36 years old, sagging, tired face - considering buccal fat removal, but what procedure will make the best improvement? (Photos)

It’s difficult to give a definitive recommendation without an in-person exam, but based on your picture, some of the tired or sagging appearance may be related more to midface volume changes and early jowling rather than excess buccal fat. In many patients, this can happen even if they have naturally fuller cheeks.
Buccal fat removal can be helpful for very selected candidates, but it may not address midface descent and, in some cases, can make the lower face look more hollow over time. For that reason, I usually recommend evaluating the overall balance before deciding on removal.
Depending on your anatomy, the improvements you’re looking for — reducing sagging, softening jowls, and restoring a youthful look — are often better achieved with a combination of:1. Midface volume restoration (fat transfer or structural filler)2. Jawline refinement (micro-liposuction or contouring if appropriate)3. Skin tightening or lifting treatments to support the lower face
These options don’t exclude buccal fat removal entirely, but they may provide a more global improvement if the main issue isn’t central cheek fullness.
A consultation with a surgeon who performs both volume restoration and contouring procedures can help determine the safest and most effective approach for your goals.