What is a buccal fat removal?

Facial aesthetics covers many aspects, and one procedure that is getting people talking is buccal fat removal. If you have considered it but do not know much about it, here you will find out what it involves, when it is recommended and whether it may be right for you. It is part of the clinic's cosmetic facial surgery in Girona procedures.

What is buccal fat removal and when should it be done?

The structure of the face includes fat bodies called buccal fat pads: encapsulated balls of fat located in both cheeks. This tissue gives structure to the face, but depending on its size it can give a poorly defined appearance. As they serve no vital function, many people choose to have them removed to slim down the face.

Buccal fat removal consists of the removal of the Bichat fat pads: a surgical reduction that eliminates the fat deposits in the middle to lower region of the cheek to achieve a more defined face.

Its technical name comes from Marie François Xavier Bichat, the anatomist who described these fat pads. In everyday language it is also known as cheek reduction surgery or «face slimming». It is important to put it in context: it is not a slimming treatment or a weight-loss solution, but a very localized facial harmonization procedure, whose aim is to define the lower third of the face in specific people. Understanding clearly what it is, what it can and cannot do, is the first step to deciding with good judgement.

What is buccal fat removal for and how does it improve the face?

Buccal fat removal serves to slim and define the middle and lower part of the face. When the Bichat fat pads are removed, the cheeks lose volume and the face takes on a more sculpted look: the contour is refined, a slight hollow beneath the cheekbone tends to appear and the jawline is enhanced. In very rounded faces, this change can give a greater sense of definition and harmony between the different planes of the face.

In practical terms, it improves:

• Definition of the lower third: the face goes from a "fuller" look to a more sculpted one.
• Cheekbone enhancement: by reducing the volume of the cheek, the cheekbones gain relative prominence.
• Jawline: it may look more defined and slimmer.

It is key to maintain realistic expectations: buccal fat removal does not completely change the shape of the face nor replace other techniques (such as chin and cheekbone surgery or contouring treatments). Its effect is subtle and localised, and not everyone notices the same degree of change, because it depends on the real size of the fat pads and on the bone structure of each face.

Buccal fat removal in women and in men

Women and men can both be operated on, with no gender limitation; what determines the indication is not sex, but the characteristics of the face. In women, the aim is usually to enhance the cheekbones and slim the cheeks for a more streamlined look. In men, the focus is often on defining the jawline and gaining facial definition. In both cases, the approach should be conservative and personalised: removing only the fat needed to harmonise, without over-emptying the cheek, which in the long term might not be flattering. That is why the individual assessment by the plastic surgeon is decisive.

What the procedure is like

The procedure begins with the administration of anaesthesia. The specialist then makes a small incision inside the mouth to gradually remove the fat located beneath the muscle and, finally, closes with absorbable sutures.

Postoperative period and care

The patient goes home the same day and can lead a normal life as long as it does not involve great effort. Usual guidelines (always according to the surgeon's instructions):

• First 24 hours: rest is recommended. On the first night it is best to sleep with your head elevated (two pillows).
• Pain and inflammation: pain is usually controlled with painkillers; applying cold helps reduce inflammation. It is normal for one cheek to be more swollen than the other.
• Antibiotics: prescribed for about 5 to 7 days to prevent infections.
• Oral hygiene: take extra care with hygiene, especially after eating or drinking, to reduce the risk of infection.
• Diet: liquid at first and, progressively, soft foods as the specialist indicates.
• Habits: avoid alcohol, tobacco and other substances in the days afterwards so as not to delay recovery.
• Return to normal: in about 2 weeks. The final result is appreciated at around 6 months, when skin retraction and muscle adhesion are complete.

How buccal fat removal is done and how long it lasts

The procedure is outpatient and usually lasts around 40 minutes. It begins with the administration of anaesthesia (local or general, depending on the case and the preferences agreed with the team). The surgeon then makes a small incision inside the mouth, at cheek level, locates the buccal fat pad and removes, in a controlled way, the appropriate amount of fat located beneath the muscle. Finally, the incision is closed with absorbable sutures that do not need to be removed. Since the whole technique is performed intraorally, there are no visible scars on the outside of the face. After surgery, a compression bandage is placed for a few hours to reduce swelling and the risk of haematoma, and the patient goes home the same day.

Does buccal fat removal age the face over the years?

It is one of the most searched questions and deserves an honest, nuanced answer. The concern has a real basis: facial fat is part of the face's natural “padding”, and with age we tend to lose facial volume progressively. The theory is that removing fat from the cheek in youth could, over the years, add to that natural loss and contribute to a more gaunt appearance or accentuate sagging in some people. It is not a baseless myth, but nor is it an inevitable fate for everyone.

What prudent clinical practice says is the following: the risk of the face “ageing” depends greatly on a good indication and moderation in the technique. When buccal fat removal is performed on a suitable candidate (rounded face, no sagging, with defined cheekbones) and only the necessary fat is removed without over-emptying the cheek, the result tends to remain harmonious. The problem appears when people who were not good candidates are operated on —for example, with an already elongated face or with sagging— or when too much fat is removed in search of an exaggerated effect. That is why it is wise to be wary of aggressive approaches and to prioritise a consultation with a plastic surgeon who knows how to say “no” when the procedure is not indicated. In short: when properly indicated and carried out with a conservative approach, buccal fat removal does not have to age the face; when poorly indicated or excessive, it can indeed work against you over time.

Risks, contraindications and care

Buccal fat removal is a common procedure with a good safety profile when performed by a qualified plastic surgeon after an appropriate consultation, but, like any surgery, it is not free of risks. Possible complications include infection (which is why antibiotics and strict oral hygiene are prescribed), hematoma or asymmetric swelling (it is normal for one cheek to swell more than the other), mild discomfort when opening the mouth in the first few days and, rarely, injury to neighbouring structures such as the salivary duct or nerve branches, which a careful approach aims to avoid. An excessive result (removing too much fat) is also considered an aesthetic complication, since the fat pads do not regenerate. It is not recommended for very long faces, with sagging skin or with poorly defined cheekbones, and pre-operative blood tests are mandatory to confirm that surgery can be performed safely.

Advantages and alternatives

Among the advantages are: slimming of the lower third of the face without visible scars, no need to repeat the procedure (Bichat fat pads do not grow back), a quick and simple technique, and a progressive change in the face after the surgery.

As for non-surgical alternatives for slimming the face, the post itself mentions facial mesotherapy (a non-invasive technique), microliposuction and the mid-face lift with minimal incisions. The specialist assesses each case and proposes the options according to expectations and characteristics. You can learn more about them in the facial aesthetic medicine unit and in the facial cosmetic surgery unit in Girona.

Results: when you see them and how long they last

The result of buccal fat removal is gradual. In the first few days the face is swollen from the normal post-operative inflammation, so at first the cheeks may look fuller, not slimmer: this is to be expected and should not cause alarm. The real difference starts to be noticeable after about a month, when the swelling subsides, and the final result settles at around 6 months, once the skin has retracted and the muscle adhesion is complete. Since buccal fat pads do not grow back, the effect is permanent in that sense; what does continue its course is the natural ageing of the face, common to everyone. Hence the importance of a measured technique and of looking after the skin over time.

How much buccal fat removal costs

There is no single price for buccal fat removal: it depends on each person's characteristics and needs, the type of anesthesia used, the complexity of the case and the centre where it is performed. That is why you should be wary of fixed figures quoted without having seen you: a realistic quote can only be given after an in-person consultation, in which the plastic surgeon examines your face, confirms you are a good candidate and defines the surgical plan. As it is a cosmetic surgery, it is considered a private treatment. At the consultation you will be given a detailed quote and, if you need it, the options for organising payment.

Frequently asked questions

Related articles

Facial Cosmetic Surgery in Girona

Aesthetic medicine techniques that rejuvenate

Otoplasty: prominent ears

Mesotherapy and Facial Hydration