Buccal fat removal takes out, wholly or partly, the ball 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.
It is a simple, short procedure with a quick recovery, and those three things explain why it has become so popular. They also explain why it is so often done badly: how easy something is technically says nothing about whether it is indicated.
Here is the uncomfortable part. The Bichat fat pad does not grow back: it is irreversible. And over the years the whole face naturally loses volume; someone reaching fifty having had that fat removed completely at twenty-five usually ends up with a hollow middle third and a more aged look, not a more defined one. That is why, when the indication is there, a portion is removed and not the whole pad.
It usually helps when there is
- Visibly full cheeks in a slim person, with no excess weight.
- A round face from real cheek volume, not from generalised subcutaneous fat.
- A wish to define the hollow under the cheekbone, with bone structure that allows it.
- Repeatedly biting the lining of the cheek because of excess volume.
- Adult age, with facial development already finished.
Worth discussing first if
- A slim face, or a cheekbone already defined: taking volume away here thins and ages.
- Under twenty-five: the face goes on losing fat by itself for years.
- Excess weight: the volume may be subcutaneous fat, which this procedure does not touch.
- Expecting a big change: the effect is subtle and shows mainly in three-quarter photographs.
- Lax skin: removing volume can accentuate the sagging rather than define.
None of these rules the procedure out on its own; all of them change the conversation.
Remove little, and only when there is excess
The Bichat fat pad is not simply fat: it is a structure with extensions that reach between the deep planes of the face, close to the duct of the parotid gland and to branches of the facial nerve. It is approached through a small incision inside the cheek, the superficial portion is brought out with external pressure and only that portion is removed, without pulling on what cannot be seen.
The amount is decided with the face in front of you and not by protocol. In most cases part is removed and the rest is kept, precisely because there is no going back. A discreet result that still looks good at forty is a better deal than a spectacular one at twenty-five.
And there is a third option that is raised in the consultation before surgery: in many cases what the person wants — a more defined cheekbone — is achieved by adding projection to the cheekbone, not by taking volume away from the cheek. That is reversible and does not compromise the face to come.
What the process is like
It is a short procedure, but the consultation beforehand carries more weight than the surgery.
Consultation
Whether the volume comes from the Bichat fat pad or from something else is assessed, the bone structure and the skin are examined, and you are told frankly whether the procedure is indicated.
Before surgery
Basic tests and a dental check-up, because the approach is through the mouth. The informed consent is signed.
Surgery
In a procedure room or theatre, under local anaesthesia. A one-centimetre incision inside each cheek and a dissolvable suture.
Follow-up
Reviews at one week and one month. Mouthwashes and a soft diet for the first few days.
Day by day
The recovery is short, but the result takes far longer than people expect.
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Days 1 to 3
Swelling of the cheeks, which during these days look fuller than before surgery. A soft, cold diet, mouthwashes and painkillers.
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Days 4 to 10
The swelling subsides. You can go back to normal social life. The internal stitches dissolve on their own.
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Weeks 3 to 8
The real change starts to show, still only partly. This is the point at which not to draw conclusions.
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Months 3 to 6
Final result. In faces with a very full cheek the change is clear; in slim faces it can be almost imperceptible, which is exactly what you are warned about before surgery.
Risks, and what is not promised
The usual risks of minor surgery — bleeding, infection, haematoma — and those specific to the approach: asymmetry between one cheek and the other and, infrequently, injury to a branch of the facial nerve or to the duct of the parotid gland, uncommon complications but ones that need specialist management.
The most important risk of this procedure, though, is not a complication: it is excess. Removing too much produces a hollowing of the cheek that has no simple correction, and that gets worse with age. It is corrected, if at all, with fat grafting or filler, with a result that rarely matches what was there.
No particular face is promised, and no general slimming effect either: this procedure does not reduce weight and does nothing for the double chin or for the jawline. These risks are reduced by a sound indication and a conservative technique. They are not eliminated. The ones that apply to your case are explained to you in the consultation and are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most about buccal fat removal
It can, and it is the most honest warning that can be given about this procedure. The face loses volume naturally over the years; if the whole Bichat fat pad was also removed in youth, the middle third ends up hollow before its time.
That is not an argument for never having it done: it is the argument for only operating on someone who has volume to spare, and for removing part rather than all of it.
The portion removed does not come back. The portion kept can increase in size with a significant weight gain, just like the rest of the body's fat.
That is why it is best to have the procedure at a stable weight and not as part of a plan to lose weight.
No. The Bichat fat pad is in the cheek, not in the neck. A double chin is a different thing and has its own treatment, which may be submental liposuction or neck surgery depending on the case.
Confusing the two is common and ends in surgery that does not solve what brought the person in.
Between three and six months. For the first weeks the cheek is swollen and looks fuller than before, which throws a lot of people.
If at three months the change seems small to you, it is worth remembering that the effect of this procedure is discreet by nature: it shows in the contour, it does not transform the face.
Question not answered here? There are more answers in the frequently asked questions.
