Buccal fat removal is having its internet moment, which means I now spend part of every week talking someone out of it.
That is not because the procedure is bad. In the right person, removing a portion of the buccal fat pad brings out the cheekbones and gives the face a triangular, sculpted shape, a small procedure with a genuinely big effect. It is because the procedure only works on the face that actually has the fullness. Done on the wrong face, it does nothing good, and the wrong faces are lining up for it online.
So the first job, before any discussion of incisions or recovery, is deciding whether you are the right face. Here is how I decide, in the words I use in my own exam room.
The Candidate Question Comes First
The mistake is doing it on somebody who does not really have the fullness. If you have a genuinely round face with fullness in the lower cheeks, you are a good candidate. If you are thin there already, taking that fat out will only hollow you as you age.
So I look first, and I am honest about whether it will help you. Some of the best outcomes of this procedure in my practice are the patients I sent home without it.
The Aging Myth, Retired
The fear I hear most: will removing cheek fat make me age faster? It is a reasonable worry, and it is misunderstood.
The buccal fat pad is not the fat your face relies on for support. Watch where we place filler as people age: up on the cheekbone, never down in the buccal area, even in very old patients. The buccal pad gives you lower-cheek fullness and nothing else. Removing the right amount takes away roundness. It does not take away the scaffolding that keeps a face looking young. In fact, slimming the lower face makes the good fullness up on the cheekbone read even better.
Inside the Mouth, Under Thirty Minutes
Everything happens inside the mouth, so there is no visible scar. The pad itself starts in the cheek and extends up toward the temple, and I remove only the portion that sits in the cheek, through two small incisions about a centimeter each on the upper inside of the mouth. Sutures go in, and the incisions heal within about five days.
The procedure runs under thirty minutes, under local anesthesia or light sedation. You go home the same day.
The Recovery Curve, Honestly
The next day you will be a little swollen, a lot like having your wisdom teeth out. The worst day is the third day. Then it gets better and better, and by day six or seven most people around you will notice nothing. Ice and sleeping propped up speed the settling. Soft food at first, no chips or spicy food, and no working out for a week so you do not invite swelling. You are essentially back to normal at two weeks.
Planning around an event? Book it six weeks or more ahead, and you will be photographing your final result rather than fighting swelling in the pictures.
The Pairings That Build the Triangle
For many round faces, buccal fat removal is half of the answer. It targets the fullness in the front of the cheek. Masseter Botox, placed in the chewing muscle at the angle of the jaw, shrinks the back half, and the two together create a stronger triangle: buccal in front, the shadow of a slimmer jaw behind. Remember that masseter Botox works on a different clock, taking about six weeks to show because we are waiting for muscle to shrink, and it can be done at the same sitting.
For a more powerful change, I often add liposuction of the lower face and neck through a tiny incision behind the ear. Whenever I lipo the face, I take a pass on the neck too, which sharpens the jawline. That adds perhaps some neck bruising that fades within two weeks, and a light facial garment for the first five days.
About Those Cable Lines You Have Seen Online
The strange cord-like lines people fear are fibrosis, and they come from two errors: taking out too much fat, and skipping the aftercare. That is why I leave a little fat behind rather than chasing the maximum, and why I insist on lymphatic massages afterward, done here in the office. The massages pull the fluid out and let everything heal smooth. Skip them and you invite exactly the problem you were afraid of.
And two reassurances I give constantly: your dimple stays, since it is not touched, and people actually pay me to create dimples. And the fullness up on your cheekbone is never touched either. That is good fullness. We keep it.
Why Restraint Is the Skill
I am double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and a Mayo Clinic plastic surgery fellowship alum. I treat the face as one connected unit: buccal pad, masseter, jawline, neck.
The art of this procedure is not the removal. It is knowing how much to take and what to leave, so the result reads as a naturally sculpted version of you rather than a hollowed one. Restraint is the difference between the before-and-afters people want and the cautionary threads they read.
For the patient-facing version, see the companion post on agulloplasticsurgery.com. The med spa pairings live with the team at swplasticsurgery.com.
Ready to Talk?
If your lower face has always looked rounder than you would like, come in and let me look. I will tell you honestly whether buccal fat removal will sculpt you or hollow you. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
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