capsule intact and gentle handling is essential to fixation. Nevertheless, in some patients with poor-quality fat pads, fixation is extremely difficult. Four-year results have been excellent. Further studies with magnetic resonance imaging of postoperative patients are necessary to assess longevity. Bichat's fat pad provides autologous vascularized tissue for midface fill. Placement may be lateral for cheek augmentation or medial for deep nasolabial folds. Jowl improvement also occurs with the removal of Bichat's fat pad from its pocket.     

Dumbbell-formed lipomas under the zygomatic arch.

Two cases of dumbbell-shaped lipoma under the zygomatic arch and the therapeutic courses are described. Both tumours were present in the buccal and temporal processes and the isthmus, which showed dumbbell forms occupying temporal and infratemporal fossae on coronal MR images. According to the location, the tumours seemed to be derived from a masticatory fat pad. The tumours were completely excised via a temporal and small cheek skin incision, with no postoperative complications. Over the 5-year follow-up period, both cases have shown good function and aesthetics, and no recurrences have been observed.     

Buccal fat pad excision: aesthetic improvement of the midface

Visual criteria for a harmonious midface depends on (1) a distinction between the anterior border of the parotid gland and cheek hollow, (2) a visible posterior border of the nasolabial fold (this signifying the most variable criterion), (3) an intervening cheek soft-tissue convexity that does not exceed the plane of a perpendicular from the midzygoma to the mandible (subtle submalar depression), (4) prominent zygomatic eminences, and (5) a well-defined mandible, particularly the angle. The space within the zygomatic arch and the mandible that defines the ideal midfacial "cheek hollow" has been established. This can be achieved through a combination of: aesthetic contouring of the facial skeleton, facial liposculpture, and cervicofacialplasty. A series of 25 consecutive patients undergoing submuscular fat removal by buccal fat pad excision to improve aesthetic midface were treated and are presented. To preserve the subcutaneous fat commonly lost with aging and to avoid late secondary deformities, only submuscular buccal fat excision is recommended in a carefully selected group of patients. The anatomy, indications, and technique for buccal lipectomy in midface contouring are discussed.