Patients with a very bottom-heavy face, which makes their face appear round, usually have enlarged buccal fat pads. These pockets of fat in the bottom anterior face are often the cause of the chubbiness and roundness. For most patients, these pads typically do not reduce in size with diet and exercise. Additionally, they tend to grow with age, making the face even more bottom-heavy. Patients with enlarged buccal fat pads are usually candidates for buccal fat removal if they have high cheekbones. However, if a patient with a bottom-heavy, round face also has moderate smile lines and marionette lines (lines that form from the corners of the mouth) suggesting they do not have high cheekbones, they must enhance their cheekbones (usually with cheekbone fillers) before or at the same time as surgery to become candidates for buccal fat removal. John Mesa, MD Buccal Fat Removal Specialist New York - New Jersey- Miami