24 year-old with puffy-looking cheeks, desiring more chiseled appearance. Am I a good candidate for buccal fat removal? (photo)

Buccal fat pad reduction is a procedure that is not commonly performed but can make sense in the right patient.  It is important to understand the anatomy before undergoing the surgery so that you are well informed.  Normal aging reduces the buccal fat pad volume.  It is true that some people have more volume in their cheeks than others.  However, it is also universally true that that volume will decrease and descend over time.  Removing too much buccal fat can cause premature aging.  It is also important to remember that replacing fat that has been removed is extraordinarily difficult if not impossible.  The main reason is the location of the buccal fat pad.  It usually resides underneath a large muscle that is responsible for majority of the power motions of your chewing.  Once that fat is removed that space collapses.  Once collapsed it is very difficult to find the exact space and to reinsert a substance such as a filler or better yet fat.  One potential solution is to use something like Sculptra.  While I generally do not advocate buccal fat pad removal, I understand why somewhat would want procedures such as this.  I tried to choose my patients very carefully and I also tried to be conservative in the amount of fat that is removed.  Surgeons who trivialized this procedure simply don’t understand how difficult it is to correct deformities that may occur.  The cost of the procedure can run anywhere from $3000-$7000, depending upon your geographic locale.  Please visit with an experienced board certified plastic surgeon.  My best advice is to always be conservative with any buccal fat pad reduction.

Dear SpanishBoy,

Buccal fat pad removal is a precise procedure and should be performed by extensively experienced surgeons.

Establishing candidacy is as important as the surgery itself and so seeking a consultation with the right surgeon will help you come up with a solid decision.

With age, the buccal fat pad will undergo atrophy and so its removal (if necessary) should be approached conservatively.

Nonetheless, facial contouring could be achieved through different procedures.

It is hard to present a definitive recommendation based on the personal photographs you have attached.

However, to establish the look in "pic 2", a surgeon could recommend mandibular (jaw) and malar (cheek) implants, supplemented with submental liposuction if necessary.

Best of luck to you.

Dr. Sajjadian

Having a full face and round cheeks is a sign of youth. Simply do a bit of research to see what concerns people in their 30's and 40's are looking to correct...Volume Loss is at the top of the list. You will find that over the next 5-15 years your cheeks and lower face will thin and you will have the desired (more chiseled) look you are wanting. If you choose buccal fat removal in your early 20's, you may be happy with the result for the next few years- BUT you will be faced with a more aged and thin look in your face in your early to mid thirties. I have a patient in my practice that is facing this exact issue. At 35 she is attractive, youthful and vibrant...but her face looks a bit tired and "deflated". She had her buccal fat removed by another surgeon when she was 22 and now, at 35, she is seeking to volumize her face with fillers such as sculptra and radiesse which will cost her approximately $3,000-$5,000 every 5 years. Although this may not be the answer that you are looking for- you may find that a visit to a professional make up artist to learn the trick to contouring facial features with blush and bronzers will get you through the next few years. Best of luck to you!

Dr.Clevens