Is buccal fat removal worth it? What is the alternative?

Buccal fat is genetically predetermined and it is usually resistant to diet and excercise. Buccal fat removal is the procedure that removes the  fullness of the chubby cheeks by removing this diet/fat resistant fat. 
There is a 'misbelieve' that buccal fat could "accelerate aging" or "make the face look older". This could happen when the surgery is performed in patients with POOR cheek bones. If the cheek bones are normal/prominent, there is no "aging" secondary to buccal fat. In my practice, when a patient has POOR cheek bones, I will perform the buccal fat removal ONLY if they enhance their cheek bones at the same time ususally with soft tissue fillers like voluma. 

Great question! The best way to determine whether you would like the look after surgery is to gently suck in your cheeks such that you can gently bite down on the cheek mucosa.  If that is the look that you are going for, then you are a candidate for buccal fat reduction.  I say reduction because you are right - overly aggressive surgery can lead to a gaunt look...in the wrong patient.  This is why its important to understand your options and what each procedure can and will do.  In the wrong patient, buccal fat pad reduction can lead to a "gaunt" look - or accelerate the aging process.  However, in the right patient, it will improve the contour of their cheeks and won't provide a gaunt appearance or overly hollow.  Your best bet is to do a consultation and spend some time speaking to the doc in great detail about what your goals and desires are.  I hope some of this helps! Best of luck.