Buccal fat removal: who it suits and who it does not

Buccal fat removal has become one of the most talked-about facial procedures on social media in recent years. The message "take out the cheek fat and your face slims down instantly" sounds appealing. Yet the most important truth about this operation is often skipped: buccal fat removal does not suit every face, and its result is irreversible. In this article we explain without selling, building a realistic expectation — who it suits and, more importantly, who it does not.

What is buccal fat removal?

Buccal fat removal (bichectomy in some sources) is the removal of part of the buccal fat pad located in the deep layer of the cheek. The buccal fat pad is a fat cushion naturally present in everyone that gives volume to the lower part of the face. In some people this pad is genetically larger, so the cheeks can look full and round even at a normal weight.

The purpose of the procedure is to create a slight slimming in the mid-to-lower part of the face. Note: slight. This is not an operation for radical change, and it should not be one.

How is the operation performed?

One of the technical advantages of buccal fat removal is that the incision is made inside the mouth. A small incision of roughly 1-2 cm is made on the inner surface of the cheek, the planned portion of the buccal fat pad is removed, and the incision is closed with a dissolving suture inside the mouth.

The practical consequence is this: there is no incision on the outer surface of the face, so no externally visible scar remains. The operation is usually performed under local anaesthesia in about 30-60 minutes, and the patient goes home the same day.

One point is worth knowing in advance: in the first days the face may look fuller than it did before surgery. This is due to swelling and is normal. The visible slimming only begins to be felt after 2-4 weeks, and the final result takes patience — sometimes up to 4-6 months.

Who is it suitable for?

In the right candidate, buccal fat removal can give a natural and attractive result. The suitable profile looks roughly like this:

• People who have genetic fullness in the cheeks despite a normal weight and are unhappy with the round appearance of the lower face
• Candidates whose facial bone structure has finished developing — usually the 20-40 age range
• Patients in whom examination confirms that the cheek fullness comes from the buccal fat pad rather than from excess weight
• People with good oral and dental health and no active infection inside the mouth
• Most importantly: people with realistic expectations — those seeking a slight, natural slimming of the face rather than aiming at a dramatic change

Who is it NOT suitable for?

This is the most important part of the article, and it is the part advertisements usually leave out.

People whose face is already thin, narrow or long. For this group buccal fat removal is most often the wrong choice. The reason has to do with age: as the years pass, facial fat naturally decreases and the face begins to slim down by itself. If you remove additional fat from a thin face today, in a few years it can look excessively hollow, tired and older. In other words, the effect you want today can work against you over time.

Those whose cheek fullness comes from excess weight. If the cause of the fullness is overall weight, it makes more sense to wait for the weight to stabilise first — the cheeks may slim down with weight loss anyway, and the operation may become unnecessary.

Patients whose face looks wide because of the chewing (masseter) muscle. In this case removing fat does not solve the problem; a separate approach directed at the muscle is assessed.

People over 40 in whom volume loss and sagging of the face have begun. Removing fat can accelerate this process, so different approaches are often more appropriate in this age group.

Those making a hasty decision under the influence of a social-media trend. A procedure being popular does not mean it suits you. Where body dysmorphic disorder is suspected, a period of reflection is recommended first.

To this list are added people with a bleeding disorder, an uncontrolled chronic condition or an active infection inside the mouth.

Irreversibility: this is why you should not rush

Here is the truth about buccal fat removal that is skipped most often: the buccal fat pad that is removed does not come back. The result is permanent — in the good sense and in the sense of risk alike.

If more fat than necessary has been removed, reversing that is not easy. Restoring the volume afterwards may require further interventions (fat transfer, for example), and that is more complex than the original operation. This is precisely why, in a good clinic, the goal is not "remove the maximum amount of fat" but a measured, cautious removal in keeping with facial proportions.

Do not forget there is a list of risks

Like any surgical intervention, buccal fat removal carries risks: long-term hollowing, injury to the buccal branch of the facial nerve (rare), the possibility of injury to the salivary gland duct, asymmetry between the two cheeks, infection and prolonged swelling. Most of these risks are reduced by correct candidate selection and an experienced hand — but they are not eliminated entirely.

How should you decide?

Buccal fat removal is not a trend but a medical decision. The right question is not "can I have my cheek fat removed?" but "what will this do to my face in the long term?".

An honest answer to that question can only be given after a face-to-face examination. An experienced specialist assesses the source of the cheek fullness (the buccal fat pad, weight, muscle or bone), takes the age factor into account and says openly if you are not suitable.

If you are thinking about the fullness of your face, you can request a consultation before you decide. The aim is not to sell you anything — it is to find out honestly what really suits your face and, where necessary, to hear the answer "you do not need this operation".

This article is of a general informational nature and does not replace medical advice; for your individual situation, be sure to consult a doctor.