Buccal fat removal has been in the news a lot lately—it all started because the plastic surgery procedure has become super popular on TikTok, with the hashtag #buccalfatremoval garnering more than 125.5 million views. Buccal fat removal, once a lesser-known plastic surgery, has gained attention this year as more celebrities and social media users have candidly spoken about the removal, reduction, or repositioning of buccal fat. Some users have even begun speculating about whether celebrities with chiseled cheekbones have had the surgery (though, to be clear, we are not speculating about the star of our lede image—she simply possesses the type of bone structure often seen as the goal of this procedure).
To be clear, buccal fat—or any type of fat, for that matter—is normal and no one should ever feel pressured to remove it. No type of bone structure is superior to another, plain and simple. That said, if you are debating getting a procedure like this, it is vital to have an understanding of how it works, any potential risks and side effects, and what it can (and cannot) do. For more information, we spoke with three board-certified plastic surgeons to explain how buccal fat-removal surgery works and why people on TikTok, among other platforms, can’t stop talking about it.
What is “buccal fat,” anyway?
The word buccal (pronounced like “buckle”) is used to refer to the cheek area that flanks the mouth. While the upper cheek area, like the cheekbones, is a popular area to add volume to (very often with a hyaluronic acid-based dermal filler), this lower area of the cheek has become an increasingly common target for removing volume in an effort to create a more defined facial contour and slimming effect.
“The buccal fat pad is a deep pocket from temple to cheek that exerts a tremendous amount of impact on the shape of the face,” says Babak Azizzadeh, MD, a board-certified facial plastic surgeon in Beverly Hills, who explains that due to natural anatomy or the aging process, the buccal fat pad can make the lower part of the face seem wider.
“Buccal fat removal can help reduce full, rounded cheeks, leaving patients with a slightly more chiseled look,” says Andrew Jacono, MD, a board-certified facial plastic surgeon in New York City. However, it can’t be done with the type of procedure typically used for fat reduction. “The buccal fat cannot be accessed with simple liposuction because it exists under the facial muscles and nerves, which could be damaged.”
What happens during buccal fat surgery?
Buccal fat surgery is one of the faster and less invasive cosmetic surgeries. “It is a quick and simple procedure,” says Dr. Jacono. “The entire procedure takes approximately 30 minutes and can be done under twilight or local anesthesia.”
That said, it’s still surgery, which means it comes with risks, so it must be performed by the appropriate doctor in the appropriate setting. “A skilled plastic surgeon knows, in terms of safety, that there are ducts and nerves enmeshed with the buccal fat, so the surgeon has to be very cautious not to damage them,” Chicago-based board-certified plastic surgeon Michael Horn, MD, tells Allure. He adds that buccal fat removal, which is an outpatient procedure and doesn’t require an overnight stay at a hospital, can be performed in a licensed ambulatory setting or in a doctor’s in-office operating room.
An incision is made inside the mouth, so there are no visible scars. “Through this incision, the buccal space is entered,” says Dr Jacono. This allows access to the buccal fat pads, which he says look like a large walnut in each cheek. Although some plastic surgeons will remove the entire pad, Dr Jacono and Dr Azizzadeh prefer not to.
“For a natural face, it is important to reduce and contour the buccal fat rather than remove it totally,” Dr Jacono says, explaining that removing the entire pad may result in too much hollowing under the cheekbones and a “sucking in” look.
Dr Azizzadeh prefers repositioning buccal fat over removal. “Instead of removing it, my technique is to move it to other areas that have lost volume over time and suspend it into place, such as in the upper cheek and deep nasolabial fold,” he says. Because he is able to work through the same incision and keep the original blood supply and vascular system intact, he says, there is no need to process the fat as one would with the grafting and reinjection involved in a typical fat transfer procedure. “I’ve found this is an extremely effective way to perform the procedure on my patients who are looking for youth, slimming in the lower face, and volume in the mid and upper area.”
Regardless of whether the buccal fat is partially removed, completely removed, or repositioned, the incisions will be closed with sutures. “The sutures are typically absorbable,” Dr. Horn says. “However, each surgeon has their own technique.”
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What is recovery like and when will you see results?
Much like the procedure itself is relatively short, recovery from buccal fat surgery can be quite quick. “Many of my patients will only take three days off from work or do it on a Friday and go back to work Monday,” says Dr Jacono. Dr Azizzadeh and Dr Horn say you may experience a week or two of swelling, which can be addressed with ice packs. “There can be some mild bruising, but if it persists, I instruct my patients to tell friends and colleagues that they just had their wisdom teeth removed if they prefer to keep the procedure to themselves,” Dr Jacono adds.
During the first few days of recovery, Dr. Horn says you may be given an oral rinse to prevent infection. “You will likely need to stick to a liquid diet for the first few days and then progress to soft foods as the soreness dissipates,” he explains, noting that some surgeons may also prescribe oral antibiotics to minimise infection risk.
Although the initial swelling will conceal your results, you’ll start seeing a difference in a few weeks. “A final result should be visible in three months or less, as the swelling needs to fully subside,” Dr Jacono says.
Who is—and isn’t—the ideal candidate for this?
Because of how buzzy buccal fat removal has become, more and more people are asking their doctors for it. However, as with every cosmetic procedure, it’s not right for everyone.
“Sometimes, I have prospective patients in their twenties who ask for this procedure, even though they don’t have particularly round cheeks, because they’ve read that this can give them an even more sculpted look and higher cheekbones,” Dr Jacono says. “I tell them that it’s not a good idea as they might be very sorry in a decade or so when their facial fat naturally starts to lessen,” causing a prematurely older look.
Instead, the ideal candidate is someone who has a “natural excessive fullness,” Dr. Horn says, or someone who, due to the buccal fat pad dropping down with age, is seeing its impact on facial shape and jowls. He adds that it’s unlikely for a plastic surgeon to agree to remove buccal fat from someone whose face already looks somewhat hollow because it could ultimately make them look more “caved in” as they age.
Dr Azizzadeh says it all boils down to the surgeon’s analysis of the patient’s facial anatomy, and he finds that there are a lot of people who are not great candidates. “Not everyone has the fat pad in the wrong place—most have it in the right place in their face,” he says. “Taking it out when it’s correctly located is not good.”
Are there any risks with buccal fat surgery?
As previously mentioned, removing buccal fat when someone is not an appropriate candidate “can produce an unnatural, skeletal effect,” Dr Jacono says. This excessive hollowness can be apparent after swelling subsides or years down the line if the patient undergoes the surgery at a younger age. Dr Horn notes that significant weight loss after buccal fat surgery may lead to a more gaunt look, too.
“Buccal fat removal is a permanent procedure, and you want to make sure that your surgeon removes only the necessary amount of excess buccal fat to give you the more sculpted and slimming contour you want,” Dr Jacono explains. In the event that you feel too much fat has been removed, your best option is fat grafting, he says, in which fat cells from another part of your body would be injected back into your buccal cheek area.
In addition to finding a surgeon who understands how much—if any—buccal fat to remove, it’s just as important to find someone who understands the anatomy of the area. Dr Azizzadeh says there are three key elements surgeons need to pay attention to in order to get the best results and safest outcome.
“Taking it out on both sides means it has to be even, so hopefully the surgeon gets it done right the first time,” he says. Secondly, the surgeon needs to understand how the buccal fat pad is associated with the facial nerve and must be meticulous to avoid causing damage. And finally, he says, “The fat pad is associated with the duct-tubing that allows passage of salivary glands to come into the mouth. If someone is not experienced, they can damage that.”
How much does buccal fat removal surgery cost?
According to the plastic surgeons we spoke to, buccal fat surgery costs between US $5,000 and US $20,000 depending on the doctor, the type of anesthesia used, and the city in which you have the procedure done.
This story originally appeared in Allure.