The Truth About Buccal Fat Removal

These days, it seems like everyone is doing it — buccal fat removal, that is. Chrissy Teigen may be the only celebrity that has gone public on social media about her sculpting solution. Still, rumor has it that much of Hollywood is opting for the cheeks-that-look-razor-sharp surgery that provides a permanent contour and chiseled face. But not everyone is jumping on the cheek fat-removing trend, and plenty of plastic surgeons advise against it. Here, we investigate the buccal fat removal craze and why it's not for everyone.

What Is Buccal Fat Removal?

Buccal fat removal is one of the most buzzed about surgical procedures for the face. It removes a pocket of fat (i.e. buccal fat) that lives inside the mid-cheek in the hollow below the cheekbone to slim and define the lower face and create more contoured and sculpted cheeks. Raymond Douglas, MD, a board certified reconstructive oculoplastic surgeon in Beverly Hills, says strategic excision of these encapsulated fat pads results in that desired V-shaped face.

And it's not just the cheeks that become more sculpted and refined. The jawline also reaps the benefits since they are less hidden by fat under the cheekbones post-surgery. A round face is cute when you're a kid, but – at least in today’s social media age – it becomes all about that chiseled cheek as an adult.

What’s Driving the Buccal Fat Removal Trend?

Buccal fat removal is nothing new. In fact, the procedure has been popular for years among patients – particularly those of South Asian heritage – with rounder faces who want more definition, says Corey Maas, MD, a double board certified facial plastic and reconstructive surgeon in San Francisco and president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).

Yet, social media and celebrities seem to be the driving force behind the current renaissance. With Google searches for the surgery up five-fold, experts say that the number of patients booking the procedure doesn't show any signs of slowing down. As a result, some surgeons predict that the face-slimming, fat-reducing surgery will be one of the top procedures of 2022. “Like any other trend, I think buccal fat removal is going to be overdone for a while,” says Peter Vila, MD, a double board certified facial plastic and reconstructive surgeon in San Rafael, CA. “But, in the right patient, it can be a great procedure.”

There's always been a desire among women to have chiseled cheekbones. “When looking at an ‘ideal’ face, we notice the high cheekbones – or zygomatic prominences – which should have a slight concavity to the cheek, followed by the jawline, which provides the boundary at the bottom,” Dr. Vila explains. Eliminating the buccal fat pad increases the concavity of the cheek so that there is a S-curve to the upper portion of the cheek. “This is similar to what women do with their makeup when contouring the cheek,” he adds.

Will Buccal Fat Removal Affect How Your Face Ages?

Removing fat from the face is a sure-fire way to ensure that it will never come back. But fat is a precious facial entity that we all lose with age. Once it's gone, it's gone for good (save for artificial restoration methods). This is one of the main reasons that surgeons warn about the long-term effects of taking out the buccal fat pads. “We naturally lose volume in the face with age, and buccal fat removal – especially if it is an aggressive resection – can develop a gaunt appearance of aging earlier in life,” cautions Samuel Hahn, MD, a double board certified facial plastic and reconstructive surgeon in Baltimore. “Removing the fat pad can lead to a more skeletal look earlier, as there is less fat remaining to give youthful fullness, which is why some people look to have the fat replaced later in life.” So, while the results may look great now, they may not remain that way as the face matures.

This is why buccal fat removal must be done conservatively, Dr. Vila says. Ideally, subtlety is best, particularly since fat plays an essential role in a well-balanced facial structure. “Requesting dramatic results will likely lead to an over-resection, which creates that dreaded hollow and gaunt appearance,” Dr. Hahn warns.

Removing natural fullness from the face can work well in faces with strong jawlines and naturally full cheeks. However, the highly desirable face shape achieved with buccal fat pad excision procedures circulating the social-sphere for younger patients in their twenties and thirties that creates the inverted triangle is probably only for the ‘now.’ It is much harder to reclaim and fill hollows down the line when the natural degradation of both fat and bone mass causes a flattening of the face. Buccal fat removal patients may see undesirable changes with age and feel the need to compensate for volume deficiencies with dermal fillers or fat transfer down the line.

The Ideal Candidate for Buccal Fat Removal

It’s important to know that buccal fat removal can be a highly successful surgery in the right patient. Ideal candidates for this procedure have significant bone structure and a larger face with extended roundness in the mid-to-lower face. “The procedure improves the relationship between the upper and mid-face by creating more of a contour by allowing the area below the cheekbone to have a gradual dip and highlighting the cheekbone to create a nice, reflective moderate slope for light to reflect,” Dr. Douglas explains.

It’s also important to consider what exactly is causing your perceived facial fullness. “There are many reasons a person's face can look full, and buccal fat alone is unlikely to be the only cause,” Dr. Hahn shares. “Generally, fullness along the posterior half of the face is due to either masseter hypertrophy, a wide mandibular angle, or parotid hypertrophy.” With that in mind, “someone who has fullness just in front of the masseter and under their cheekbone would have good results,” he says. Anyone with a leaner face should avoid the procedure since removing buccal fat can make the face look hollowed out and older than it is.

Younger patients tend to do better with buccal fat removal because more facial fat presents additional fullness. Dr. Maas shares that there are no absolute age or gender barriers here. What's more important is that the face is mature and fully developed (read: no baby fat). Good candidates for buccal fat removal have:

• A round, babyface with ample facial fullness
• Plumpness in the center portion of the face that is unresponsive to other fat-reducing methods
• A mid-face that is out of proportion with other facial features
• Tight, elastic skin

While it may not seem as obvious as the conversations about facial fullness, skin quality also plays into the final result. Dr. Hahn says that older patients or those with looser skin may have a suboptimal outcome. Younger patients with more elastic skin and minimal looseness tend to see better results since their skin and tissue can easily and quickly contract.

Beyond that, certain autoimmune diseases can cause permanent and unwanted changes to the shape of the face that can be addressed with buccal fat removal. “For many of the patients we treat with autoimmune thyroid diseases, their cheek fat pads and surrounding lower facial area expand and enlarge, thus creating a fuller, more rounded face,” Dr. Douglas shares. “These patients are less age-appropriate candidates but more conditionally appropriate candidates.” In these instances, removing the fat pads creates shape and contour and gives patients the ability to look like themselves again. “This is one scenario whereby it is often the best and only option for the patient population,” he says.

What Buccal Fat Removal Surgery Entails

Buccal fat removal is a surgery, but it is considered a relatively minimally invasive one that takes about an hour. Small incisions are made within the inside of each cheek to remove the fat pad. Dr. Maas says the oral incisions heal quickly with a soft diet. “There’s some swelling, so most patients look the same when they come out of surgery and then gradually develop the desired contour,” he explains. Final results will be visible in two to three months.

It is possible to make buccal fat removal part of a larger facial fat grafting procedure. The removed fat can be purified and then injected into an area of the face where visible revolumization is beneficial, like under-eye hollows. “This specific type of fat is well-received in the hollows and is different from fat taken from liposuction,” Dr. Douglas says. “It adapts well into the tissue, but it needs to be properly done and monitored for contamination and bacteria as it comes through the oral cavity.” If you are interested in fat transfer, be sure to discuss it with your surgeon during the consultation process.

Cheek-Contouring Alternatives

If you are not a candidate for buccal fat removal, there are other professional and at-home treatment options that can yield a more sculpted and contoured countenance without sacrificing your precious fat supply. They include:

1. Cheek Filler: It may seem counterintuitive to fill a full face, but a small amount of strategically placed cheek filler can help emphasize the high portion and create additional contour. However, as Dr. Vila warns, only a small subset of patients fit this scenario.
2. Chin Filler: Enhancing the chin with filler creates an optical illusion of sorts. Alongside a more prominent chin and jawline, fuller cheeks can look more proportional.
3. Kybella®: One of the many off-label uses of the fat-dissolving injectable Kybella® is to thin out buccal fat. Dr. Douglas says using it in a concentrated area breaks down and eliminates excess adipose fat cells without removing the entire pad.
4. Weight Loss: Although it's impossible to tell the body precisely where to lose weight, adopting a healthy diet and exercise plan can help slim the face. “Losing some weight can help make a face look less full,” Dr. Vila notes.
5. Makeup: A tried-and-true sculpting trick? Makeup. Celebrity makeup artist Patrick Ta gave us his top tips for contouring the face. They are foolproof – we promise!

No matter what your favorite influencer or celebrities say, there is no one-size-fits-all solution for chiseled cheeks. Buccal fat removal can be a transformative surgery for the right candidate, but it is definitely not for everyone. Consulting with a board certified facial plastic or plastic surgeon is the best way to determine the best treatment protocol for your anatomy and aesthetic goals.