Why I Don’t Perform Buccal Fat Removal
Buccal fat is a natural deposit of fat that sits between the cheekbones and jawline, adding shape, definition and contour to the face. It contributes to the fullness of the mid-face, creating a youthful and balanced appearance. This layer of fat is relatively resistant to fluctuations in body weight, meaning that it often remains consistent throughout adulthood, providing stability to facial contours.
The surgical procedure for buccal fat removal—also known as cheek reduction—involves making small incisions inside the mouth to extract the fat pad. It’s a straightforward procedure that typically requires local anaesthesia, with most patients experiencing an average recovery period of 7 to 10 days. There’s minimal scarring since the incisions are internal, and the appeal lies in the promise of a more sculpted and refined facial profile. However, while the technique may seem simple, its implications are far from simple.
The Rise in Buccal Fat Removal Requests
I have noticed a significant rise in patients, particularly those in their 20s and 30s, seeking buccal fat removal. Many are inspired by celebrity culture and social media trends that glorify a more chiselled, angular facial look, characterised by prominent cheekbones and a sharper jawline. This aesthetic is widely seen as the modern ideal, and influencers often present buccal fat removal as a quick and effective route to achieving these features.
While the procedure itself has been around for decades and is sometimes performed in conjunction with other surgeries such as facelifts, its popularity among younger individuals is relatively new. Unlike older patients who might combine the procedure with other facial rejuvenations, young adults seek buccal fat removal as a standalone treatment to achieve an immediate cosmetic result. This increase in demand raises concerns, particularly about the long-term effects on facial ageing, which are irreversible.
Key Reasons I Choose Not to Perform Buccal Fat Removal
Although buccal fat removal may deliver an immediate, aesthetic look, I refuse to perform this surgery because of the potential long-term consequences for my patients.
Accelerates the Natural Ageing Process
One of the most significant issues with buccal fat removal is its irreversible impact on the natural ageing process. Fat plays a crucial role in maintaining a youthful appearance by supporting the skin and providing volume. Buccal fat, in particular, acts as a natural filler that softens the face, masks fine lines and contributes to a youthful fullness. As we age, we naturally lose facial fat and collagen, leading to a reduction in volume and elasticity. This process creates the sagging, thinning and hollowing that many associate with an ageing face.
By removing buccal fat at a young age, patients effectively accelerate this ageing process. What begins as a sculpted look in the 20s or 30s can result in a hollow, sunken mid-face by the time patients reach their 40s and beyond. The buccal fat that was once removed to achieve a fashionable, angular appearance becomes a missing component that could have supported the skin’s structure as natural ageing sets in.
Hollows the Face Rather than Creating True Definition
Many patients seek buccal fat removal in the hope of achieving sharper cheekbones and a more contoured look. However, this desire for definition can be misleading. Removing buccal fat does not truly enhance the natural bone structure; it only removes fullness, which can result in a gaunt, hollow appearance over time. True definition comes from a balanced combination of fat, muscle and bone, and removing a crucial element like buccal fat can disrupt this harmony.
Some patients are initially satisfied with the more sculpted look following the procedure. However, as time passes and the natural ageing process begins to take hold, dissatisfaction often emerges. The face can appear prematurely aged, with a thin and sometimes skeletal appearance. For these reasons, I caution patients against seeking permanent alterations to achieve a look that is more effectively and safely, obtained through non-surgical methods, such as makeup contouring.
Irreversibility and Challenges of Correction
Unlike other cosmetic procedures, buccal fat removal is permanent. Once the fat has been removed, it cannot be restored. While there are corrective options available, they are far from ideal. I have seen an increasing number of patients who previously underwent buccal fat removal now seeking correction to address the hollow, aged look that has developed over time. Dermal fillers can be used as a temporary measure to replace some lost volume, but they are not a perfect solution and require ongoing maintenance. Bio filler is also another more natural procedure that can be used to help improve side effects from buccal fat removal. A more permanent corrective option is fat grafting, which involves transferring fat from another part of the body to the face.
Given the irreversibility of buccal fat removal, it’s vital for patients to fully understand the long-term consequences. Many patients find that what looked fashionable and desirable in their 20s no longer suits them a decade later. Facial aesthetics evolve, but surgical alterations do not; making it crucial to avoid choices driven by temporary trends.
Prioritising Natural Beauty and Timelessness
Trends come and go. What is popular today, whether it's heavily contoured cheekbones or an exaggerated jawline, may not be considered aesthetically pleasing in the future. I often tell my patients that their face should not be a canvas for trends but rather a reflection of their unique beauty. Cosmetic procedures should enhance the natural features of an individual, not follow transient styles that may fall out of favour.
Many patients are unaware of how facial ageing will change their appearance over time. Removing a natural element like buccal fat can lead to regrets later when the face requires volume to maintain a youthful and balanced look. This is why I prefer to offer non-permanent solutions, such as makeup contouring or temporary fillers, which can be adjusted as personal aesthetics evolve.
Safer Alternatives to Achieve Facial Contouring
For patients seeking to enhance their facial definition, I often recommend non-surgical options. Makeup contouring can effectively create the illusion of a more sculpted face without any permanent changes. High-quality skincare, alongside treatments that boost collagen production, can also help maintain skin elasticity and a youthful appearance.
If a patient is still considering a more permanent change, I might suggest subtle use of biofillers to enhance natural bone structure. This allows for adjustments over time, accommodating shifts in facial volume and aesthetic preferences as patients age. For the right patient, I may also recommend fat transfer to the face to enhance the facial contours after a careful and thorough consultation.
Facial Harmony
As a facial plastic surgeon, my priority is to help patients achieve results that not only look good today but will continue to look good for decades to come. While buccal fat removal can provide an immediate fix for those seeking a sculpted look, the potential long-term consequences far outweigh the short-term benefits. A hollowed, aged appearance is not something I want my patients to experience years down the line.
In my practice, I strive to educate patients on the importance of preserving the natural balance of their face. Enhancing facial aesthetics should be about complementing one’s unique features, not succumbing to fleeting trends. In my view, the healthiest and most beautiful outcome is achieved by respecting the natural contours of the face, allowing patients to age gracefully and naturally, with their facial harmony intact.
