The Truth About How Buccal Fat Removal Really Works
For years, celebrities and social media influencers have said their highly contoured cheeks and chins were a trick of skilled makeup artisans. But only recently has the procedure known as "buccal fat removal" circulated online as the real catalyst behind over defined cheekbones and razor-sharp jawlines — and while some celebrities like Chrissy Teigen have outright admitted to going under the knife, interest in buccal fat removal has only spiked as social media users pour over the highly defined features of Hollywood's elite.
Buccal fat removal is far from the first plastic surgery trend to go viral; but unlike the now-ebbing Brazilian butt lift, it seems to only be just past its initial cusp of a crescendo into widespread popularity among both women and men. One recent NBC report pegs buccal fat procedures as being nearly three times as popular in 2021 alone, and the chiseled cheek look is also gaining popularity, alongside chin filler, to entirely reframe one's face in just a few clinic sessions and with relatively minimal recovery time.
But not everyone is a perfect candidate for buccal fat removal — critics of the procedure say that in some instances, removing cheek fat can end up aging way beyond your years. And as many patients learn in consultations, a buccal fat removal procedure may not be the only surgery you need to achieve an overly defined look that you may be wishing for. What exactly happens during the surgery in the first place, then? And are there any risks that you should ask about during a consultation? Read on to learn more about what plastic surgeons want you to know about buccal fat removal surgery.
What is buccal fat?
A formal way of referring to facial fat that makes up full cheeks, buccal fat pads are a feature that every person has in some way, shape or form, explains New York-based Konstantin Vasyukevich, M.D., a double board-certified facial plastic surgeon specializing in facelifts. "The volume of buccal fat pads, however, can vary depending on several factors — if you look in the mirror, the area between the cheekbone and jaw is where your buccal fat pad lies," he adds.
How prominent or profound your own buccal fat pad looks depends largely on genetics that also influences the muscular definition of other areas of your face as well. Meaning, some people will naturally be predisposed to have more buccal fat than others; their faces appear rounder or fuller than others. If you're having trouble pinpointing where your buccal fat pad is by examining your cheeks in the mirror, this is likely an indicator that you may be able to achieve a more chiseled look without resorting to this particular procedure — fillers may be more in line with your own needs.
Older individuals may notice the fat in their cheeks change shape and sag, a normal transition for most as they age, says Babak Azizzadeh, M.D., FACS, a board-certified plastic surgeon who serves as director of Beverly Hills' Center for Advanced Facial Plastic Surgery and board member of the American Society of Plastic Surgeons.
"The buccal fat pad becomes only prominent when patients have very round faces that — due to excessive buccal fat or aging, likely in genetic factors — results in a lower-positioned buccal fat pad that slides down to the jawline, rather than the corner of the mouth," Dr. Azzizadeh explains. "As a result, this can be prominent."
How do buccal fat removal surgeries work?
Gradual weight loss achieved through steady commitments to dietary and fitness routines may begin to reshape buccal fat pads over extended periods of time. But cosmetic surgeons often indicate that weight loss alone can't achieve the same profound look that surgery can produce. And ultimately, there aren't any other alternative procedures or non-invasive options that you may turn to, adds Dr. Azizzadeh. "The buccal fat pad is a fairly static structure in our face," he explains. "And it doesn't change a significant amount with weight loss or weight gain, unless there is dramatic and severe weight loss or weight gain… as a result, we almost always recommend surgery."
This cosmetic surgery — which isn't usually covered by insurance and can cost between $3,000 and $8,000, though costs vary widely per provider according to the American Society of Plastic Surgeons (ASPS) — isn't considered painful, says Dr. Vasyukevich. The primary goal is to reshape the face by softening the fullness of your cheeks, working to highlight cheekbone structures. Many surgeons do this by performing buccal fat removal alongside a few other targeted treatments, including facial fillers, which can be done in sessions leading up to a buccal fat removal surgery.
What the procedure actually entails isn't as intrusive as you may think. Most surgeons set out only to reduce a portion of the buccal fat pad, especially in younger patients, as a full removal can often cause skin sagging as you age. While patients will be under anesthesia, the procedure usually is complete within an hour or two, including prep time, per ASPS materials.
Warning: The TikTok video below contains graphic content that might be disturbing to some readers.
Most commonly, surgeons choose to remove targeted buccal fat through a small incision inside of your mouth — which leaves no visible scars on the exterior of your face. Surgeons will ensure this careful incision is in an area that won't impact salivary glands or facial nerves, remove the fat manually, and then close up the incision to allow for healing.
Before and after
While there will be a time of recovery after a procedure, nearly all patients who undergo buccal fat removal can expect to visually see a slimmer, contoured cheek structure, with pronounced cheek hollows that may not have been as noticeable prior to surgery. It varies from person to person, but nearly all should expect post-procedure swelling that may last anywhere between several days to several weeks; surgeons and post-op staff will monitor you in at least one follow-up appointment, if not more, within a month. It may also take time for slimming results to be noticeable, as recovery ebbs into your new normal.
Depending on your surgeon's consult, you may opt for a buccal fat reduction versus a full removal — this is crucial for anyone who already has a particularly angular or thin facial profile. A full buccal fat pad removal for adults could potentially leave some looking overly gaunt or older, which many surgeons work to avoid.
Recovery
Most patients can expect to see swelling in their cheeks for at least 10 to 14 days, according to Dr. Azizzadeh. You may be required to stick to a liquid diet during this period, and may also need to use prescribed oral rinses daily to avoid infection inside the mouth, per ASPS.
You can expect a longer recovery time if your surgeon is pairing buccal fat removal with other procedures in order to enhance additional areas of your face. "I also perform buccal fat pad suspension and removal with my facelifts to further support the cheeks, and the face on reduced jowling," Dr. Azizzadeh adds. "In those cases, the patients will have additional recovery from their deep plane facelift procedure."
Surgeons spend a lot of time discussing best recovery practices with their patients in consults and pre-op preparation sessions leading up to the procedure, as buccal fat removal is permanent. Dr. Vasyukevich says following your specific recovery instructions is crucial in order to help your face take its new shape and avoid any additional risks.
Risks
When conducted by a qualified, accredited surgeon, buccal fat removal is considered comparatively low-risk by those in the field of cosmetic surgery — and recovery is simple and straightforward. Some patients can experience complications that include infection, facial nerve damage, permanent numbness or salivary duct injuries, according to the ASPS. "The facial nerve is intimately associated with the buccal fat pad, so facial nerve injury is a primary concern," Dr. Azizzadeh explains.
The most significant risk is an aesthetic one, he explains, as buccal fat removal is permanent — and some patients simply won't know how the procedure will affect their face as they age. Some surgeons may demand multiple consultations where they will attempt to determine how a permanent loss of facial fat may affect the face as their patients age.
Ideally, candidates for the procedure are not younger than mid-20s, nor older than mid-40s, with a full cheek structure and in good standing health; materials published by the Cleveland Clinic note that for those who are considered clinically obese or overweight, buccal fat pads may not be the only factor causing a full face, and buccal fat removal wouldn't provide expected results.
"The primary consideration for buccal fat pad removal is usually removing enough of it, or removing too much," adds Dr. Azizzadeh. "Removing buccal fat when it's not indicated can result in significant hollowness, which isn't a desired result. Asymmetry, or removing more on one cheek than the other, is also a concern."
Downsides
Buccal fat pads contribute to facial fullness, or the "cherub" look that so many associate with youth — as people naturally age, these pads atrophy and the skin around them will sag. "The biggest concern is that as a person ages, they naturally lose volume in the buccal fat area," Dr. Vasyukevich says. "So removing buccal fat when you are younger may create the illusion that you age quicker down the line."
While aesthetic options like face filler may help reverse this effect as you age, hollowing out your cheeks while you are young may preemptively introduce the need for such actions. Ultimately, this is why surgeons are cautious to only remove partial amounts of the buccal fat pad in most situations, working to maintain symmetry as well.
And some surgeons may recommend alternatives to buccal fat removal that can achieve contouring effects without the risk of gaunt-like hollowing in the near future. This is especially true for someone who may wish to lose weight in the months and years following the surgery, as those who lose significant weight afterward "may look more hallowed out than someone else who has done the procedure," Dr. Vasyukevich adds.
"Patients should not expect their faces to sag with buccal fat pad removal," Dr. Azizzadeh clarifies. "If it's removed appropriately and suspended, which I often do alongside deep plane facelifts — as well as reposition buccal fat when I take it out through the gumline — patients should not see any significant looseness or laxity of skin."
Can buccal fat grow back?
The short answer? No. Other than experiencing weight gain, which may alter a facial structure in other ways once buccal fat has been removed, there may be scenarios in which your face may seem fuller after surgery has occurred.
"Buccal fat doesn't grow after it's been removed; however, if during the removal process, it's not secured — which is very commonplace in most patients who have had buccal fat removed — the remaining buccal fat pad can glide down into its original place," Dr. Azizzadeh explains.
"This leaves the temple area hollowed, and the lower face full again, or the jawline full again; as a result, a lot of people think it's grown back, but it hasn't. It's just slid back down the remaining tissue that is there," he continues.
The best way to avoid this risk is to seek out a certified, licensed plastic surgeon who will work to ensure remaining buccal fat is proportional to your jawline.
Bottom line: Beyond its ability to go viral on social media accounts, buccal fat removal is popular for a reason; in a justified procedure, it can help create contouring above a jawline and bring more confidence and comfort to those who require it. Given it's fairly non-invasive and free of a prolonged, painful recovery, buccal fat removal may seem more attainable or approachable to most compared to other cosmetic surgeries. But the best kind of buccal fat removal procedures focuses on reducing fat pads rather than total removal, as losing all of your cheek fat can create a gaunt, hollowed-out look that is far from natural and obvious to the naked eye. This is especially crucial to consider as you age, given that it's expected for bone structures to become pronounced naturally over time. Getting more than one consult for a buccal fat removal procedure isn't a bad idea, as this procedure is permanent — and while Dr. Vasyukevich indicates that facial fillers may reverse the unnatural look of a full buccal fat pad being removed, this route is extremely costly and requires upkeep. Working to establish good communication with your surgeon is key before making any decisions to undergo surgery.
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