Malar Augmentation with Pedicled Buccal Fat Pad in Orthognathic Surgery: Three-Dimensional Evaluation.

BACKGROUND: Contemporary orthognathic surgery contemplates three-dimensional facial soft-tissue harmonization as one of the basic pillars in treatment planning. In particular, prominent malar regions are regarded as a sign of beauty and youth by Western societies. The aim of this article was to perform a subjective and objective three-dimensional evaluation of the pedicled buccal fat pad technique for malar augmentation in the context of orthognathic surgery.

METHODS: Six consecutive patients with underlying dentofacial anomalies and bilateral malar hypoplasia were managed with simultaneous orthognathic surgery and pedicled buccal fat pad malar augmentation. Patient morbidity and satisfaction with the procedure were evaluated with a visual analogue scale. Cone-beam computed tomographic data were used to perform a volumetric analysis at 1- and 12-month follow-up by means of image superimposition.

RESULTS: Subjective analysis revealed excellent patient satisfaction and minimal pain. Mean malar volume was 115,480.91 mm preoperatively, 124,586.32 mm 1 month after surgery, and 119,008.77 mm 12 months after surgery. Thus, the final mean increase 1 year after surgery was 3527.86 mm and the average amount of resorption was 5577.55 mm. The median variations in volume were 7.77 percent at 1-month follow-up and 3.52 percent at 12-month follow-up.

CONCLUSIONS: In conclusion, the pedicled buccal fat pad technique is a reasonable alternative for malar augmentation in the context of orthognathic surgery. The results of this preliminary report suggest that it provides satisfactory soft-tissue augmentation; avoids the use of foreign materials; and has minimal morbidity, high patient satisfaction, and adequate stability at 12-month follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.