make the incision the cut on the inside of the mouth it's done either at the bite level when the teeth are clenched together where that bite level is or what's called the max low gingival buccal sulcus so it's it's basically on the inside up there okay so two different options for making incisions the local anesthesia is infiltrated just into the mucosa which is the inner skin of the cheek itself so the anesthesia is not coming in this way it's just like when you're at the dentist it's going in on the inside of your mouth just anesthetized the mucosa once everything is numb the incision is made usually with cautery usually monopolar cautery we make the little cut into the mucosa take an instrument like a curved clamp and you spread through that buccinator muscle until you find this yellow buckle fat pad it's quite yellow in its appearance and you basically then start to like tease it out of its pocket once you get it removed or partially removed you buzz the base of that pad and you control the bleeding in that way and then you take it out and you close the incision with usually dissolvable sutures it seems easy right like what can go wrong not a big deal well here's a video of me doing the procedure i used to do this procedure but then i stopped so make sure if you're not subscribed yet to please hit the subscribe button and the notification so you know when we put out new videos since we're doing that more more often and we're really trying to incorporate what you guys are giving us and the suggestions and doing all that so subscribe if you aren't already thank you so much so now i want to get into like a little bit of a disclaimer here okay so this video is meant to highlight my personal experience in my own surgical practice it's not meant to suggest that buccal fat removal surgery should not be done by anybody that is not the purpose of of this talk there are surgeons out there who get consistent results and have happy post-op patients i'm sure after the surgery and and everyone's happy right my practice it didn't really work out and i'll get into why there are six reasons why actually reason number one is that there is in my opinion too much patient discomfort during surgery if it's done awake most patients want to have this surgery under local anesthesia this way you can avoid the risks of general anesthesia and you can also avoid some of the extra costs usually if you go to a doctor or surgeon like myself you're getting a procedure in the procedure room that's just a flat fixed price for surgeons fee right if you're getting something like say rhinoplasty there's usually additional fees like for the operating room for anesthesia costs and and that all adds up so a lot of people are looking to avoid that if they can and in terms of the numbing you can numb the inner part of the cheek as i mentioned earlier but you cannot numb the deeper structures that are all like within the cheek where the actual fat pad is that does not go numb it's only the inside of the cheek the mucosa that skin that goes numb the inner skin so as you go and you tug on this buccal fat pad on these internal structures where the fat pad is people actually feel like their face is
START_INTERACTION_TOKEN so make sure if you're not subscribed yet to please hit the subscribe button and the notification so you know when we put out new videos since we're doing that more more often and we're really trying to incorporate what you guys are giving us and the suggestions and doing all that so subscribe if you aren't already thank you so much so now i want to get END_INTERACTION_TOKEN