Everything to Know About Buccal Fat Removal

If you've noticed a dramatic increase in the number of celebrities and influencers who suddenly develop sky-high cheekbones that narrow into a jawline so sharp it could carve a turkey, you're not alone. And if you've scrolled through their Instagram comments full of compliments and questions about their new look only to see lots of "it's just contour :)" but are thinking it looks a little more permanent than makeup, you're definitely not alone. A quick search of "celebrity cheek surgery" reveals a slew of alleged before-and-afters, but what exactly—if anything—did they have done?

A cosmetic surgery procedure called buccal fat removal is one of the most-requested facial cosmetic procedures to emerge over the past few years, inspired in large part by celebrities rumored to have undergone the surgery themselves. The conceit is simple: By removing the pads of fat in your mid-cheek area (called buccal fat pads), you can reveal a slimmer and more contoured face. Think: Bella Hadid, whose picture often pops up as inspiration for the look. The results vary, but they almost always come with defined cheek hollows that almost look the way they would if you were puckering your lips or blowing a whistle. As with any cosmetic surgery, there are significant pros and cons to the procedure.

We took a closer look into this permanent solution to a snatched face, often requested by young people, to see what exactly it entails, why it's suddenly so popular, and what it will look like years into the future.

The Procedure

Cosmetic surgery, not unlike fashion, is constantly seeing updates and developments. They could be improvements on "classic" surgeries like new breast implant material; they could be breakthroughs on procedures doctors have been trying to nail for decades, or they could be newer procedures developed to reflect changing beauty standards. Buccal fat removal has been around for decades but, in the past, it's typically performed in conjunction with other procedures. Only recently has it come into vogue as a solo surgery, which many doctors attribute to constant exposure to "perfect" people on Instagram and selfie culture.

"The size of the buccal fat pad varies from person to person and one cheek’s pad may be larger than the other," explains board-certified plastic surgeon Dr. Michael Horn. So the procedure itself varies somewhat from patient to patient. That being said, buccal fat removal procedures all have the same objective: "To slim the cheeks and surgically target the area of the cheek hollows," says Horn.

Before

The American Society of Plastic Surgeons recommends avoiding anti-inflammatory drugs like Aspirin or herbal supplements in preparation for buccal fat removal, as they can increase bleeding. Dr. Horn also advises patients to stop smoking.

Depending on the setting in which the procedure is performed, and whether it's under general anesthesia, you'll also need to plan your transportation ahead of time.

During

The procedure itself is straightforward. Most candidates feel they have an excess of fat in their face, or an especially round or babylike face, and want more definition. As Horn explains, "buccal fat removal can be performed in a licensed ambulatory setting, or in a doctor’s in-office operating room. It can be performed under IV sedation or general anesthesia."

Patients do not have to remain overnight, as it is an outpatient procedure (though it is recommended "that patients have someone to remain with them at home the first night following surgery," Horn says).

Here's how it works. "The procedure entails an incision inside the mouth on the inner area of the cheek," says Horn. "Once the fat is removed from each side, a surgeon closes the incisions with sutures. The entire procedure takes less than one hour."

After

The entire procedure can take 30 minutes or less with swelling gone in around two weeks with zero visible scarring. You'll be given a special mouthwash to prevent infection and though a liquid diet is required for about a week, you'll be able to resume almost all of your usual activities the next day. Horn says that the sutures used in the procedure are typically absorbable. "However, each surgeon has his/her own technique," he adds. "Patients are advised not to disturb the sutures with their hands or tongue during the healing process."

Buccal Fat Removal Recovery

The recovery from buccal fat removal—following that two-week period mentioned above—will be focused on healing. Swelling for several weeks after the procedure is not at all uncommon, and you'll likely need to return for a follow-up appointment at some point within the month.

"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. You can experience swelling, bruising, and discomfort for up to two weeks," Horn says.

Buccal fat removal lasts forever, so it's important to follow all of the aftercare instructions to ensure a smooth recovery.

The Candidates

Considering buccal fat removal's huge spike in popularity, a wide variety of surgical candidates are requesting the procedure. I spoke with Dr. Samuel J. Lin, MD, and board-certified plastic surgeon, about who's best suited for the procedure and who he advises against getting the surgery.

"An ideal candidate is typically a younger patient in the 20s to 40s with overly full, round, or chubby cheeks who seeks a more balanced facial appearance," Dr. Lin tells me. "The candidate would also ideally be a non-smoker and in good physical health."

That last part is important, not just for surgical safety but aesthetically as well. For candidates deemed clinically overweight, it's often not the buccal fat pads in particular that are causing facial fullness and results would be very minimal. In fact, there are a few different factors that could be causing excessive face fat that's not prominent buccal pads, including overly-developed jaw muscles from teeth grinding. Many men choose to undergo the surgery as well, looking for a stronger jawline and a more mature look altogether.

Anyone who wants to undergo buccal fat removal should also be wary of the more long-term results of the procedure. While defined cheek hollows and less fat might look great on younger patients now, it's worth considering how it will look as it ages. "The natural aging process causes fat loss in the face, which increases with every decade," Dr. Lin explains. "Patients beyond the age of 50 generally are not recommended cheek reduction surgery. The procedure may lead to sunken cheeks and may enhance other signs of facial aging at increased ages." Additionally, if you already have a thin or particularly angular face, buccal fat removal isn't recommended as results may leave you looking gaunt, worn, or older than you are.

Buccal Fat Removal Cost

The procedure typically costs between $2,000 and $5,000, depending on your geographic location, the facility your procedure is performed in, and whether you're under generalized or local anesthesia (typically safer and lower in cost).

The Risks and Rewards

It's undeniable that buccal fat removal can look striking and sophisticated. For many with so-dubbed chipmunk cheeks, the procedure is a welcome one that can quell a lifetime of insecurity. But despite a quick and relatively "easy" procedure, many doctors have expressed hesitation for performing the surgery on very young patients due to how much facial volume and structure can change over the decades. Research is still emerging on the clinical costs of removing mid-face fat, and there are even entire forum threads dedicated to 20-something patients who underwent the permanent procedure and regret the loss of fat in the face.

While it's safe to say most patients are happy with their results, one of the risks of buccal fat removal—and all plastic surgery, really—is that you just don't know how it will look on your aged face until you're actually that age. And considering so much of visible aging is wrapped up in decreased volume in the face, there's room for regret decades in the future. The popularity of 30-second TikToks and Instagram shots showing buccal fat before-and-afters may make the procedure look more casual than it really is.

But for every regretful post, there are others that describe buccal fat removal as the best thing to ever happen to them. Happy customers cite increased confidence and self-esteem as two of their favorite results from the procedure, the best possible outcome of any plastic surgery.

The Future

Certain cosmetic procedures come in and out of style to reflect changing beauty standards and ideals. While buccal fat removal is popular now, it's unknown if the procedure is here to stay and will reach the ubiquity of other surgeries like rhinoplasty. "The American Society of Plastic Surgeons currently does not publish yearly statistics of buccal fat removal procedures; therefore, predicting future trends of this procedure is difficult," Dr. Lin tells me. However, "it is unlikely that buccal fat removal will reach the same popularity as Botox, soft tissue fillers, breast augmentation, rhinoplasty, or eyelid surgery, but only time can tell if this procedure will increase in popularity."

As with all things related to your body, the best person to speak with regarding this surgery is a doctor. A board-certified cosmetic surgeon will provide you with plenty of in-person consultation and help decide if this permanent procedure is right for you.