Buccal Fat Removal

Buccal fat removal (also called buccal lipectomy) is a surgical procedure that removes the buccal fat pad — a discrete pocket of fat inside the cheek, above the jawline — to create a slimmer, more sculpted appearance to the midface. It is performed through a small incision inside the mouth, with no visible external scar.

Your surgeon will assess you and advise whether this procedure is suitable, but the final decision is always yours.

You may be a good candidate if:

• You have naturally full, rounded cheeks caused by prominent buccal fat, and this is the primary source of your facial fullness (rather than descended tissue, water retention, or dental/jaw structure)
• You are aged roughly 20s to early 40s, with good skin elasticity
• You have realistic expectations that this is a subtle, permanent contouring procedure, not a solution for jowls, loose skin, or wrinkles

You are likely not a good candidate if:

• You have a naturally thin face, low body weight, or a family history of your face thinning with age
• You are over 45, especially with early signs of skin laxity — in this group, apparent cheek fullness is often caused by tissue descent rather than excess fat, and a facelift may be more appropriate
• You are a man with a naturally round face in your 20s — male facial fat often reduces naturally with age due to hormonal changes, so early removal can lead to a gaunt look later in life
• You have active oral infections, uncontrolled bleeding disorders, or decompensated diabetes
• You are unable to stop smoking for at least 2 weeks before and after surgery

Buccal fat removal can create a more sculpted, contoured midface for well-selected patients with a genuinely full buccal fat pad. Because the fat pad does not regenerate once removed, results are permanent.

Facial fat transfer repositions your own fat elsewhere to add structural support and volume rather than remove it — sometimes more appropriate for patients whose fullness comes from other causes. Minimally invasive skin-lifting procedures treat tissue descent, which is often mistaken for excess buccal fat in older patients. Cheek/structural augmentation with implants or fillers can enhance definition without removing tissue.

The procedure is usually performed under local anaesthetic, sometimes with sedation, and takes around 30–45 minutes.

• A small incision (a few millimetres) is made inside the cheek, opposite the upper back teeth
• The surgeon uses gentle pressure from outside the cheek to help deliver the fat pad through the incision
• Blunt dissection (rather than sharp cutting) is used near the edges of the fat pad to reduce the risk of injury to nearby nerves and the salivary (parotid) duct
• A conservative, measured amount of fat is removed from each side — commonly cited as an average of around 2–3ml per side
• The incision is closed with a dissolvable suture; no external scar results

All surgery carries risk. Because buccal fat removal is permanent and irreversible, understanding the risks — including delayed ones that may not appear for years — is especially important.

General risks of any operation: infection, bleeding, allergic reaction.

Specific risks of buccal fat removal:

• Facial nerve injury (buccal branch): the buccal branch of the facial nerve runs close to the fat pad and can be affected during dissection. Most injuries are neuropraxia (a temporary stretch or compression injury) and resolve within weeks to a few months as the nerve recovers; permanent nerve injury is rare when careful, blunt dissection technique is used . Because the muscles around the mouth often receive nerve supply from more than one branch, an isolated buccal branch injury frequently causes only subtle, temporary weakness rather than permanent paralysis
• Salivary (parotid) duct injury: the parotid duct passes near the fat pad and can occasionally be injured, causing swelling or, rarely, a fistula requiring further treatment
• Temporary swelling, bruising, and numbness: common in the first 1–2 weeks and typically resolves within 4–8 weeks as the intraoral incision heals
• Premature facial hollowing / "skeletonisation": because the removed fat pad does not regrow, and buccal fat is one of the compartments that otherwise helps buffer natural age-related facial fat loss, removing it can mean that normal ageing volume loss becomes more visible sooner — sometimes not apparent until the patient's 40s or 50s. This is the most significant long-term risk and a major reason careful patient selection matters
• Pseudo-jowling: loss of structural support in the cheek can allow the skin to drape more loosely over time, appearing as premature jowls
• Asymmetry: can occur if uneven amounts of fat are removed from each side
• Accentuation of nearby hollowness: removing buccal fat can make adjacent hollow areas, such as the temples, more noticeable by comparison

• Tell your surgical team about all medications, blood thinners, and supplements
• Stop smoking for at least 2 weeks before and after surgery
• Have any active dental or oral infections treated before proceeding
• Discuss your long-term facial ageing pattern and family history with your surgeon — this procedure requires careful individual assessment of your facial fat distribution and how your face is likely to change over the coming decades

• Swelling is usually most noticeable in the first few days and improves significantly within 1–2 weeks, with final settling by 4–8 weeks
• A soft diet is usually recommended for the first few days, and you'll be given a mouth rinse to keep the intraoral incision clean
• Avoid strenuous exercise for about 1–2 weeks
• Watch for red-flag symptoms and seek urgent review if you notice: rapidly expanding swelling or a fluctuant lump (possible infection/abscess), inability to close your eye or drooping of the mouth corner (possible nerve injury), pus or fever, or swelling near the ear that worsens with eating (possible salivary duct problem)

Is buccal fat removal reversible? No. The fat pad does not grow back once removed, even with weight gain. If you're later unhappy with excessive hollowing, options are limited to fat grafting or fillers, which do not fully replicate the original structural support.

What will my face look like in 10–20 years? This depends heavily on your starting anatomy. Well-selected patients with conservative removal generally maintain a balanced contour. Patients with thin faces, low BMI, or early skin laxity at the time of surgery are more likely to develop progressive hollowing and a gaunt appearance as natural ageing fat loss adds to the surgical change.

What are the signs of nerve injury, and will it be permanent? Signs include an uneven smile, difficulty puffing out your cheeks evenly, or drooping at the corner of the mouth. Most cases are temporary neuropraxia that improves over weeks to a few months; permanent injury is uncommon with careful technique .

Am I too young or too old for this procedure? Most suitable candidates are in their 20s to early 40s with genuinely prominent buccal fat and good skin elasticity. Patients over 45, especially with early skin laxity, are usually better served by a facelift or other tissue-repositioning procedure, since visible fullness at this age is more often due to tissue descent.

Can this be combined with other procedures? Yes, though your surgeon will discuss whether combining buccal fat removal with other facial surgery is appropriate for your specific anatomy and goals, and whether it increases combined operative or anaesthetic risk.

--- This document is for general information only and does not replace a full, individualised consultation with your surgeon.