Buccal Fat Removal a Good Option for Slimmer Face?

Buccal fat pad excision in the right patient is an excellent procedure.
My fine colleagues are absolutely correct to worry about using the procedure willy nilly in every young patient with an overly full face in whom the natural history of their faces would eventually produce a beautiful face.
However many patients simply have overly full faces in the lower cheek region. And they will have this for most of their life. The bulging buccal fat pads simply prevents their face from being pretty. Often one of their parents has the same feature, even in advanced age. They and their parents suffer with the "chipmunk cheek" look well into advanced age.
The natural history of the buccal fat pad is that it shrinks with age. In younger patients it is full. In older patients it is much smaller. In elderly patients it is often almost absent. In fact as patients age we often see what is left of the buccal fat pad slightly bulging out through the disappearing SMAS layer. This is routinely addressed in facelifts in older patients by fixing the SMAS layer on top of the buccal fat pads, a shadow of what they used to be.
So where is the shrinkage that supposedly occurs if the fat pad had been removed if the buccal fat pad disappears anyway?
By the time the patient has "burned through" their facial fat, fat in the entire face has diminished, both in the buccal fat pad as well as the cheeks and face as a whole. Are we avoiding the surgery on the buccal fat pads that would have an instant and huge benefit (see pictures below) so people can look good when they are 80?
One of the features of a beautiful face, both in women and men, is a juxtaposition of the cheekbone area to the cheeks. The cheekbone area is fuller than the cheek area. The S-shaped curve on the 3/4 view is attractive and in fact defines the most beautiful faces of our era.
It is possible to augment cheeks, either with fat injection, LiveFill(TM) or cheek implants. However in faces that aesthetically would not benefit from further widening in the cheek area, is that the right choice?
Our practice has been a champion of retaining volume in the face with LiveFill(TM) grafts and 100% SMAS preserving facelifts. However, not all volume looks good in all patients. Fat underneath the chin looks bad. Should that be kept so that when the patient gets older they have some spare fat? Should we start a "Save the double chin foundation"?
It is simply not beautiful when the cheeks are overly full. In such patients, buccal fat pad removal can be an immediately and profoundly satisfying procedure.

Treatment of ‘chubby cheeks’ cannot be achieved alone with buccal fat pad removal; a fact that I encounter time and time again when seeing patients in consultation for lower facial sculpting. My approach is to use a combined protocol that redefines aesthetic contours of the face. This includes the following: 
  
Buccal Fat Pad Removal Non-surgical Muscle-Fascia Tightening Venus Legacy or Venus Viva Ultherapy Submental Liposuction or Coolsculpting   
The combined approach is ideal. Buccal fat pad removal is a exceptional procedure that can remove excess fat from the cheek pads. Using an intraoral approach, a small incision is carried through the mucosa to remove a small fat pad within the cheek. Closure of the incisions is minimal with an absorbable suture and patients will experience some swelling post-operatively. We use SwellX tablets post treatment. Once healed, the contour of the cheek is improved and we begin Non-invasive tissue tightening to further enhance results. 
  
Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Buccal Fat removal is a good, actually an excellent plastic surgery procedure to slim the face. Chubby cheeks or fullness of the lower anterior cheeks is commonly caused by enlarged buccal fat pads. Buccal fat removal by removing the buccal fat pads permanently, makes the face less full, more thin and/or chiseled in patient candidates. The video below helps to understand who could be a candidate for buccal fat removal.