Buccal Fat Pad Flap in Orthognathic Surgery: Facial Soft Tissue Volume's Redistribution Strategy to Improve the Esthetic Outcomes

Traditional osteotomic procedures can fail to restore the natural appearance of the face and can sometimes highlight the intrinsic decrease in the volume of soft tissues; in these cases, soft-tissue-improving procedures should be considered. The authors describe a new strategy that can help redistribute facial soft tissues and enhance facial esthetics in orthognathic surgery using a pedicled buccal fat flap to increase the volume of the malar soft tissue envelope. Between January 2017 and January 2021, 47 patients with dentoskeletal deformity who needed to increase the projection of the cheekbone contour underwent orthognathic surgery with simultaneous pedicled buccal fat pad flap for malar augmentation. Preoperative and postoperative facial appearance was evaluated by clinical examination and analysis of photographs to assess the occlusal and esthetic outcomes. A patient questionnaire was used to assess self-evaluation satisfaction scores. A good projection of the cheekbone contour was obtained, and noticeable postoperative facial esthetic improvement was observed in all patients. The overall esthetic improvement was considered "excellent" by 89.36% of patients, and facial esthetic improvement was assessed as "very much improved" or "much improved" by the clinicians in 95.7% of cases. The buccal fat pad flap is a promising and easy technique in orthognathic surgery that helps harmonize the malar region; improve esthetic outcomes with predictable and lasting long-term stability; and ensure very low morbidity and great esthetic satisfaction.