Applied Surgical Anatomy of the Buccal Fat Pad: Extension Nomenclature, Neurovascular Hazards, and Clinical Implications

This review aims to provide an applied surgical–anatomical synthesis of the buccal fat pad, harmonise the commonly used extension nomenclatures, and summarise the principal neurovascular structures at risk, major clinical applications, and representative pathologies relevant to current surgical practice. A narrative, anatomy-oriented review was conducted using cadaveric, imaging-based (CT/MRI), and surgical literature. The evidence was organised thematically around extension anatomy, fascial boundary planes, neurovascular relationships, and procedure-related surgical risk. Two main extension frameworks, the 4-extension and 6-extension models, were identified, and their correlation improves anatomical orientation and comparability across studies. Key structures at risk include the parotid (Stensen’s) duct, buccal branches of the facial nerve, and the buccal and transverse facial vessels, all of which show variable relationships to the buccal fat pad. Safer surgery depends on accurate plane selection, limited dissection, and gentle mobilisation rather than forceful traction to reduce haemorrhagic and neural complications. The review also outlines clinically relevant pathology, including traumatic herniation or pseudoherniation and tumour or tumour-like lesions involving the buccal fat pad. An integrated applied-anatomical framework of the buccal fat pad, combining extension mapping with neurovascular risk awareness, may improve operative planning and support safer, more predictable aesthetic and reconstructive procedures.