Cheek reduction takes under an hour and leaves no visible scar. The published complication range is 8.45 percent to 18 percent, and the trade shows up decades later.
Buccal fat removal is a short operation with a long tail, and the five checks below all happen before anyone picks up an instrument.
The procedure itself is modest. A small cut inside each cheek, part of the fat pad removed, dissolvable stitches, home the same day.
What is not modest is what sits next to that fat pad, and what your face does on its own over twenty years.
Five things to settle before the consultation ends
Cleveland Clinic says buccal fat removal is a surgery to remove the fat between your cheekbones and jaw bones, and that it is sometimes called a cheek reduction. Everyone has this fat. The operation takes some of it away permanently.
Five things are worth settling out loud first.
- Whether your face is already narrow. Cleveland Clinic says you may not be a good candidate if your face is narrow, or over a certain age, because buccal fat diminishes with age. A narrow face has less to give.
- Who is actually operating. Cleveland Clinic says the surgery is usually performed by a provider with special training in plastic surgery, such as a licensed plastic surgeon. Ask to see before and after photographs of this procedure.
- The published complication rate. NIH puts it between 8.45 percent and 18 percent. Not a rare event rate. Ask the surgeon for their own, and how many they have done.
- What sits next to the fat pad. NIH says the fat pad sits close to multiple vessels, the facial nerve and the parotid duct, and removal can damage them. Cleveland Clinic lists facial nerve and salivary duct injury among the risks.
- How long before you can judge it. Cleveland Clinic says healing takes about three weeks, but several months before the final result. A verdict at two weeks is a verdict on swelling.
Notice what is not on that list. There is no undo, and the fat pad does not grow back.
Why the same cheeks look different at 55
NIH says the buccal fat pad contributes to facial aesthetics and lets the muscles of the face glide past each other. It also calls it Bichat's fat pad, after the anatomist who described it in 1802.
It sits between the masseter and the buccinator, two of the muscles you chew with. Not decorative padding. A bearing surface.
Harvard Health names overcorrection as one of five risks: removing too much buccal fat can result in a hollow or sunken appearance, especially as you age and naturally lose fat in the face.
Cleveland Clinic makes the same point from the other end: you may not be a good candidate over a certain age, because buccal fat diminishes with age anyway.
Put the two together and the trade is clear. The face loses this fat on its own schedule. Surgery moves that schedule forward and cannot move it back.
Removing too much buccal fat can result in a hollow or sunken appearance, especially as you age and naturally lose fat in the face.
Take the five checks with you
One sheet: the five checks, what sits next to the fat pad, and the nonsurgical options.
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⬇ Download your plan (PDF)Five routes that do not involve an operating room
Harvard Health lists five nonsurgical ways to reduce facial fat, and is careful about what each one can and cannot do.
None is a like for like substitute. Harvard says the cosmetic route gives less dramatic results than surgery.
Cosmetic treatments. Harvard says dermatologists use heat, cooling or injections on facial fat cells, with less dramatic results than surgery.
Diet and exercise. Losing overall body fat slims the face too, but Harvard is explicit that fat cannot be spot reduced.
Hydration. Harvard says research shows drinking water can help you feel fuller and support weight loss efforts.
Sleep. Harvard says lack of sleep raises cortisol levels, which can increase appetite and lead to weight gain, and suggests aiming for at least eight hours.
Facial exercises. Harvard says the effectiveness is still debated and continues to be investigated. The weakest item on its own list.
Three cheek reduction beliefs that do not hold
Three ideas do most of the damage here, and each one has a published answer.
It is not really surgery. Cleveland Clinic lists infection, facial nerve injury, salivary duct injury, numbness and asymmetry among the risks, and says to call right away for excessive bleeding, signs of infection or an abnormal taste in the mouth. NIH puts the complication rate at 8.45 percent to 18 percent.
If I take too much off, filler can fix it. Neither Cleveland Clinic nor Harvard Health offers that as a remedy. Harvard names overcorrection as a risk of the procedure and describes the result as hollow or sunken, especially as you age. The honest planning assumption is that the fat is gone for good.
Two weeks and you will see the result. Cleveland Clinic says healing runs about three weeks and the final result takes several months. Harvard says full results are visible once the swelling has completely gone down, which may take several months. What you see at two weeks is still swelling.
To your health,
Ageless Coach
Age Strong. Live Long.
This article is education, not medical advice. Cleveland Clinic says to call your provider right away after surgery for excessive bleeding, signs of infection, results that are not healing well or an abnormal taste in your mouth, and to call 911 for shortness of breath, chest pain or an abnormal heartbeat.