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Given the popularity of cheek implants and filler, the thought of removing fat from your cheeks for aesthetic purposes might be perplexing. But buccal fat removal, another common procedure, promises more sculpted cheeks resulting from a strategic fat excision.
While buccal fat removal has been around for years, it's gained more attention recently. Google trends reveal that searches for "buccal fat removal" on the search engine spiked during the last month compared to the past five years. Anecdotally, Babak Azizzadeh, M.D., F.A.C.S., a double board-certified plastic surgeon at Center for Advanced Facial Plastic Surgery, says he's noticed an uptick in patients asking about the procedure in his practice, attributing the new interest to an increase in celebrities and influencers sharing that they'd had the procedure on social media.
Of course, you should never just follow the crowd when it comes to something as important as a cosmetic procedure (or anything else for that matter), and buccal fat removal is no exception. If you're considering it for yourself — or are just curious what the fuss is all about — here's the deal.
What is buccal fat?
The word "buccal" just means anything referring to the cheek area, and so buccal fat is — you guessed it — fat located within your cheek. "The buccal fat pad is a super deep, very lean fat structure that actually starts up in the temple area and goes all the way — in most people — to the corner of the mouth area," says Dr. Azizzadeh.
So, what is buccal fat removal?
Put simply, buccal fat removal is a surgical procedure that permanently reduces the aforementioned fat. With age, the buccal fat pad in your cheek "doesn't atrophy like the other fat pockets that we have in our face, but it tends to drip down moving down closer to the jowl space and the jawline," says Dr. Azizzadeh. (Related: Can You Do Anything to Define Your Jawline?)
"As a result, if this buccal fat is in the wrong place, it makes your face less chiseled and more rounded," says Dr. Azizzadeh. Additionally, it's possible to simply have a certain amount of buccal fat that your cheeks are on the rounder side from a young age thanks to genetics. And so some people turn to buccal fat removal in hopes of achieving a more sculpted face.
With that in mind, there are typically two groups of individuals who are candidates for the procedure, says Dr. Azizzadeh. One would be someone in their 40s or 50s who may feel their jawline or lower cheek area appears wider or heavier or is drooping. The other is someone in their twenties and 30s who just has an interest in slimming a round face shape is too round, he says.
What can you expect from a buccal fat removal procedure?
The surgical procedure takes about 30 minutes, and can be performed under local or — if you're rather anxious and prefer it — general anesthesia, says David Shafer, M.D., F.A.C.S., a double board-certified plastic surgeon at Shafer Clinic. In the operating room an incision is made "about one centimeter in length inside of your mouth, right by your back molar teeth," says Dr. Shafer. Then, the buccal fat is removed — "it's about the size of a small grape," he adds. The doctor closes up each incision with dissolvable stitches, which means you don't have to return to have the stitches removed.
The recovery process lasts a few days. "Post-operatively, the first three days, you get a sort of 'chipmunk look,' as if you'd gotten your wisdom teeth removed — a lot of swelling around the area where you removed the fat pad," says Dr. Azizzadeh. "After that, it really quickly settles down, and the swelling goes away. For most people, in four, five, or six days, their swelling is gone, they look pretty good to go out and do their normal stuff." It's not until several weeks later, though, that you'll be able to see your final results since residual swelling can linger, he says. (Related: How Getting Kybella Transformed My Double Chin *and* My Perspective)
Does buccal fat removal make you age faster?
Buccal fat removal isn't without controversy. There's an ongoing debate in the aesthetic beauty community about whether the procedure is being performed too frequently and overzealously, leaving people with results that they eventually regret. Skeptics argue that removing that small piece of fat may contribute to a greater degree of facial sagging with age since buccal fat does helps fill out areas of the face that can begin to look sunken with age.
The key to assuring satisfactory results is finding a surgeon who's perfected their technique and goes in with a light hand, according to Dr. Shafer. "In the past, buccal fat removal got a bad name since surgeons were taking out all of the fat and making people look very hollow, which can actually make you look older," he explains. "What you want to do is take out about half of the fat and leave some of it there, so you have more of a softer, natural curve than a depression or a hollowness. Conservatively taking out the buccal fat gives you better long-term results and a more natural appearance."
Some people report that buccal fat seems to "reappear" years after their procedure and that their temple area has become more hollow-looking, says Dr. Azizzadeh. The likely culprit is that the buccal fat pad is not held in place by tissue, and so when you remove a portion, the upper part of the fat pad that wasn't removed will still travel downward with age, he says.
As a solution, Dr. Azizzadeh came up with a technique for repositioning the buccal fat higher rather than taking it out. "We're taking fat and putting it in an area that people typically want volume, and it's suspending and supporting the fat pocket so it doesn't move back down," he says. (Related: The 2021 Shape Beauty Awards: Derm Favorites)
Are there other possible downsides to buccal fat removal?
It's possible to end up with cheek asymmetry if your surgeon mistakenly takes out more fat on one side than the other, says Dr. Azizzadeh. They could also take out too much (creating a sunken-in look) or not enough (minimizing the effect) from both sides, he says.
On a more serious note, the procedure can lead to health complications if your surgeon doesn't have an adequate understanding of facial anatomy. They can potentially damage the facial nerve (the nerve that allows you to smile) or the parotid duct (a duct that allows saliva to enter your mouth), according to Dr. Azizzadeh. "Those things don't happen often, but in inexperienced hands, they can," he says.
It goes without saying that you want to take care in choosing a surgeon if you're interested in buccal fat pad removal. "It's really important that patients go to — especially for this procedure — a board-certified plastic surgeon or ENT doctor who specializes in cosmetic procedures," says Dr. Shafer. "You don't want to go to a med-spa or a run-of-the-mill doctor for this. This is a specialized procedure." It's worth the effort of looking into their credentials rather than choosing based on a buccal fat removal before and after Instagram post alone, he says.
What else should you know about buccal fat removal?
If you're wondering about what you can expect when it comes to buccal fat removal cost, the answer is that it varies — a lot. "It's really going to range," says Dr. Shafer. I would say [the cost] could be anywhere between $4,000 or $10,000." (Related: How to Decide Exactly Where to Get Fillers and Botox)
And, again, as a reminder: The procedure is permanent! Meaning, you want to be 100 percent sure of your decision before opting for buccal fat removal. That said, there are some options in the case that you end up disliking your results. "In the past, if [a surgeon] took out too much buccal fat, you were kind of screwed because there was no remedy for it," says Dr. Shafer. "Now, let's say somebody did decide, 'oh, I like the full aesthetic,' we have dermal fillers like Voluma, or other treatments, or fat grafting that you can do to put some of that volume back if needed."
The main takeaway here? Buccal fat removal might be in favor at the moment on social media, and sure, it's relatively quick and easy vs. other permanent facial surgeries, but you still want to do your homework before you go removing parts of your cheek, OK?