Buccal fat removal - Is it possible there isn't any fat to extract?

Hello, thank you for your question. It is hard to tell without a physical examination. I recommend you to schedule a consultation with a board certified plastic surgeon.

I'm sorry to hear about your experience! If you are experiencing chubby cheeks, your surgeon most likely did not complete the incision in the ideal position to reach the fat pad that he was looking for. Another nonsurgical option to slim the cheeks and jaw is to inject botox into the masseter muscles, which will provide results for approximately 3-4 months. However, if you are still interested in completing the procedure, I would recommend you to complete additional consultations with multiple plastic surgeons. This way, they can assess your cheeks and create a treatment plan that will help you achieve your aesthetic goals. 
Best of luck!
Kian Karimi MD, FACS

The anatomy of the buccal fat is fairly consistent and should be present in every patient.  The correct pocket may not have been found and thus the fat may not have been found.  Although it does appear like a fairly simple and easy procedure, experience makes the world of difference in this surgery.  Placing the incision in the correct location and finding the appropriate planes should lead right to the buccal fat pad.  

It sounds like your surgeon was unable to find the fat pad. Though this surgery sounds simple and safe, it does take experience with this procedure to experience success. The fat pad is located behind the muscle so maybe your surgeon was unfamiliar with the nuances of the procedure. I would suggest that you ask for your money back and find another surgeon. If you indeed have a chubby face, then you would have a fat pad that can be reduced. 

Thank you for your question and I’m sorry you did not receive the results you hoped from your surgery. It does sound like the surgeon may have created the incision too low to locate the fat pad. It also requires separating the buccinator muscle fascia to access the encapsulated pocket of fat. I often perform buccal fat pad removal as an effective face slimming technique. Other options might include Botox injections to slim a wide jawline or liposuction to treat jowl formation. I encourage you to find a board-certified facial plastic surgeon with extensive experience in facial contouring procedures to ensure a better result the next time around. 

Unless one is experienced at buccal fat removal, it is easy to confuse the very small amount of fat that sits near the incision with that of the deeper buccal fat pad. (which looks very different and has a surrounding capsule). It is possible this is what may have occurred and I have seen that numerous times in prior buccal lipectomy patients ini which complete buccal fat pads were found. Whether that is what has occurred in your case is unknown. 

Hi @EasyGoing - Thanks for your question. It sounds like perhaps the surgeon made the incision lower than is required. Typically the removal of buccal fat pad requires a tiny 1-2 cm incision on the inside of your mouth and should be 1cm above and behind the part of your cheek across from the second upper molars. 
Once this small incision is made the buccinator muscle fascia is spread apart and the fat is easily removed. Typically just 2-3 grams on each side is enough to produce significant aesthetic improvement.
There are multiple small procedures that I like to use for proper facial slimming because one surgery (buccal fat pad removal) is not always the right answer for all causes of "chubby faces".
The ideal candidate for buccal fat pad removal has fat in the cheeks that is above the border of the mandible or jawline and towards the front of your face. This is easily treated with buccal fat pad removal. 
 If the prominence or “chubbiness” is towards the back of the jaw (like under the ears), then this is actually an oversized masseter muscle which can easily be treated with Botox which will shrink the muscle. This typically requires 25 Units of Botox on each side.Lastly, if there is excess fat below the mandible/jaw and in the neck then this may require a neckslimming procedure such as neck liposuction or a mini-incision necklift which is a great option in patients under 30 and involves removal of fat in the neck and tightening of the plastysma muscle. 

Best of luck,
Dr. Karan Chopra
★★★★★
Minneapolis Plastic Surgeon
Face ⨀ Breast ⨀ Body Expert
Johns Hopkins Trained
Cosmetic Fellowship Trained