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What do the famous faces of Ariana Grande, Brad Pitt, Miranda Kerr, and Mario Lopez have in common? They all have dimples. Technically speaking, those small indentations in the cheeks that appear when some people smile are a genetic abnormality. Aesthetically speaking, many consider dimples to be an attractive facial feature. “Women and men are enticed by a dimple and wish to have one,” says [Douglas Monasebian, MD, DMD](https://aedit.com/provider/douglas-monasebian-md-200), a New York City-based board certified plastic and maxillofacial surgeon.  

For those who like the look of dimples but weren’t born with them, there is a cosmetic surgery called dimpleplasty that can create them in one or both cheeks. “I have performed this procedure on both sexes and on all ages,” Dr. Monasebian notes. So, what do you need to know about dimpleplasty? The experts break it all down.

## **What Are Cheek Dimples?**
Dimples are indentations in the skin that can be found on different parts of the body (think: cheeks, chin, buttocks). Today, we’re talking about the [cheeks](https://aedit.com/concern/cheek-volume). Fovea buccalis (a.k.a. cheek dimples) are the small depressions in the lower cheek that make their appearance when some people smile. “A dimple is simply an anatomic defect in the cheek of the face,” Dr. Monasebian shares. 

All you need to do is consider the faces of your friends and family to realize that not everyone is born with this facial trait. Dimples “can be hereditary or acquired and can change as we age,” says [David Shafer, MD](https://aedit.com/provider/david-shafer-md-153), a board certified plastic and reconstructive surgeon in NYC. They can also occur on one or both sides of the face. “Depending on the anatomy, various shapes and locations of dimples can form,” he adds.

Cheek dimples are formed by differences in the muscles and skin of the face. “Dimples occur due to gaps between the muscles around the mouth,” Dr. Shafer says. They are most often caused by changes in the zygomaticus major, the muscle responsible for movement in the lower face. While the muscle typically runs from the [cheekbone](https://aedit.com/aedition/cosmetic-procedures-to-define-cheekbones) to the corner of the mouth, it can separate into two bundles. Both bundles are connected to the mouth, but one is also tethered to the skin above it – that’s what causes the dimple. It does not pose any functional or medical threat.

Just as no two faces are the same, no two dimples are the same. “There are different types of cheek temples that vary depending on the ethnicity and sex of the patient,” Dr. Monasebian explains. “Dimples can be of varying length, depths, and angles.” As such, the dimples created via dimpleplasty can be customized (more on that below).

## **What Is Dimpleplasty?**
In simplest terms, a [dimpleplasty](https://aedit.com/procedure/dimpleplasty) is a cosmetic surgery with the goal of creating permanent dimples in the cheek. “Dimpleplasty is a surgical procedure to purposely form an adhesion between the overlying skin and the underlying muscle,” Dr. Shafer explains. It’s an outpatient procedure that typically takes under an hour to complete.

The procedure can be performed ‘[awake](https://aedit.com/aedition/awake-surgeries-without-general-anesthesia)’ with the patient numbed with a local anesthetic or under a mild sedation. “The incision is on the side of the mouth, so there are no visible incisions on the outside of the skin,” Dr. Shafer notes. Through the intraoral incision, the surgeon will remove any tissue (as needed) and place an absorbable suture at the site of the desired dimple. “The goal of dimpleplasty is to artificially cause internal adhesions, or scars, between the muscle and skin, so the tethered skin dimples as the muscle contracts,” he explains.

Depending on the aesthetic goals of the patient, dimpleplasty can be performed on either side or both sides of the face. 

### **Dimpleplasty Recovery & Results** 
The results of dimpleplasty are immediate and permanent, though they evolve during the healing process. “I do advise the patient that, during the first few weeks, the dimple will be present at both rest and during smiling and talking,” Dr. Monasebian explains. “With time, the resting dimple will fade and they will have the dimple more when they smile, which is how a natural dimple appears.” Dr. Shafer agrees. “The result may look more pronounced at first and can fade over time,” he says. “Everyone continues to age, as can areas of dimpling.” In most cases, “a dimpleplasty ages naturally with the patient,” he adds.

In terms of recovery, the most common effects are temporary [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery) and bruising. Most patients can return to work or school within a few days. Because of the intraoral incision(s), you’ll need to stick to a liquid diet for the first five days after surgery. Normal eating, activity, and dental care can usually be resumed within the first one to two weeks.

It's important to remember that every surgery has risks. Dr. Shafer explains that longer-term [adverse effects](https://aedit.com/aedition/guide-to-cosmetic-surgery-complications) include scarring (“how we make the incision is inside the mouth, so this is minimized,” he notes), hyperpigmented skin due to trauma, and infection. “As with any surgery, once there is an incision it can’t be removed,” he cautions. “If there is [scarring](https://aedit.com/aedition/how-to-treat-every-type-of-scar), there are treatments that can help, such as laser and special injectables.”

## **Achieving a Lasting Result** 
Dimpleplasty truly is a personalizable procedure. “The cheek dimple can be customized with respect to its location, depth, and length,” Dr. Monasebian says. “In addition, I can create a dimple on both sides or just on one side or even match an existing dimple.” That’s right: If you were born with one dimple but would prefer symmetry, a plastic surgeon can add a dimple to match.

As with any cosmetic surgery, it’s imperative to find a [board certified plastic surgeon](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) who specializes in the procedure you are interested in. In the case of dimpleplasty, it’s important they understand your anatomy and aesthetic goals, in addition to understanding and accounting for how the dimple will evolve. “I usually over-correct the formation of the dimple because it will fade initially,” Dr. Monasebian shares. “I have to rely on the body to heal the dimple adequately.” And then there is the role of Father Time. “The dimple will age as the skin ages,” he notes. “The procedure will not alter the skin, so the patient’s skin will normally age as they age.”

At the end of the day, it’s all about achieving a safe and optimal result. “Like most of the aesthetic procedures I perform, patients are looking to enhance themselves,” Dr. Monasebian explains. “I strive for natural-looking plastic surgery, and it is in this manner that I create dimples.” The net-net: “As with any elective surgery procedure, if there is no harm for the patient and the patient feels better by having the dimple, I discuss with them all the risks and benefits and proceed with the dimple creation,” he says.

Aesthetics

Plastic surgeons break down what to know about the cosmetic surgery that can create dimples in the cheeks.

The Benefits Of Dimpleplasty For Creating Cheek Dimples

Want Dimples? This Cosmetic Surgery Creates Them

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These days, it seems like everyone is doing it — [buccal fat removal](https://aedit.com/procedure/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](https://www.raymonddouglasmd.com/), 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](https://aedit.com/concern/cheek-volume) 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](https://www.maasclinic.com/), 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](https://www.aafprs.org/)). 

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](https://aedit.com/aedition/biggest-medical-aesthetics-trends-of-2022-for-face-body). “Like any other trend, I think buccal fat removal is going to be overdone for a while,” says [Peter Vila, MD](https://aedit.com/provider/peter-vila-md-16177), 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](https://aedit.com/aedition/cosmetic-procedures-to-define-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](https://aedit.com/aedition/best-procedures-to-restore-facial-volume). 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](https://aedit.com/provider/samuel-hahn-md-20403), 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](https://aedit.com/aedition/facial-harmony-in-aesthetic-medicine). “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](https://aedit.com/aedition/best-cosmetic-procedures-plastic-surgery-to-consider-in-your-20s) and [thirties](https://aedit.com/aedition/best-cosmetic-procedures-plastic-surgery-to-consider-in-your-30s) 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](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery), 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.

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/>

It is possible to make buccal fat removal part of a larger [facial fat grafting](https://aedit.com/procedure/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](https://aedit.com/aedition/best-aesthetic-procedures-to-minimize-dark-circles). “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](https://aedit.com/procedure/cheek-augmentation-with-fillers) 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](https://aedit.com/procedure/chin-augmentation-with-soft-tissue-fillers) 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®](https://aedit.com/procedure/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](https://aedit.com/aedition/why-you-should-lose-weight-before-plastic-surgery) 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](https://aedit.com/aedition/contouring-tips-from-celebrity-makeup-artist-patrick-ta). 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](https://aedit.com/procedure/cheek-augmentation-and-cheek-reduction-solutions). Buccal fat removal can be a transformative surgery for the right candidate, but it is definitely not for everyone. [Consulting](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation) 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.

Surgeons sound off on why the trendy sculpting surgery isn’t for everyone.

The Pros And Cons Of Buccal Fat Removal

The Truth About Buccal Fat Removal

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[Hyaluronic acid (HA) fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) are consistently among the most popular non-surgical cosmetic procedures performed each year, and now there is a new HA injectable in town specifically for the cheeks: [Restylane® Contour](https://www.restylaneusa.com/). 

When you consider that the [2020 Yelp Economic Average Report](https://www.yelpeconomicaverage.com/) found that cheek filler searches have risen 218 percent between 2018 and 2020, it would seem the product is right on time. Below, everything you need to know about the first-of-its-kind [cheek augmentation solution](https://aedit.com/procedure/cheek-augmentation-and-cheek-reduction-solutions).

## **What Is Restylane® Contour?**
This week, the United States Food and Drug Administration approved Restylane® Contour, a new HA dermal filler for [cheek augmentation](https://aedit.com/concern/cheek-volume) and the correction of midface contour deficiencies in adults over 21. It joins Galderma’s existing suite of HA filler, including Restylane® Silk and Restylane® Kysse for the [lips](https://aedit.com/procedure/temporary-lip-fillers) and perioral lines, Restylane® Refyne for nasolabial folds, and Restylane® Defyne for [chin augmentation](https://aedit.com/aedition/best-chin-augmentation-enhancement-procedures) and deep facial wrinkles to name a few.  

Restylane® Contour is Galderma’s first product for the cheeks to be formulated with its proprietary XpresHAn Technology™. The unique manufacturing process creates a smooth injectable gel that, when placed into the skin, allows for dynamic expression. The result? A softer and more natural look.

 ## **The Benefits of Cheek Augmentation with Restylane® Contour**
“Cheeks are the cornerstone of the face,” says [Leslie Baumann, MD](https://lesliebaumannmd.com/), a board certified dermatologist in Miami and a lead investigator in the clinical trial of Restylane® Contour. But the way aesthetic providers approach [cheek augmentation with filler](https://aedit.com/procedure/cheek-augmentation-with-fillers) has evolved over the years. “Focusing on natural contour and not just volume loss can result in a dynamic expression that amplifies their natural beauty,” she explains.

Restylane® Contour was created with this in mind. “In the past, it was all about volume for the cheeks, but consumers today are looking for natural-looking results, such as the dynamic expression provided by XpresHAn Technology™,” says Diane Gomez-Thinnes, head of Galderma U.S. “While individual results may vary, 98 percent of Restylane® Contour patients were pleased with their result at one year. The dynamic results truly speak for themselves.”

The results Gomez-Thinnes is referring to come from a 48-week, randomized, comparator-controlled, multicenter, pivotal Phase 3 study conducted at 15 centers across the United States. There were 270 patients involved between two groups. [In the study](https://www.multivu.com/players/English/8888051-galderma-fda-approval-restylane-contour/), patients treated with Restylane® Contour required less total volume to achieve optimal results compared to a competitive product. The results last up to a year.

According to Galderma, the filler was well-tolerated for [cheek enhancement](https://aedit.com/aedition/cosmetic-procedures-to-define-cheekbones) during the study using both [needle and cannula](https://aedit.com/aedition/guide-to-injectable-techniques-needles-for-botox-filler) injection methods. As with any HA dermal filler, the most commonly observed side effects were [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox), swelling, and injection site pain, tenderness, redness, and itching. With that said, the report indicated that “85 percent of patients did not experience any adverse events.”

Now Trending

Restylane Contour Cheek Filler: Benefits, Recovery, Results

Restylane Contour Is Here To Change The Cheek Filler Game

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High cheekbones. We all want them, but why? Scientific research has found that prominent cheekbones might be linked with [higher levels of estrogen](https://onlinelibrary.wiley.com/doi/full/10.1111/j.1473-2165.2007.00333.x) and may even be an [indication of trustworthiness](https://www.fastcompany.com/3035362/what-your-face-says-about-how-trustworthy-you-are). Regardless of the reason, there’s no doubt that defined cheekbones are ‘in.’ While we may not all be as genetically blessed as Kendall Jenner or Bella Hadid, there are a number of ways we can define our cheekbones. 

## **What Are High Cheekbones?** 
‘High cheekbones’ is a phrase we’ve probably all heard of at some point. In theory, we get it. But do we really *understand* what it means to have defined cheeks? Also referred to as the malar bone or zygomatic bone, the cheekbones are the facial structure that supports the cheeks. When the bones sit closer to the eyes, they are considered to be ‘high’ cheekbones. 

On the other hand, if cheekbones are closer to the tip of the nose, they are considered to be ‘low’ cheekbones. While high cheekbones may be considered a desirable feature, they don’t define beauty. Jennifer Lopez, Salma Hayek, and Kate Moss are just a few insanely gorgeous celebrities who have lower cheekbones. 

## **Best Procedures to Define Your Cheekbones**
While a [good contour kit](https://aedit.com/aedition/contouring-tips-from-celebrity-makeup-artist-patrick-ta) can create the illusion of higher cheekbones, there are a number of in-office procedures that offer temporary and permanent solutions. Below, two board certified plastic surgeons break down the best options.

### **1. Dermal Filler** 
The same filler that you use in your [lips](https://aedit.com/procedure/temporary-lip-fillers) and [under the eyes](https://aedit.com/procedure/under-eye-filler) can also be used in the cheeks. [Cheek fillers](https://aedit.com/procedure/cheek-augmentation-with-fillers) are injected with the goal of lifting and plumping up the area to give them more definition — though a little goes a long way. “Use no more than one cc of filler on each side and check in a mirror,” says [Gerald Imber, MD](https://www.drimber.com/plastic-surgeon-nyc/), a board certified plastic and reconstructive surgeon in New York City. “Overdone cheekbone filler can be dissolved by injection, but it is not a precise process, so overfilling should be avoided.”

To better control the placement of the filler, [Kian Karimi, MD](https://aedit.com/provider/kian-karimi-md-17458), a board certified facial plastic and reconstructive surgeon in Los Angeles, uses a micro-cannula for over 90 percent of his [injectable fillers](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers). “This allows me to get into different compartments of the face precisely and safely for accurate placement of fillers,” he says. “Since the micro-cannula is not sharp, it minimizes the risk of injecting fillers into blood vessels, which can lead to scary complications.”

Filler results are immediate and can last one to two years (or more), depending on the product used. Patients may experience some swelling and bruising for a few days following the treatment. Dr. Imber says filler is the preferred option for patients who are “trying out” the look. “The filler dissipates over the course of a year, and one can then course more permanent fat grafting,” he explains. 

### **2. Fat Grafting**
Speaking of [fat grafting](https://aedit.com/procedure/cheek-augmentation-with-fat-transfer) (a.k.a. fat transfer), the procedure is often considered a natural alternative to cheek implants and a [more permanent solution](https://aedit.com/aedition/comparing-dermal-fillers-vs-fat-grafting-for-facial-rejuvenation-contouring) than dermal filler. “It is, in fact, a totally natural substance,” Dr. Imber shares. Instead of using a foreign substance to augment, the doctor removes the patient’s own fat from another part of the body — usually from the stomach or thighs — and injects it into the cheeks. There is no risk of rejection with the treatment, and it is Dr. Imber’s “first choice” for cosmetically defining the cheekbones thanks to its permanence, natural result, and minimal downtime.

The two-step procedure first involves extracting the fat from the donor site through liposuction. The fat is then purified and injected into the cheek. A percentage of the fat is reabsorbed into the body, so your doctor may ‘overfill’ the area to start. “Using fat can affect a more gradual augmentation of the entire cheek area and a significant portion is permanent,” Dr. Imber explains. It should be noted that weight gain or loss can impact results, so maintenance may be necessary.

After the procedure, most patients experience swelling, bruising, and redness on the face and at the donor site for a few days. Full recovery can take up to six weeks, but most people are able to resume daily life after 48 hours. 

### **3. Thread Lift**
A thread lift procedure involves placing [PDO threads](https://aedit.com/procedure/pdo-thread-lift) subcutaneously to lift the skin. It is commonly used on the midface, jowl, and neck to target aging and is a great option for the cheeks when there is sagging without volume loss.  Dr. Karimi describes the ideal candidate as someone with great cheekbones who is experiencing “smile lines.”

Each thread contains small barbs along the surface, which help it grab and lift the targeted area. When the needles are withdrawn, they cause the tissue to gather over the thread, lifting the skin. New fibrous tissue will soon form around the PDO threads, which help keep them in place and hold the tissue.

“If someone does have volume loss then we recommend a combination of threads and fillers,” Dr. Karimi says. “This allows us to lift the cheek in a natural way and not depend on fillers to try to lift a cheek, which can lead to an overfilled or unnatural appearance.” For the most natural-looking thread lift, Dr. Karimi uses NovaThreads Infinity Threads. They last at least a year. 

### **4. Cheek Implants**
[Cheek implants](https://aedit.com/procedure/cheek-augmentation-with-implant), also known as cheek augmentation, is a permanent augmentation procedure that increases the cheek’s volume and projection. “Cheek implants, when perfectly seated in place, look entirely natural and are permanent,” Dr. Imber says. “They are solid silicone substances added on top of the cheekbone, and their preformed shape mimics the bone.” 

While it is a surgical procedure, most patients are in and out of the surgery room within an hour. After the general or local anesthesia is administered, the plastic surgeon will make a small incision beneath the eyes or in the mouth to create a small pocket for the implant. Once the implant is inserted and secure, the doctor closes the incision and applies a compression or bandage to help reduce the swelling.

While Dr. Imber notes the potential benefits of cheek implants, he prefers other augmentation methods. “The problem is they often slip or aren’t seated properly,” he cautions. “These days, I opt for fat grafting or filler.”

## **The Takeaway**
As with all cosmetic procedures, there is an art to finding the [right proportion](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection) for cheeks. Dr. Karimi likes to follow the “Goldilocks Principle” (i.e. not too much and not too little). “There are practitioners that will pull out rulers and calipers, but I think a good conversation with the patient to understand goals and then augmenting one's own natural cheek and enhancing their beauty is the way to go,” he says. “A great injector will know how to balance this and produce beautiful, natural, and reproducible results.”

From filler and fat grafting to threads and implants, these are the best cosmetic procedures for higher cheekbones.

Cosmetic Procedures For Higher Cheekbones

4 Procedures To Define Your Cheekbones

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[Buccal fat removal](https://aedit.com/procedure/buccal-fat-removal) might be the hottest cosmetic procedure you’ve never heard of. Plastic surgeons have been performing it for decades, usually in conjunction with other facial surgery, but this relatively simple procedure alone is gaining in popularity for its potentially dramatic impact. Buccal fat surgery involves removing, through a small incision, all or part of the buccal fat pad, which is located below each cheekbone in between the buccinator muscle (which aids in chewing) and several other facial muscles. In the right candidate, the result is a slimmer midface, the surgical equivalent of very slightly sucking in your cheeks for a selfie. 

This type of cheek reduction surgery is becoming more widespread, says New York City-based board certified plastic surgeon [Benjamin Paul, MD](https://aedit.com/provider/benjamin-paul-md-392), “because the procedure is becoming better exposed; Instagram and our selfie culture has people face-tuning and reviewing their (facial) contours with a fine-tooth comb; and a chiseled look is in.”

While seeking out a surgery seen on social media has become ubiquitous, particularly among millennials, plastic surgeons caution against it. Nashville-based board certified plastic surgeon [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), explains that “when executed properly, buccal fat removal gently changes the contour of the face. But it can certainly be over-resected – which means too much fat is removed. Going from a full face to a severely sculpted look is not subtle. We have to recognize that what sells on social media is not necessarily what works in reality.” 

Instead of relying on someone else’s sculpted selfie, both doctors encourage people to consult with a board certified plastic surgeon qualified to evaluate each patient’s unique anatomy. Beverly Hills plastic surgeon [Andrew Frankel, MD](https://aedit.com/provider/andrew-frankel-md-275) emphasizes that while buccal fat removal “can be dramatic in certain situations, it will not necessarily make a round-faced person have a less round shape.” Dr. Unger elaborates: “Patients who are otherwise fairly thin but have those ‘chipmunk cheeks,’ are ideal candidates,” as well as those whose facial shape has changed with age. “Facial aging is a descent of tissue and a loss of volume. Over time, the upper cheeks descend; our egg shape becomes more square. So buccal fat resection works when done as a conservative removal of excessive fullness in the central and lower cheek, where nobody wants volume.” Which is why Dr. Unger frequently performs buccal fat removal with other facial rejuvenation procedures: “It’s a combination of filling in the valleys and reducing the peaks to create an elegant contour.”

Despite its growing reputation as a “lunchtime tweakment,” buccal fat removal is still surgery, with all of the associated risks, as well as a price tag of around $3,000 to $6,000, depending upon the patient’s facial anatomy and desired goals. All three aesthetic surgeons interviewed perform buccal fat removal alone under local anesthesia, an option that’s trending with younger patients, and under general anesthesia when combining it with other procedures, which is more common in patients seeking facial rejuvenation. In Dr. Frankel’s practice, he tends to perform buccal fat removal in conjunction with submental (under-chin) liposuction and [chin augmentation](https://aedit.com/procedure/chin-augmentation). “Those patients are often looking for a more slim, chiseled appearance and are also [younger](https://aedit.com/aedition/9-ways-to-look-younger-without-surgery) as a group,” he says. In Dr. Unger’s practice, he frequently combines buccal fat removal with treatments like neck liposuction, facial fat grafting, in-depth facial resurfacing, and minimally-invasive contouring procedures like FaceTite and NeckTite, “to restore the egg shape” of a youthful face. 

When performing a buccal fat removal procedure, the plastic surgeon numbs the cheek with a shot of lidocaine, then creates a small incision in the cheek wall at the level where the upper and lower teeth meet. The buccal fat pad, distinct in both color and consistency from the surrounding fat, is “gently teased out of its compartment,” says Dr. Frankel, “then cauterized. The incision is closed with absorbable sutures and the other side is then done.” The procedure generally takes about a half-hour.

After buccal fat pad removal surgery, patients can generally expect minor discomfort and swelling that persists for about a week to ten days – sometimes longer. Dr. Paul advises patients to ice for the first 48 hours to mitigate the swelling, to stick to a soft food diet for a week, and to avoid exercise for 10 days. Typically, patients are able to work from home after a few days, and can return to work (provided it does not involve strenuous activity) in a week. According to Dr. Frankel, “the results become optimal around four to six months.”

Though [complications](https://aedit.com/aedition/what-to-do-if-you-are-unhappy-with-your-plastic-surgery-results) are rare in the hands of an experienced, board certified plastic surgeon, risks associated with buccal fat pad removal surgery include infection, hematoma (blood accumulation), seroma (fluid accumulation), damage to nerves and/or salivary glands, asymmetry, as well as general anesthesia risks (if applicable). “Without proper knowledge and experience this simple procedure can turn into a long, bloody surgery with potential nerve injury or injury to the parotid duct,” Dr. Frankel says.

Beyond these immediate complications, Dr. Frankel warns, improper or unwarranted buccal fat pad removal “can lead to premature facial aging due to volume depletion. Over time a hollowness can develop in the cheeks and the skin can become lax; especially in older persons or those with less elastic skin.” Dr. Unger adds, “Fat is there for a reason – it’s a glide plane.” Fat is necessary, says Dr. Unger, to lubricate the muscles involved in chewing and speaking. “If you’re getting overly sculpted, you could get lots of complications functionally, or you could look strange.” Although there is little recourse for patients experiencing medical complications, Dr. Frankel notes that an overly gaunt appearance “can be rectified by injecting filler back into the cheeks.” 

If you’re considering buccal fat pad removal surgery, talk it over with a board certified plastic surgeon who has experience in facial aesthetics. To give you an idea about what to expect before, during, and after buccal fat procedures, The AEDITION spoke with several patients.

After discovering buccal fat removal on the Internet, Tamara* sought the advice of a plastic surgeon to address excess volume in her mid and lower face. “I had full cheeks since I was very young and wanted to know if there was anything I could do about it,” she said. “For me, it was combined with neck liposuction to refine my lower face contour.” Now that her final results are apparent, she “absolutely” would do it again. “I do feel better about myself and my looks, especially in photos,” she says. “I love the improvement in my cheeks. I look thinner and have a better contour. It’s really a subtle but elegant improvement.”

Caroline* also became aware of buccal fat removal surgery through Instagram. “In recent years, I started noticing a lot of those ‘can you guess what she’s had done’ pictures of celebrities and models coming up on my feed. I was intrigued by the idea of being able to achieve some of that incredible bone structure through what seemed like a relatively simple procedure.” After researching and consulting with a local plastic surgeon, however, Caroline received a response she wasn’t expecting. “The surgeon told me that because my face is fairly narrow and thin – I don't have those ‘chubby cheeks’ – I wasn’t a good candidate. He said that I’d be much better off adding volume to my cheekbones with filler or fat than removing it from below the bone and risking being too skeletal as I get older. Although it surprised me at first, I was grateful that he wasn’t just trying to take my money for a procedure that wasn’t right for me.”

Like any other cosmetic surgery procedure, the decision to undergo buccal fat pad removal should be a collaboration between patients and their plastic surgeons. Handled correctly in the appropriate candidate, the surgery is subtle but impactful not only for the cheek area, but the facial contours as a whole. As Dr. Unger observes, “it’s like any type of facial rejuvenation. You look like an improved version of yourself, but no one else should recognize a surgical difference.”
 
*Patient’s name has been changed.

Buccal fat removal might be the hottest cosmetic procedure you've never heard of. Here's everything you need to know about the high-impact procedure from plastic surgeons Dr. Benjamin Paul and Dr. Jacob Unger, as well as real patients.