Buccal Fat Pad Transposition for Midface Augmentation in Facial Gender Surgery: A Case Series

Abstract

Midface augmentation and lower face fullness reduction is commonly performed in facial feminization surgery. Traditionally, approaches such as fillers, fat grafting, bone repositioning, and alloplastic implants have been performed. In the evolving landscape of FFS, we present a case series utilizing a pedicled buccal fat pad flap to augment the midface while reducing lower facial volume. This case series consisted of 4 patients who elected to proceed with gender-affirming facial surgery to augment the midface and contour the lower face. Buccal fat transposition involves accessing the fat pad through an intraoral incision and resuspending the fat pad to the desired midface position. The fat pad is then secured to the periosteum in the desired position. Concomitant procedures performed included mandibular contouring and genioplasty, partial masseter muscle resection, and facial fat grafting. No postoperative complications were observed. Subjective improvement in midface fullness and a reduction in lower-face fullness were appreciated. Our case series indicates that buccal fat pad transposition is a promising technique in gender-affirming facial surgery. Contrary to alternatives, such as fat grafting or implants alone, this method can simultaneously improve midface fullness while contouring the submalar and lower facial region. Careful patient selection, good fixation technique, and appropriate adjunctive procedure utilization are essential to achieve consistent results.