Is Buccal Fat Removal a Good Idea?
Buccal fat. It’s not a term—nor an anatomical designation—that anyone gave much thought to a few years ago. And now, well, it’s on everyone’s lips…. And coming out of everyone’s cheeks. Or so it would seem.
Buccal fat removal has become the social media-trending cosmetic surgery du jour, ever since it was rumored—or, in the case of Chrissy Teigen, confirmed—that certain celebrities had undergone the procedure in order to obtain especially photogenic sculpted cheekbones. Previously, buccal fat removal was reserved only for the rare patient with extremely full cheeks who was looking for a slight reduction, or occasionally for an older patient undergoing a facelift whose facial fat had become somewhat displaced with age. Now, post-procedure TikTok and Instagram shares of before-and-after results have driven demand for the procedure to unimaginable levels.
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Buccal fat, for the uninitiated, is a layer of fatty tissue located in the mid-cheek. It acts as a cushion between the muscles we use when chewing, allowing them to seamlessly glide over one another. Removing this fat is relatively simple: A surgeon makes small incisions in the cheeks near the upper molars, teases out a small amount of fat, and stitches up the entry point with a couple of stitches. It can be done under general or local anesthesia, according to preference, and results in only minor bruising and swelling that typically resolves in about a week.
It's easy, and it’s also easy to see why it’s desirable: When buccal fat is removed, its absence hollows out the area just below the cheekbone, so that the bone itself appears more pronounced. But it may not be as dramatic as TikTok leads you to believe. “In certain faces it can give a little more delineation, but the changes are usually small,” says New York plastic surgeon Melissa Doft, MD. “You are not going to see the crazy changes that some people talk about on Instagram. It’s very subtle.”
For those who naturally have very round cheeks, Doft says, buccal fat removal can provide a desirable slimming and shaping effect. But there is a major caveat, and hence why buccal fat isn’t for everyone: “In order for someone to be a candidate,” she says, “I think you need to have a really full face and come from a family of really full faces. You need to know where your genetics are going.” This is because facial fat loss is an inevitable part of aging, and the older we get, the more fat we are probably going to want—which is why fat-grafting and fillers often come in to play as people seek to recapture the plump cheeks and soft contours of their youth.
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“Fat is truly one of the secrets to looking younger,” says New York plastic surgeon Adam Kolker. “The biggest paradigm shift in our understanding of facial aging over the past several decades has been that we lose facial soft tissue volume as we get older. While it is felt that buccal fat probably remains relatively stable over an individual’s lifetime, it is clear that facial fat surrounding this region atrophies over time. Removal of buccal fat might produce a more defined, chiseled look in youth, but may lead to a more gaunt, hollow and drawn look with the passage of time.”
Moreover, there are still a lot of question marks about the various ways this might manifest. “Because this is a new fad, we don’t really know how people who have had this are going to age,” says Doft. “The population being treated now is drastically different from the population that was being treated before, so we just don’t have the long-term data.” Also something to remember: Unlike a Brazilian Butt Lift, once it’s done, it’s done. Should someone have buccal fat removal remorse and want their cheeks back, Doft says, “that’s going to be really hard to reconstruct, if you can reconstruct it at all.” For those who have had a happy result with buccal fat removal but who begin to see unwanted age-related hollowing, she says, “the likelihood is that we are going to be fat grafting into a lot of cheeks in the future.”
Kolker concurs. “Buccal fat pad removal tends to be most commonly desired by women in their 20s and 30s,” he says. “This is a time when facial soft tissue tends to be more abundant. Someone who has had buccal fat pad removal will quite possibly need some form of facial volume restoration in the future. With soft tissue atrophy over time, injectable fillers, or autologous fat grafting (using one’s own fat harvested from elsewhere on the body) may be beneficial.”
For those who are truly good candidates for buccal fat removal, the results can be beautiful. But the main thing to remember when considering the procedure is that your face will change over time, and it’s important to weigh the aesthetic result you want now with what you are hoping to see down the road. “This is not an operation for everyone,” Doft says. “It’s very specific.”
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