Why don't more physicians perform buccal fat removal?

Buccal fat removal is not performed by many surgeons because although it seems to be an easy surgery, it is not. It requires technical skills to perform the procedure without damaging the delicate structures inside the face. Additionally. in order to deliver a good result, the surgeon should be specialized on procedures of the case since other areas of the face may be necessary to address at the same time of performing buccal fat removal to deliver a cosmetic pleasant result. 

Buccal fat removal is a great way to get some subtle contouring of the mid-face region. For the right candidate, it can be a powerful technique to provide good mid-face contour. On average, we are able to remove 2.5 cm to 3 cm of fat on each side. In contrast, we typically inject 1 cm to augment each cheek bone. It can be performed under local anesthesia or with sedation and can be performed as part of a facelift surgery or just all on its own. I am not sure why more surgeons do not offer it. It is a great procedure that patients love.

Not a lot of docs perform buccal fat pad reductions for a variety of reasons.  Whether it be they are not comfortable with the procedure, to personal philosophy and everything in between.  Not everyone is a great candidate for buccal fat reduction and this is something that your doc needs to evaluate before even discussing it.  Particularly if you brought it up first.  I would hope they gave you an explanation as to why you may not be a good candidate for it, if they felt that way.  I hope this helps answer your question.