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if you look at Ruth Bader Ginsburg some pictures of her later in life youll see that there is some prominence in this Buckle fat pad area so this is called pseudo herniation due to buccal fat pad fascia weakening the fascia is what keeps the fat in inside of this pad and you can get some weakening of that fascia and you can get this pseudo herniation where it looks like its almost sagging down and its the actual buccal fat pad so during a facelift or if theres another surgery that were doing in that area and someones under general anesthesia especially an older patient you could make an argument for removing that buccal fat pad at that time in those instances and thats where I still consider doing it but its a pretty specific indication and its not the type of surgery that I recommend now for my younger patients and really not even for most older patients