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Background:. Breast augmentation surgical planning based on soft-tissue characteristics including the type of lower-pole pocket direction has been described. Objective outcome measures of the effects of some of these choices on postoperative lower-pole settling, including dual-plane dissection type, have been lacking. Objective:. The aim of this study was to determine whether the type/extent of dual-plane dissection, patient age, or variables in breast implant characteristics affected implant–soft tissue dynamics of the lower pole of the breast enough to cause difference in implant settling during the postoperative period. Methods:. Measurements of nipple-to-inframammary fold distance in primary breast augmentation patients were collected prospectively for 227 female primary breast augmentation patients during postoperative visits over an 8-year period. Changes in this distance during the postoperative period were evaluated for correlation with dual-plane dissection type, patient age, implant fill material, implant size, and implant profile. Results:. Increasing dual-plane dissection type did demonstrate a trend toward greater postoperative lower-pole stretch. Only implant profile affected lower-pole stretch, with statistical significance shown in the ultrahigh-profile group. Age, implant fill material, and size of implant did not show any notable effect. Conclusions:. Ultrahigh-profile implants cause significantly more lower-pole stretch postoperatively, whereas increasing dual-plane dissection type appears to have some effect as well. Age, implant material, and size of implant are of less importance over a 6-month period.

Summary:. Buccal fat contributes significantly to the contour of the face, but the contribution of buccal fat is often neglected on examination and in surgery. A case of isolated buccal fat removal is examined. Previous literature relevant to this case is discussed and the author’s experience from 10 subsequent lower facial rejuvenation surgeries combined with buccal fat reductions is presented with suggestions.