Buccal Fat Removal
Buccal fat removal means extracting the buccal fat pad, a package of fat sitting between the chewing muscles where it acts as a cushion. It is a straightforward operation with quick recovery, but one thing should be said up front: it has become far more popular than its real indication justifies, and it is one of the few facial procedures whose result can worsen over the years rather than hold.
When is it recommended?
- A rounded midface due to a large buccal fat pad, in patients with good cheekbone support.
- Pseudo-herniation of the pad towards the cheek, which can appear with age or after a facelift.
- Repeated biting of the cheek lining due to prominence of the pad.
My approach
This is one of the few procedures where I frequently recommend not operating. The reason lies in the biology of the buccal fat pad itself: it is constitutional fat, independent of body weight and determined by genetics, and it follows a natural cycle — it grows during development, peaks between ages 10 and 20, and from then on slowly decreases throughout adult life. That means that in a young patient part of that roundness will disappear on its own. Removing it at twenty can give an attractive short-term result and a prematurely gaunt face at forty, when the surgical loss adds to the one that comes with age. And it is irreversible surgery: the fat removed does not come back.
A round face does not always mean buccal fat
Before considering surgery it is essential to identify where the roundness actually comes from, because there are several causes and only one is solved by buccal fat removal. It may be generalised subcutaneous fat, which responds better to changes in body weight. It may come from hypertrophied masseter muscles, common in people who clench their teeth, where the treatment is entirely different. It may be due to a lack of cheekbone projection making the cheek look full by contrast, in which case removing fat worsens the problem rather than solving it — what is needed is volume above, not subtraction below. Or it may indeed be a prominent buccal fat pad. Only in this last case does surgery make sense.
Recovery
It is one of the most manageable facial operations. The incision is made inside the mouth, with no visible scar, and it is usually performed under local anaesthesia. Swelling peaks at 48 hours and most patients resume normal activity within 3 or 4 days, with a soft diet and mouth rinses during the first week. It is worth bearing in mind that the definitive result is not visible until 2 or 3 months have passed: until then swelling can give a misleading impression, in one direction or the other.
Frequently Asked Questions
At what age is buccal fat removal advisable?
I am in favour of waiting. The buccal fat pad reaches its maximum volume between ages 10 and 20 and then decreases naturally, so operating very young anticipates a change that was going to happen anyway. In patients under 25 I usually recommend waiting and reassessing, unless the volume is genuinely disproportionate. From 30 onwards, when facial anatomy has stabilised, the decision can be made with far more confidence about how the result will age.
Can buccal fat removal be reversed?
Not directly: the buccal fat pad that is removed does not regenerate. If over the years the face ends up too hollow, the only option is to restore volume with the patient’s own fat or with filler, which improves appearance but does not reproduce the original anatomy exactly. It is precisely because of this irreversibility that the indication deserves particular caution, rather than being driven by the procedure’s popularity.