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The face contains multiple compartmentalized fat pads that extend across the cheek as well as along the jawline. The fat pads along the jawline, like those in the cheek, droop with age, falling over the jawline. This results in jowling as well as the formation of marionette lines. There is little research evaluating the changes in size of the fat pads that form the jowls with age. This may be because studies of the volume of an area whose shape changes as it falls is difficult. It may also be difficult to account for other changes, such as weight gain or loss, over long periods of time when designing a study. However, plastic surgeons frequently observe that individuals experience enlargement of their jowl fat pads with age. I have found only one recent study – the only evaluating volume changes in the lower face with age – that supports what is widely seen clinically (1). This study identified thickening of the jowls with age. However, it should be cautioned that this study was limited by the fact that it simply compared a total of sixty women split into three age groups and did not follow them as they aged. However, it did account for things like body mass index (BMI) in each patient, thereby reducing the influence that overall weight has on the results. More and better-quality research is required to evaluate and characterize the changes that occur in the size and shape of jowl fat with age.
In contrast, the buccal fat is located deep in the face, much deeper than the jowls. It also sits superior to the superficial jowl fat. Buccal fat winds through deep structures in the cheeks in a complex shape, surrounding important structures such as blood vessels, a salivary gland duct, and branches of the facial nerve. The research is mixed as to whether buccal fat increases in size, decreases in size, or remains the same size as we age. Many surgeons feel the buccal fat remains approximately the same size with age or even enlarges. More research is required, however. This is why only a portion of buccal fat is removed with buccal fat removal surgery. This is also why buccal fat is removed in individuals who do not anticipate significant weight loss, though long-term weight loss is difficult to predict.
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