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 13

Buccal fat pad reduction

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.

Orange County Facial Plastic Surgeon
5.0 out of 5 stars 71 reviews

Cheek (Buccal) Fat Pad Removal - Cautionary Tale

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.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 102 reviews

Buccal fat removal

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
4.3 out of 5 stars 12 reviews

Buccal fat pad removal

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.

Problems with buccal fat removal

There are 2 problems with buccal fat removal and they are that the short term results are not very dramatic and the long term loss of facial fat and volume can leave you gaunt looking if you had buccal fat removal when you were younger.

Buccal Fat Removal

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 12 reviews

Buccal fat removal.

I agree totally with what Dr. Rand said. Patients are almost always unhappy with the poor results achieved.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 32 reviews

Must be conservative with buccal fat pad removal

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
5.0 out of 5 stars 44 reviews

Buccal Fat Pad

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 143 reviews

Questionalble results

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.

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.