Question 1

What is buccal fat removal?

Accepted Answer

Buccal fat removal surgery contours the lower third of the face and makes cheekbones look more defined by reducing the buccal fat pads in the lower cheeks. Also known as buccal lipectomy, cheek reduction surgery, or face thinning surgery, this minimally invasive surgery can create a more sculpted facial contour in adults who still have a “baby face” look.

“Buccal fat removal is an excellent procedure for patients who feel that their face is overly round or chubby and would like to achieve a more chiseled look,” says Dr. John Mesa, a board-certified plastic surgeon in New York City who specializes in buccal fat removal.

The buccal fat pad sits between facial muscles, in the cheek hollows just below your cheekbones. It gets its name from the Latin word bucca, meaning “cheek." It’s sometimes also called Bichat’s fat pad, due to Dr. Xavier Bichat, the French anatomist who first described it. Because of this, you may also see this procedure called bichectomy, or bichectomia in Spanish.

The size of these pads varies from person to person, regardless of weight. Large buccal fat pads are often a genetic feature, with rounded cheeks running in families.

While it can thin with age, buccal fat can't usually be reduced by diet or exercise, which is why this minor outpatient surgery has become increasingly popular.

Buccal fat pad removal can also be paired with cheek augmentation with injectable fillers, cheek implants, or fat transfer to create more sharply defined cheekbones. It’s also frequently combined with other cosmetic surgery procedures like a mini facelift, chin lipo, FaceTite, or a chin implant, to reduce a double chin and contour the jawline.

Related: Chrissy Teigen Revealed She Had Buccal Fat Removal

See board-certified plastic surgeon Dr. John Mesa react to real buccal fat removal patient experiences and results.

Question 2

What are the pros and cons of buccal fat removal?

Accepted Answer

Pros

Most reviewers on RealSelf who've had buccal fat removal surgery say it was Worth It, with many citing a subtle improvement in facial contour and definition.
If you’re concerned about full cheeks, this procedure can give you a sleeker face with more pronounced cheekbones.
Cheek reduction surgery leaves no visible scars because the incisions are made inside the mouth.
Results are permanent, even if you gain weight.
Cheek fat removal is a relatively quick surgical procedure, typically taking under an hour.
Downtime is minimal. Most patients can return to their normal activities after three days (despite the lingering swelling).
It’s a much safer option for cheek fat reduction than liposuction, which can damage facial nerves.

Cons

Swelling during healing can last for a couple of weeks before it subsides. RealSelf members have described it in their reviews as having “chipmunk cheeks,” similar to after having dental work done.
Buccal fat pads may shrink over time in some people, so your lower cheeks could look too hollow as you age. Some surgeons avoid performing cheek fat removal on patients in their 20s and 30s because of this risk, but there's a lack of peer-reviewed published data that support these opinions, according to Dr. Mesa.
If the surgeon removes too much fat or you lose weight post-procedure, your face may look overly gaunt as you age.
If your surgeon doesn’t extract the right amount of fat from each cheek, you may be left with asymmetry that needs to be corrected via a revision procedure (at additional expense).
Beyond the usual risks of surgery, this procedure carries additional risks in inexperienced hands. Potential complications include damage to salivary ducts (that can cause severe facial swelling, due to accumulation of saliva on the affected cheek), hemorrhaging, and (rarely) nerve damage that may lead to facial muscle weakness. The best way to mitigate these risks is to find a board-certified plastic or facial plastic surgeon (not a dentist) who understands the entire facial anatomy intimately and has safely performed hundreds of cheek reduction procedures.

Related: Buccal Fat Removal—and the Debate Dogging the Insta-Famous Fix

Question 3

How much is buccal fat removal surgery?

Accepted Answer

Buccal fat removal costs depend on your surgeon’s credentials, level of experience, location, and the details of your procedure. Cosmetic procedures are not covered by insurance, but most providers accept financing options like CareCredit.

See our complete guide to buccal fat removal costs

Question 4

Buccal fat removal before and after pictures: what to look for

Accepted Answer

As you're choosing your provider, look for buccal fat removal pictures with similar lighting, angles, facial expressions, and proportions.

The best after photos show improved facial balance, with more emphasis on the cheekbones (rather than the lower face). A three-quarter view should show a natural-looking cheek contour, going from rounded to either flat or slightly concave. An extremely hollowed look may look dramatic at first, but it can indicate that too much fat was removed, paving the way for an overly gaunt look as the patient ages.

Look at as many photos as possible from any surgeon you’re seriously considering, to make sure their results are consistently excellent.

The buccal fat removal before and after photos in our gallery were shared by the provider who performed the procedure, with the patient's consent.

Question 5

Who's a good candidate for buccal fat pad removal?

Accepted Answer

Buccal fat reduction isn’t for everyone. A 2023 study on the procedure stresses that “appropriate patient selection is critical for preventing an aged or unnatural appearance.”

Ideal candidates are healthy nonsmokers with normal BMIs and good (ideally high) cheekbones, who have chubby cheeks or a round face due to an abundance of buccal fat.

Both men and women can benefit from the surgery, though male patients may be more interested in pairing it with cheek, chin, and jaw augmentation, with either dermal fillers or implants, to create even more sharply defined facial features.

If you’re naturally lean, removing 100% of the buccal fat pads may not be wise, as the results could eventually make you appear more mature than you are. In these cases, a board-certified plastic surgeon or facial plastic surgeon can advise if a partial buccal fat removal procedure (where just a portion of the buccal fat pads is removed) could be an option for you.

“As we age, the face naturally loses volume, and having a reduction in facial fatty tissue may lead to a gaunt look over time,” says Dr. Matthew Richardson, a facial plastic surgeon in Frisco, Texas. For this reason, many think it’s not a good idea to perform buccal fat removal on patients who already have a slim face and just want more definition.

During your initial consultation, your provider will examine your face to ensure it’s the buccal fat pads that are contributing to the roundness. People who have wide cheeks from overdeveloped jaw muscles will have a better result from Botox or another neuromodulator, which can relax the masseter muscle and slim the face over time.

“People with poor cheekbone definition may need to enhance them with dermal fillers, fat transfer, or cheek implants before or at the same time as the procedure to achieve an aesthetically pleasant result with buccal fat removal,” Dr. Mesa explains.

Question 6

Does buccal fat removal help with jowls?

Accepted Answer

When performed on appropriate patients, buccal fat pad removal can help reduce the appearance of jowling. Excess buccal cheek fat can drag the skin down, and removing it—again, in the right person—can offer a slight lifting effect (though not as dramatic as a facelift).

It’s important to remember, however, that facial fat lends structure and support. Especially if the patient doesn’t have high cheekbones, removing buccal fat can actually trigger some degree of lower-face sinking or sagging.

Also keep in mind that any pre-existing sagging can become more obvious once excess fat is removed. If you're concerned that your skin may not have enough elasticity to bounce back (usually only a concern for patients in their 40s or beyond), talk with your doctor about skin tightening treatments.

Question 7

Is buccal fat removal worth it?

Accepted Answer

Buccal fat removal has a type: embedded-entry-inline id: Ks6V6ARYAktTMUTOEu3el Worth It Rating from RealSelf members, so a solid majority of patients who've had the procedure say the results are worth the time, expense, and recovery.

For the best chance of a successful result (and avoiding buccal fat removal gone wrong), choose a surgeon who is:

experienced in removing buccal fat and can accurately assess if you’re a good candidate
judicious about how much fat they remove

The result of removing buccal fat from your midface is permanent, and some reviewers on RealSelf members regret having the procedure, saying it left them looking overly hollow and prematurely aged.

As you're choosing your surgeon, pay close attention to their before and after photos, looking for these four signs of good buccal fat removal results.

Question 8

How does buccal fat removal surgery work?

Accepted Answer

Here’s what to expect during this short procedure.

First, your provider will apply a topical anesthetic to the inside of your cheeks followed by injections of lidocaine. They may also give you oral sedation, if you’d prefer to be in a light sleep-like state. General anesthesia is usually not necessary unless you're also having other procedures in the same operation. (It's also much more expensive and carries some additional risks.)
Once you’re sufficiently numb, your surgeon will make a small incision, about a half-inch long, on the inside of each of your cheeks to access the buccal fat pads.
They should then carefully tease out and remove the appropriate portion of fat, usually a walnut-size amount.
Finally, they’ll close the incisions with dissolvable sutures.

You’ll be sent home with a chin strap for support, antibiotic medication, and a medicated mouthwash to prevent infection.

Question 9

How painful is buccal fat removal?

Accepted Answer

The procedure itself isn’t painful because your cheeks should be fully numb from the local anesthesia. “Most people tolerate the procedure very well and compare it to a dental procedure,” says Dr. Mesa.

If you don't feel fully numb as your surgeon begins the procedure, let them know immediately, so they can administer additional anesthesia.

Any discomfort you feel during recovery will likely be mild enough to be alleviated with ice and over-the-counter pain medication like Tylenol.

If pain is a major concern, talk with your provider about prescription pain medication for the first few days of your recovery.

Question 10

How long does buccal fat removal recovery take?

Accepted Answer

Most patients need three to four days of social downtime, but a week of buccal fat removal recovery time is even better, if you can take it.

Expect some discomfort (which you can treat with over-the-counter pain medication) and significant swelling during the initial recovery. In fact, it's likely that your face will look fuller during your initial recovery than it did before your procedure.

Most of the swelling should subside within three weeks.

Here’s how to help reduce swelling after buccal fat removal:

Stick to a soft-food diet and avoid anything too hot or spicy for at least 24 hours, to avoid irritating the incisions.
Follow a regular icing regimen, as directed by your doctor. “Apply light ice packs to your cheeks for the first day and drink iced water,” says Dr. Mesa.
Wear a chin strap at night for the first two weeks, to give your facial skin some extra support as it heals and retracts into the newly created hollows. This helps prevent new skin laxity.
Sleep on your back with your head elevated for at least the first week.

Question 11

How soon will you see results?

Accepted Answer

You’ll see your initial results in about three weeks, once most of the swelling has gone down.

It can take as long as three or even six months to see your full results, as your skin settles into your new cheek hollows.

See buccal fat removal before & after photos

Question 12

Is buccal fat pad removal permanent?

Accepted Answer

Yes, buccal fat pad removal results are permanent. Even if you gain weight, the fat that’s removed won’t grow back.

However, weight gain can make your face look plumper as the remaining fat cells in other areas expand. This can mask or distort your face fat removal results, so it's still a good idea to maintain a healthy weight.

Question 13

Does buccal fat removal age you?

Accepted Answer

A buccal fat removal procedure will make you look more mature, but it should not make you look older if you have high cheekbones. "High cheekbones are the key to achieving a youthful look with buccal fat removal at all ages, even if all (100%) of the buccal fat pad is removed," Dr. Mesa explains. "Patients with chubby cheeks with ‘weak’ cheekbones can become good candidates if they enhance their cheekbones before or during the procedure with dermal filler injections, fat transfer, or cheek implants, thus avoiding looking aged with the procedure," he says.

Some plastic surgeons do express concern about how well buccal fat removal results hold up over time, as patients age. Researchers point to a lack of studies on the long-term implications of buccal fat removal surgery, so how patients will look 10 years later is a controversial topic.

It’s also not known how much buccal fat persists or atrophies over time, from person to person. It can be hard to predict which patients will lose or retain buccal fat.

According to a recent study in the medical journal Plastic and Reconstructive Surgery, “there is great debate as to how much of the buccal fat pad diminishes with age. However, there is good evidence to indicate that the buccal fat pad does diminish significantly as aging progresses.” The authors cite research showing that the buccal fat pad generally increases in size between ages 10 and 20, and then decreases over the next 30 years.

They go on to note that “deflation of this fat compartment leads to a lack of support for the medial cheek and middle cheek fat, aggravating the descent of these compartments.” This can lead to sagging cheeks and jowls.

On the other hand, Dr. Sarmela Sunder, a facial plastic surgeon in Beverly Hills, points out that patients of certain ethnicities typically see the opposite effect: fat hypertrophy (enlargement) with age, which means they gain cheek volume over time.

Question 14

Can you reverse buccal fat pad removal?

Accepted Answer

Buccal fat is unlike any other fat in the body, and there’s no reliable way to restore it to its original state once the fat pad has been tampered with.

That said, if you’re unhappy with the results of your buccal fat reduction, or "if several decades pass and volume loss is an issue, there are ways to deal with this,” says Dr. Richardson.

Dermal fillers can offer a temporary solution for gauntness. Collagen-building injectables, like Sculptra and dilute Radiesse, tend to yield a more natural look in the cheek hollow than hyaluronic acid gel fillers like Juvéderm, doctors say.

“With the collagen stimulators, it’s all about subtle volumization, which is why I like them for [the buccal hollow],” says Washington, D.C., facial plastic surgeon Dr. Michael Somenek. “There’s something to be said for maintaining a little bit of concavity here, because it gives you that accentuation of the cheekbones.”

For some, facial fat transfer can be a better and more cost-effective solution. Dr. Steven R. Cohen, a board-certified plastic surgeon in San Diego, specializes in augmenting the buccal fat pad directly with a combination of microfat and nanofat (and has published on the safety and efficacy of his technique).

Still, plastic surgeons generally agree that the buccal fat compartment, given its distinct anatomy, is a very difficult area to graft, so if going this route, be sure to see a skilled surgeon who has vast experience with the procedure.

Related: Buccal Fat Restoration Is Now a Thing. Here’s How Doctors are Fixing Gaunt Cheeks.

Question 15

Is buccal fat removal safe?

Accepted Answer

When it’s performed by an experienced, board-certified plastic or facial plastic surgeon, buccal fat removal is a safe, relatively straightforward surgery.

That said, it does come with a few risks and potential complications that your surgeon should discuss with you during your initial consultation.

As with any surgery, there’s a risk of infection, bleeding, scarring, and injury to surrounding tissue and structures.
Studies show that possible buccal fat removal complications include hemorrhaging, trismus (lockjaw), and facial-nerve damage, which can lead to numbness, other changes in sensation, and (in rare cases) partial facial paralysis. These changes are usually temporary, but they can be permanent.
An inexperienced surgeon can also damage your facial ducts or the salivary glands.

Finding a board-certified plastic surgeon or facial plastic surgeon who has extensive experience with this cosmetic procedure is crucial to avoiding a botched buccal fat removal procedure.

“You want to see someone who’s capable and qualified to do a proper facial analysis and who understands your unique facial structure, as well as the results you’re hoping to achieve,” says Dr. Mesa.

Question 16

What are the alternatives to buccal fat pad removal?

Accepted Answer

A few other treatments can make your cheekbones pop, exaggerating the buccal hollow.

Cheek fillers: Injectable fillers like Voluma, a hyaluronic acid–based filler that’s FDA-approved for cheeks, can create the appearance of more robust cheekbones and even camouflage jowls. Cheek fillers are much less expensive than surgery, and results last for years.
Facial fat transfer: Some doctors achieve this result with fat transfer too. “It may seem counterintuitive to add fat when you say your problem is chubby cheeks, but we can add volume to the highest and most projected point of the cheekbone and taper it to the lower face,” says Dr. Benjamin Caughlin, a plastic surgeon in Oakbrook Terrace, Illinois.

Question 17

Sources & studies

Accepted Answer

Rohrich, Rod J., Jalalabadi, Faryan. “The Five Ds for Safe and Effective Buccal Fat Removal.” Plastic and Reconstructive Surgery. 2023 Mar 1.

Rohrich, Rod J., et al. “The Role of the Buccal Fat Pad in Facial Aesthetic Surgery.” Plastic and Reconstructive Surgery. 2021 Aug 1.

Benjamin, Martin, and Richard G Reish. “Buccal Fat Pad Excision: Proceed with Caution.” Plastic and Reconstructive Surgery. Global Open, Wolters Kluwer Health, 16 Oct. 2018.

Moura, L-B, et al. “Buccal Fat Pad Removal to Improve Facial Aesthetics: an Established Technique?” Medicina Oral, Patologia Oral y Cirugia Bucal, Medicina Oral S.L., 1 July 2018.

Cohen SR, Fireman E, Hewett S, Saad A. “Buccal Fat Pad Augmentation for Facial Rejuvenation.”Plastic and Reconstructive Surgery. 2017 Jun.

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Where is my buccal fat? Could I benefit from reduction? (Photos)

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