Buccal fat removal: why we say no more often than we say yes

Buccal fat removal takes out, wholly or partly, the pad of fat that sits inside the cheek. It slims the middle third of the face and brings out the cheekbone. It is done from inside the mouth, with no visible scar, takes half an hour and you are back to normal life in under a week.

Those three things — short, simple, quick — explain why it has become so popular. They also explain why it is so often done badly: technical ease says nothing about whether it is indicated.

The uncomfortable part: it is irreversible

The buccal fat pad does not grow back. It is not fat you regain by putting on weight, nor tissue that regenerates: what is removed is removed.

And here comes what is almost never said in a sales consultation: with the years, the whole face loses volume naturally. Someone who reaches fifty having had that pad taken out entirely at twenty-five usually has a hollow middle third and looks more aged, not more defined.

You are making a decision at twenty-five that you pay for at forty-five, and there is no way to undo it. That is why, when it is indicated, a portion is removed and never the whole pad.

When we say no

These are the situations in which, in our consultation, the answer is usually no:

• A thin face, or cheekbones already defined. Removing volume here thins and ages. This is the commonest case of all.
• Under twenty-five. The face goes on losing fat by itself for years: what looks like roundness today will go without surgery.
• Excess weight. If the volume is subcutaneous fat, buccal fat removal does not touch it and the result will disappoint.
• Lax skin. Removing volume under skin that no longer retracts accentuates the sag rather than defining anything.
• Expecting a big change. The effect is subtle and shows mainly in a three-quarter photograph. Anyone expecting a different face will leave thinking nothing was done.

What it does not do, however it is advertised

It does not slim you. It does not reduce a double chin, which is another compartment and another procedure. It does not correct the facial oval or the jawline. It is not a substitute for losing weight.

If what bothers you is the double chin or a poorly defined jaw, this is not the procedure, and having it anyway will not bring you closer to the result you want.

When yes

There is a real indication and it is narrower than the advertising suggests: a face with a genuinely full middle third, in someone with stable weight, good skin quality, past twenty-five, and with the right expectation of a discreet change.

In that case a portion is removed, the rest is left, and the result ages well. It is a good operation when the person having it is the right one.

And a word about where

It is done from inside the mouth, very close to the duct of the parotid gland and to branches of the facial nerve. Being short and under local anaesthesia does not make it an improvised consulting-room procedure: injury to that duct or that nerve is a serious and permanent problem.

Ask who will be operating and where, just as you would for any other surgery.