Why don't more doctors perform fat grafting to anatomical buccal space?

Fat grafting to restore volume after buccal fat removal is a safe and efficient procedure. There are a few things to be taken into account as it is a secondary procedure from a surgeons point of view, but it can be performed safely. Facelift surgeons are probably most familiar with the buccal fat pad. I probably would start my research there.

The buccal space is a loose areolar space which means that it is spread over a wide area and with loose attachments. It is very difficult to inject far into this space. Fat is normally injected in small parcels in order to get attachment to the blood supply and survive. The buccal space does not allow for small quantities of fat to be injected accurately over a wide area. One would have to inject a large bolus of fat which can appear very unnatural and bulky. This also increases the risk of fat necrosis.

I am not sure that I have heard about reasons to avoid placement of fat grafts in particular compartments that already have fat deposits, including buccal fat pads? It may be very specific location which will require good anatomical orientation which can be provided with ultrasound imaging. Hope this helps.