Primarily popularized by social media over the past year, buccal fat pad removal is a surgical procedure to remove deep fat pads located between the cheekbone and jawbone. The surgery is quick, recovery is minimal, incisions are hidden inside the cheek, and the results can look very good – but this cosmetic trend comes at a troubling cost.

Despite the purported benefits, I choose not to do buccal fat pad removal surgery on the vast majority of patients who ask me about it because of the negative long-term implications. In this article, we’ll cover facial anatomy, procedural techniques, why buccal fat pad removal is usually not advisable, and the alternative treatments that I recommend for patients.

Buccal Fat Pad Anatomy

First described in 1732, the buccal fat pad is a deep facial structure that primarily serves as a gliding pad during the contraction of masticatory and mimetic muscles – the muscles you use to chew food or make facial expressions. Additionally, the fat pads provide cushioning for vital structures, protecting them from the impact of muscle contractions or external forces. It is worth noting that the volume of buccal fat pads can vary throughout an individual’s lifetime.

The buccal fat pad is anchored by six ligaments, connecting it to the maxilla, posterior zygoma, and the inner and outer edges of the infraorbital fissure, as well as the temporalis tendon or buccinator membrane. Within each lobe of the fat pad, there are several nutritional vessels, and they contribute to the formation of the subcapsular vascular plexus. Nearby important structures also include the parotid gland, which provides saliva to the mouth, and the buccal branch of the facial nerve, which innervates the outer nose and upper lip muscles. The buccal fat pad extends up into the temple, but only the cheek portion is removed surgically.

Buccal Fat Pad Removal Overview

Surgical removal of a buccal fat pad, known as buccal fat pad excision, is typically performed under local anesthesia, general anesthesia, or IV sedation. During the procedure, we make a small incision on the inside of the cheek near the second upper molar. Through this incision, we carefully separate the fat pad from surrounding tissues, ensuring the preservation of nearby nerves and blood vessels. Next, we gently grasp the buccal fat pad and remove it. Incisions are then sutured up with dissolvable stitches. The procedure is quick – less than one hour – and patients may experience mild swelling or bruising after their buccal fat surgery. To learn more about what the procedure entails, here is a good surgical resource video published by Dr. Rohrich and Dr. Jalalabadi in the Plastic and Reconstructive Surgery Journal that walks through procedural steps and best practices for safe and effective buccal fat pad removal.

When is Buccal Fat Removal Surgically Indicated?

Buccal fat removal can yield some impressive results, creating a more contoured face and sculpted submalar area – but only in a small subset of patients. In particular, patients who have fullness in the lower part of the cheek that protrudes when they speak or put their tongue to the roof of their mouth may benefit from buccal fat pad removal.

Why I Generally Don’t Recommend Buccal Fat Removal

For most patients, removing buccal fat is a bad idea. We naturally lose facial volume as we age, which is why it’s important to preserve natural fat stores when we’re young, rather than removing them. Without buccal fat, people in their 40s and 50s have sallow, sunken, and more mature-looking faces. And once the fat pads are gone, they can’t be replaced. We can try restoring some facial fullness through grafting down the road, but it may not look as natural.

Alternatives to Buccal Fat Removal That I Recommend

When patients ask me about buccal fat removal, here are some treatment options I recommend to slim the face and balance facial features instead:

Neuromodulation

Some patients have strong or overly developed masseters – the jaw muscles you use when you chew. Injecting botox into the masseters causes the muscle fibers to decrease in size, which slims the face and creates a natural depression between the cheekbone and jawbone. The results from masseter botox usually last 4-6 months, there is zero downtime, and it’s a much more affordable option than cosmetic surgery. Patients who grind their teeth or suffer from strain-induced headaches also typically benefit from masseter botox, citing symptom relief.

Dermal Fillers

Dermal fillers are cosmetic injectables used to add volume, contour, or enhance facial features. These fillers commonly contain materials such as hyaluronic acid, calcium hydroxylapatite, poly-L-lactic acid, or other materials that can be safely injected into the tissues of the face. Injecting filler along the cheekbone and jawline can help define the submalar region, mimicking the effects of buccal fat removal.

Malar Fat Grafting

Similar to cheekbone dermal fillers, malar fat pad augmentation through grafting can also achieve an appealing facial concavity. During a fat grafting procedure we take a small volume of fat from the thighs, flanks, or abdomen and inject it into the targeted areas.

Chin Augmentation

A strong, well-defined, and balanced jawline can dramatically change the face. Augmenting the chin with an implant or dermal filler lengthens and accentuates the jawline while providing more projection. While subtle, chin alterations can help sculpt, slim, and balance the face.

Submental Liposuction or CoolSculpting

Eliminating stubborn fat deposits under the chin helps strengthen the jawline.

Weight Loss

Shedding extra pounds through healthy weight loss techniques can also help sculpt the cheekbones. Everyone metabolizes energy and stores fat uniquely, but in general, the lower your body fat percentage is, the slimmer your face will look. This isn’t the case for everyone – some lean patients naturally hold more weight in their cheeks.

Book a Facial Balancing Consultation at Plastic Surgeons of Northern Arizona Today

Our award-winning, board-certified plastic surgeons provide surgical and non-surgical facial cosmetic treatments to help you feel your best. During your consultation, we’ll talk about your goals, anatomy, and most appropriate treatment options.