Everything To Know About Cheek Reduction Surgery — AKA Buccal Fat Removal

Buccal fat removal (or “buccal fat pad excision”) is a cheek contouring plastic surgery that has grown increasingly buzzy in recent years, leading to a boom in questions about cost, risks, and before and after photos. While the surgery has been around for decades, Google searches for “buccal fat removal” more than doubled between January 2019 and September 2021, stirred mostly by social media. “[It’s] been one of these little secret procedures that gives you a modelesque, chiseled face,” says New York City plastic surgeon Dr. Lara Devgan, MD, who is particularly well-known for posting videos of the procedure to her 650,000 followers.

The relatively simple surgery removes fat from the middle of the cheeks, below the cheekbone, via an incision inside the mouth. The ensuing “sucked-in” look emphasizes the cheekbone and jawline (think: permanent Zoolander face). While not for the squeamish, videos of the excision are highly watchable as the fat typically pops out in satisfying little lumps.

In September 2021, Chrissy Teigen stirred up further interest when she shared she had undergone the procedure on her Instagram. “I did that Dr. Diamond buccal fat removal thing here,” she said, referring to Beverly Hills plastic surgeon Dr. Jason Diamond, MD, whose celeb patients include January Jones, Kourtney Kardashian, and Amber Valletta.

But many doctors are concerned that interest in the procedure is predominantly among younger patients who have yet to see the natural facial hollowing that occurs with age. In fact, the journal Plastic and Reconstructive Surgery published a study in August 2021 to warn overzealous doctors. “Maybe it looks good in your 20s, but when you get to be 40 and 50, you might look older than the person that didn’t do that procedure,” says Bethesda, Maryland plastic surgeon Dr. Jennifer Porter, MD, who has seen a noticeable uptick in people asking for the procedure by name.

To learn more about the pros and cons, appropriate candidates, and the logistics of buccal fat pad excision, read on.

Who Should Consider Buccal Fat Removal?

Like with every cosmetic surgery, not all people are eligible for buccal fat removal. A suitable patient is someone with a full, roundish face who is already close to their stable weight. “It didn't matter how much weight I'd lose, my cheeks were always puffy,” says Linda*, 31, a patient of Dr. Devgan’s who had been thinking about the procedure since she was a teenager. “I spent a lot of money on facial treatments, massages, beauty tools, and products, which offered temporary results. I figured a permanent solution would be better financially, but also for my own peace of mind.”

That said, only an experienced facial plastic surgeon can really tell you if it’s the right fit. “More than 50%, even 80%, of people who ask for it are not good candidates,” says Dr. Diamond. (All doctors TZR interviewed said at least 50% of people should not get the procedure.)

“Somebody who [is not a good candidate] has an overly thin face or has more than one centimeter of pinchable laxity when they're not doing the procedure along with a larger surgery like a facelift,” says Dr. Devgan. Instead, surgeons might suggest alternatives such as filler or an implant in the cheeks or jawline, thread lifts, liposuction under the chin, a facelift — or nothing at all.

How Should You Pick A Doctor?

If you’re considering a buccal fat removal procedure, be sure to look for an experienced board-certified plastic surgeon who makes you feel comfortable and shows before and after images so you know that you share aesthetic goals. During a consultation, your doctor will get a detailed medical history and exam, do a facial analysis, ​​and discuss the procedure, risks, benefits, alternatives, indications, and costs. If you are a good candidate, you’ll schedule the outpatient appointment. (Never feel pressured to book a procedure.)

And don’t be afraid to change your mind. Stevie, a 34-year-old patient in Los Angeles, booked surgery in early 2020, which ultimately had to be postponed. When he went back a year later, he felt differently about the doctor and chose to forgo his deposit and look for a new surgeon. “I found Dr. Sagar Patel who had so many buccal fat before and afters and the consultation was much better, so I felt really confident,” he says. “He also ended up being less expensive.”

Why Do Some Doctors Think Buccal Fat Removal Is A Bad Idea?

Seeing the words “trend” and “plastic surgery” together is usually a red flag, but this procedure is by no means new — it’s been around for close to 60 years. Plus, unlike the “ski slope” nose job of yesteryear, a contoured face has remained a desired aesthetic for generations. Beverly Hills plastic surgeon Dr. Babak Azizzadeh, MD believes surgeons and patients just became more interested in buccal fat in the last decade as injectables brought more awareness to facial contouring.

“Younger doctors are super excited because it’s a fun thing to do and you can see the difference right away,” says Dr. Porter. But a review published in the journal Plastic Reconstructive Surgery in October 2018 noted that there has been no long-term research assessing how buccal fat removal surgeries age with time.

Dr. Azizzadeh aims for a middle ground by removing only a conservative amount from the buccal pad and immediately relocating (or rotating) some of the fat into the apple of the cheek without cutting the blood supply. This increases overall contour with less fat loss. He does this without removing and processing the fat, which is the process for fat grafting—it all happens at once through the same oral incision.

Because the fat still has its blood supply and vascular system, Dr. Azizzadeh finds the fat more likely to “take” under the skin. (With traditional fat grafting the fat is cleaned, processed, and injected to create permanent “living” filler.) Other doctors also often add volume to the apples of the cheeks with a hyaluronic acid-based filler or fat grafting in conjunction with buccal fat removal to enhance the results. “Volume needs to be in the right place,” says Dr. Azizzadeh. “That’s the art of the procedure.”

What Actually Happens During Buccal Fat Removal?

“The procedure can be done under local anesthesia — it’s about the same intensity as getting a cavity filled,” says Dr. Diamond. Many doctors also offer Valium to nervous patients; Stevie opted to take it. “You get the initial shot and once you’re numb you don’t feel anything except pushing and pulling.” The surgery itself can be completed in about 15 minutes.

The pushing and pulling is the incision being made at or an inch away from the upper gum line a little further back than your canine teeth (the cut is only a few centimeters or less) and the fat being cut out with a scalpel. The buccal fat pad extends from the temple down to the corner of the mouth — this surgery focuses on the “baby cheeks” area. The fat gets “teased out,” as Dr. Porter puts it, and then dissolvable sutures are used to sew up the gum line incision. “I’d say the worst part of it, and it wasn’t even bad, was the tugging at the very end to make sure everything was out,” says Stevie. Some people actually photograph the lumps after they’ve been removed—they’re a golden yellow (the color of fat) and range from the size of a small walnut to as large as half a golf ball.

How Is The Recovery From Surgery?

Swelling is noticeable for three days after the procedure, but icing the area can help to reduce swelling. Plan to eat mushy foods, avoid chewy things like gum or steak, and rinse your mouth with a disinfecting mouth wash multiple times a day. For the first week, you’ll also sleep with your head elevated, avoid bending over, and reduce salt intake to help the swelling go down faster. The sutures will slowly dissolve in 5-7 days.

“I definitely noticed [the sutures] but I only felt them when I moved my tongue to the side of my mouth,” says Stevie of the recovery process. “I didn't really notice them dissolving but the tissue stayed hardened throughout the healing process. I still can feel the slightly hardened areas.”

As for the big reveal? “I could see results even when I was still a bit swollen,” says Linda, whose before and after photos were posted here (Stevie said the same). “I like that my face doesn't look as wide as it used to, particularly when I smile or I get my picture taken.” You’ll need to give it about six weeks for the swelling to fully subside to see the final result.

What Are The Risks Of Buccal Fat Removal?

Dr. Azizzadeh warns that an inexperienced surgeon could damage the duct that allows salivary glands to come into the mouth, or the facial nerves that help us smile. Aesthetically, the final effect could be so subtle that it's a letdown or, worse, too extreme if it turns out someone was not the right candidate.

“I recently had a 25-year-old who had buccal fat reduction with another doctor and now she’s complaining about jowling — she essentially needs a facelift,” says Dr. Diamond, who is seeing more botched buccal fat excisions in his practice. “Because the fat comes from a deep place in the skin, this is not an area you can refill [with filler or fat grafting].”

How Much Does Buccal Fat Removal Cost?

According to RealSelf, the average cost is $2,475. But the cost can vary greatly by the location of the doctor’s office, their pedigree, operating room fees, and the specifics of your own procedure. With a well-renowned doctor in New York City, for example, the price can be $10,000 or more. As with any plastic surgery, cost should be just one of many factors to consider before undergoing the elective procedure.

*not the patient’s real name