Why Are Doctors Against Buccal Fat Pad Removal?

I have such fat round cheeks. All my life I have been made fun of. I had Vaser LIpo on my cheeks and I still feel i need buccal fat removal. I look like a bulldog. I have a very round face. Isn't buccal fat removal ok for some people? i feel i am one of them. i want a slim face. is that so bad?

Doctor Answers 17

Cheek (Buccal) Fat Pad Removal - Cautionary Tale

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As we age we lose fat and volume from our faces and our face sags resulting in the familiar deflated, sagging facial aging familiar to all. Fat loss is particularly seen in the Cheek Fat Pad (of Bichat) which results in accentuation of the cheek, temple and side of the eye socket bones and a sick, malnourished appearance (compounded further by illness).

While there is room for performing a Bichat fat pad removal in extreme, "moon face" round faces, we do so knowing that these patients may also have accentuated bony faces later in life. In milder cases of accenuated facial fat pad presence the likelihood of a long-term substandard result is so great that we generally avoid doing this operation in most patients.

Memphis Plastic Surgeon

Buccal fat pad reduction

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Thanks for your question.  I find buccal fat pad reduction to be a great procedure in the properly selected patient.  Fullness in the lower cheeks or "chipmunk cheeks" can be treated this way.  Liposuction or skin tightening technologies will not be the right choice when buccal fullness is apparent.  The buccal fat pad sits deeper in the cheek under muscle.  This is different from skin fat that can be liposuctioned. Proper diagnosis is important. Also, this fat pad may get smaller when we are elderly giving a hollow look in this area  This procedure is also not commonly performed so many surgeons may feel uncomfortable with it.  

I have many happy patients with this procedure.  Careful selection and counseling are key.  Results evolve nicely over a period of weeks to months. Please talk to an board certified surgeon experienced in buccal fat reduction to see if you are a candidate.

Raymond E. Lee, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 101 reviews

Buccal fat removal

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Buccal fat removal can be a very good procedure in the right patient. The problem is that as you age this fullness of your cheeks may go down. Therefore, this procedure should only be performed in those people with true protrusion.

Sandy Sule, MD
Dallas Facial Plastic Surgeon


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The main issue is that as plastic surgeons we are always combating fat loss and fat decent in the face. One of my favorite procedures is fat transfer to the face. That is because it really gives people a rejuvenated look. It replaces the lost and augments the fat that has fallen. 

So why then would we ever remove fat? Well some people, probably because of genetics, have a full and proportionately prominent buccal fat pad. So this disproportionate area of fat makes the other areas of the face aged even more. 

All that being said, not everyone is a candidate for buccal fat pad removal. I am critical of the patients I select. Often times fat transfer in conjunction with this procedure is able to give a more “ideal” heart shaped face. This can make a big difference in patients as a combo. It may seem counter intuitive to add fat when you say your problem is fat cheeks. What we do is add fat around the cheeks to the side of the highest and most projected point of the cheek bone and taper it to the lower face. This helps to camouflage overly chubby cheeks.  This is especially helpful in thin women and in combination with buccal fat pad removal is a powerful maneuver. All of this can be done in clinic with some calming medications and local anesthesia.

I recommend getting a consult with a surgeon who does this procedure frequently to get a full facial analysis to make sure your specific goals are addressed.

In the facebook video below we describe out treatment process.

Hope this helps.

Best of luck.


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Buccal fat pad removal

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Some people are candidates for this procedure.  It should be done only in carefully selected patients to avoid creasting facial deformities.  Perhaps, what you are really hearing is that you are not a candidate, and perhaps you should hear that.

Must be conservative with buccal fat pad removal

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Doctors aren't against buccal fat pad removal but the resection must leave some fat behind so that the cheeks don't look gaunt as the person ages.

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Buccal Fat Removal

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Buccal fat removal, in the right candidate, can really slim down the face.  It needs to be performed judiciously though to avoid taking out too much and giving a gaunt appearance, which is usually not flattering.  Please consult with a board certified specialist in the face who can assist you with achieving the results you seek.  3-dimensional computer imaging can also help you visualize what you may look like afterwards and serve as a useful communication tool with your surgeon. 

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Buccal Fat

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Buccal Fat removal is a great procedure for the patient who has a full lower face.  It contours the face for those who have excess fat pads .  It is a simple procedure that is accomplished by removing the buccal fat from inside the mouth under local anesthesia .  There is no scarring and minimal pain.  I suggest you see an experienced surgeon to find out if you are a candidate.  Best of luck to you.   

H. George Brennan, MD, FACS
Newport Beach Facial Plastic Surgeon
4.7 out of 5 stars 15 reviews

Buccal Fat Pad

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Buccal fat pad, like any other surgical procedure, must be the right procedure for you.  The challenge is determining if you are going to be a good candidate.

  1. Family history of "full" faces-  Families with full faces who age with full faces are likely to benefit from buccal fat removal.  Families whose fuller faces eventually turn gaunt should avoid this procedure
  2. Buccal fat excess-  There are multiple fat pads in the face.  The key is to determine if buccal fat pad removal is beneficial

The technical challenges of buccal fat pad removal are to be non disruptive to the surrounding structures.  I prefer to remove the buccal fat pad in the office under local anesthesia with a minimal intraoral incision for the following reasons:

  1. Patients can see the buccal fat removed-  
  2. Quicker recovery than general anesthesia
  3. Able to tolerate foods earlier with less intraoral swelling

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 177 reviews

Buccal fat extraction

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This is not  a well know procedure and not all sugeons offer this treatment.  The procedure is generally performed by facial plastic surgoens, oral surgeons and plastic surgeons. The results of the procedure are not completely predictable. It must be performed on suitable candidates or it can produce irreversable hollowing of the cheeks.  When this procedure is carried out on the right patient it can produce signficant improvement in facial contour.  One must be evaluated to assess if they are a suitable candidate.  Other procedures that can enhance facial contour include chin implantation, botox to masseter muscle, and jaw angle surgery.

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.4 out of 5 stars 118 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.