Buccal Fat Pad Removal
The popularity of a sculpted, model-like facial appearance has led to increased interest in buccal fat removal, also known as bichectomy or buccal lipectomy, which reduces volume in the mid-to-lower cheeks. For the right candidate, removing these fat pads subtly enhances the cheekbones for a more contoured and chiseled facial appearance.
You should only undergo this procedure if you have a substantial amount of fat in the cheek area, so research ahead of time and look for a skilled and experienced board-certified facial cosmetic surgeon to help you learn if you are a good candidate.
What are buccal fat pads?
Buccal fat pads are small pads of fat, each about the size of an egg yolk or walnut, located in the lower portion of the cheeks between the cheekbone and jawbone.
How is buccal fat removal performed?
The buccal fat removal procedure is typically performed under local anesthesia with sedation so that you are awake but comfortably relaxed during surgery. It can also be performed under general anesthesia for patients who prefer it or for those who are having more extensive combination surgery.
During this cheek reduction surgery, your surgeon creates intraoral incisions (inside the mouth) to access the buccal fat pads. This incision is placed inside of the cheek, near the back of the mouth. Your surgeon extracts the buccal fat pads from this incision, carefully removing the right amount of fatty tissue to achieve a natural result without causing a gaunt or aged appearance. There are two techniques your surgeon may use to remove the fat pad:
- Direct excision, in which the fat pad is manually loosened and removed
- Liposuction, in which a small cannula is used to suction out fat
One or both of these techniques may be used during surgery to re-contour the cheeks and help you meet your goals. Buccal fat removal surgery typically takes less than an hour to complete.
Good candidates for buccal fat removal
You should be in good health and a non-smoker with a stable body weight before proceeding with surgery. This procedure is usually best suited for those who have plenty of fullness in the lower cheeks, or “chipmunk cheeks.”
You should be motivated to see more definition in your cheekbones and jawline, but you must also understand that results from this surgery can be subtle. It is key to have realistic expectations about the procedure’s results.
Note that this procedure might not be suitable for individuals with a naturally thin face, as removal of buccal fat could potentially lead to a gaunt or overly aged appearance due to natural volume loss that occurs over time.
Combined procedures
While buccal fat pad removal results may be subtle on their own, this surgery can be combined with further facial contouring procedures to help achieve your goals if you desire greater transformation in your features. Procedures commonly paired with buccal fat removal include:
- Neck/chin liposuction
- Submentoplasty
- Chin augmentation
- Rhinoplasty
- Cheek augmentation
- Jaw enhancement with dermal filler
These procedures may further enhance the cheeks or jawline or provide balance and symmetry to facial features, enhancing your results.
- Key Benefits
- Terms to Know
Creates a more sculpted facial appearance for the right patient
Can be performed under local and sedation anesthesia for quick recovery
No visible scars, as incisions are placed inside the mouth
Buccal: Pertaining to the cheek or the mouth.
Buccal Fat Pad: A pad of fat naturally located in the middle of the cheek, beneath the cheekbones. It can contribute to fullness in the lower part of the face.
Intraoral Incision: A surgical cut made inside the mouth. In the context of buccal fat removal, these incisions are typically made inside the cheek, which allows for no visible scarring.
Local Anesthesia: A type of anesthesia that numbs a small area of the body. In buccal fat removal, it may be used to numb the area of the cheeks where the procedure will be performed.
Sedation: The administration of a sedative drug to reduce irritability or excitement. In some cases of buccal fat removal, patients may opt for sedation in addition to local anesthesia.
Outpatient Procedure: A type of procedure in which patients can return home on the same day after surgery.
Facial Asymmetry: Unequal or unbalanced proportions of the face.
Facial Contouring: A set of cosmetic procedures aimed at enhancing the shape and structure of the face. Buccal fat removal is a type of facial contouring procedure.
Facial Rejuvenation: A term referring to cosmetic procedures that aim to restore a youthful appearance to the face.
Facial Aging: The changes that occur in the face over time, such as loss of skin elasticity and facial fat, which can lead to wrinkles, lines, and changes in the shape and contour of the face.
Subcutaneous: Situated or applied under the skin.
Sutures: Stitches used by surgeons to hold together the edges of a wound. In the case of buccal fat removal, these are placed inside the mouth following the procedure.
What to expect during your consultation
During your consultation, your facial cosmetic surgeon will assess your facial anatomy, skin elasticity, and personal aesthetic goals to determine if you may benefit from buccal fat removal. They will also review your medical history and make sure that you are in good health before recommending surgery.
You will have the opportunity to ask questions about the procedure, recovery, potential complications, and expected results. You should also ask to see before and after photos of the surgeon’s previous patients, looking at patients who resemble you in the “before” photos to get a glimpse of the results you could expect from this surgeon. Ask the surgeon how many buccal fat pad removal surgeries they have performed to ascertain whether they have sufficient expertise and experience with this specialized procedure.
Recovery and results
Following the procedure, patients typically return home the same day. Initial recovery usually lasts a few days, during which time patients may experience some swelling and discomfort in the treated area. Most people can return to work and light activities within a week. You may need to eat a liquid-only diet at first to avoid straining or damaging your intraoral incisions, and you may need to avoid eating any sharp or hard foods for a period of time after that, as well. It may take several weeks for the swelling to fully subside and for final results to become visible.
It’s important to note that while the procedure can dramatically change the contours of your face, it does not prevent the natural aging process or changes in facial fat distribution that may occur with significant weight loss or gain.
Risks and complications
As with all surgeries, buccal fat removal comes with potential risks. These may include infection, bleeding, asymmetry, unfavorable scarring, and changes in sensation. More rare complications can include facial nerve damage or an unnatural, hollow look if too much fat is removed. These risks can be minimized by choosing a board-certified facial cosmetic surgeon with experience in performing this procedure.
Frequently Asked Questions
Are the results of buccal fat removal permanent?
Yes, the results of buccal fat removal are generally permanent. This is because the removed buccal fat pads do not grow back. However, any remaining fat cells may still grow if you gain weight, so changes in weight and other factors like aging can still affect the overall shape and fullness of the face.
What kind of anesthesia is used during buccal fat removal surgery?
Buccal fat removal is usually performed under local anesthesia, meaning the patient is awake but the area being operated on is numbed. Sedation can also be used for patients who prefer to be more relaxed through the procedure. The choice will depend on your comfort level and your surgeon’s recommendation.
How should I prepare for buccal fat removal surgery?
Preparation may include avoiding certain medications and substances that could increase bleeding, like aspirin, NSAIDs, and alcohol. Smoking should also be avoided, as it can hinder the healing process. A short period of fasting may also be necessary before the procedure.
Are there non-surgical alternatives to buccal fat removal?
Currently, there are no non-surgical alternatives that provide the same results as buccal fat removal. Weight loss can help reduce overall facial fat, but it doesn’t specifically target the buccal fat pads. It is important to work with a skilled facial cosmetic surgeon with experience in a breadth of facial procedures to learn about any alternatives that may help you meet your goals.
How does buccal fat removal affect facial aging in the long term?
Buccal fat removal may accelerate the appearance of aging in some individuals. The face naturally loses fat with age, and removing additional fat can contribute to a more aged appearance over time. Each individual will age differently, and the effects will vary from person to person.
Can the buccal fat pad grow back after removal?
Once removed, buccal fat pads do not grow back. However, overall facial fullness can still be influenced by factors such as weight gain.
Can buccal fat removal change my smile or facial expressions?
Buccal fat removal should not impact your smile or facial expressions. The buccal fat pad is not directly involved in facial movements or expressions. However, significant swelling post-surgery can temporarily affect the appearance of your smile.
What criteria do surgeons use to determine how much fat to remove?
Surgeons use various criteria to determine the amount of fat to remove, including the size of the fat pad, the patient’s other facial features, and their aesthetic goals. Making this choice based on such complex factors requires refined aesthetic and medical judgment. The aim is to create a natural, balanced look that enhances the patient’s features for years to come.
Is there a chance of nerve damage during buccal fat removal surgery?
While rare, there is a small risk of facial nerve damage during buccal fat removal, which could result in facial weakness or asymmetry. However, the procedure is typically safe when performed by a qualified, board-certified facial cosmetic surgeon with a detailed understanding of facial anatomical layers.
What is the cost of buccal fat removal, and is it covered by insurance?
The cost of buccal fat removal can vary widely based on surgeon’s fees, geographic location, and other factors. Since it’s considered a cosmetic procedure, it is not typically covered by insurance. You will have the chance to discuss cost and payment options, such as financing, with your surgeon during the initial consultation.
What are the qualifications I should look for in a buccal fat removal surgeon?
Your surgeon should be board-certified in cosmetic surgery or plastic surgery and should have extensive experience in facial cosmetic surgery. They should also be able to provide before-and-after photos of previous buccal fat removals and have positive reviews from past patients.
Surgeons who are certified by the American Board of Facial Cosmetic Surgery (ABFCS) have undergone a rigorous vetting process and passed comprehensive exams on modern facial aesthetic procedures and treatments. Learn more about how to choose a surgeon »
How long does the procedure take, and can I go home the same day?
Buccal fat removal typically takes one hour or less, and it is an outpatient procedure, meaning you can go home the same day. However, you will need someone to drive you home and potentially stay with you as you recover from the anesthesia.
How will my diet and eating habits be affected immediately after the surgery?
Immediately after the surgery, your diet may be limited to soft foods and liquids to avoid straining the surgical site. Most patients will want to avoid sharp or hard foods for a period of time, as well.
How often will I need to schedule follow-up appointments after the surgery?
Follow-up appointments can vary based on the individual and the surgeon, but typically, the first post-operative visit is within one week of surgery, with additional visits scheduled over the following weeks to months as needed to monitor your healing process and assess results.
How will buccal fat removal affect my facial contours in profile view?
Buccal fat removal can give the face a more sculpted, defined appearance in the profile view. By reducing fullness in the lower cheeks, it can highlight the cheekbones and create a more angular facial structure.
References
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Grillo R, de la Puente Dongo JL, de Moura Moreira L, Dos Santos Queiroz AG, Teixeira RG. Effectiveness of bandage in the incidence of major complications on bichectomy: literature review and case series of 643 bichectomies. Oral and Maxillofacial Surgery. 2022 Sep;26(3):511-517. doi: 10.1007/s10006-021-01008-z.
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Board-certified facial cosmetic surgeons certified by The American Board of Facial Cosmetic Surgery have rigorous training and are vetted to maintain the highest standards in patient care, including operating only in accredited surgical facilities. They also dedicate all or a significant portion of their practice to aesthetic procedures of the head, fact, and neck—so you know you are in the hands of a specialist.