Buccal fat removal (BFR) is a cosmetic surgical procedure performed to reduce fullness in the lower cheeks, creating a more contoured and sculpted facial appearance. The technique involves removing a portion of the buccal fat pad, a naturally occurring pocket of fat located deep within the cheek. This reduction aims to highlight the cheekbones and define the jawline. While the procedure is sought after for its permanent slimming effect, the long-term results can sometimes lead to an overly hollow or gaunt look, especially as the face ages and naturally loses volume. This potential for an undesired outcome raises the question of whether the procedure can be reversed for patients experiencing regret or premature facial hollowing.
Understanding the Permanence of Buccal Fat Removal
The term “reversal” is misleading because buccal fat removal is biologically permanent. The buccal fat pad is a distinct, encapsulated structure located deep within the cheek, separate from general subcutaneous fat. The surgical process involves making a small incision inside the mouth to access and remove a portion of the fat pad. Unlike weight-related fat deposits, the excised portion of this structural component does not regenerate or grow back.
Because the removed fat cells are gone permanently, simply undoing the initial surgery is anatomically impossible. This permanence is why overly aggressive fat removal can lead to a prematurely aged or sunken facial appearance over time. Therefore, the focus of any correction must shift from true reversal to volume restoration in the affected area.
Non-Surgical Volume Replacement
For patients who experience mild to moderate hollowing after buccal fat removal, non-surgical volume replacement is the primary approach. This involves using injectable dermal fillers, typically composed of hyaluronic acid. These fillers are strategically injected into the mid-face and lower cheek area to mimic lost volume, softening an overly defined contour. Hyaluronic acid fillers are appealing because they offer immediate results with minimal downtime, making them a less invasive option than surgery. The temporary nature of these injectables is also a benefit for patients who want to test the effect of added volume before committing to a permanent solution.
Fillers typically last between six and eighteen months, requiring repeat treatments to maintain the desired fullness. A limitation of fillers is that they are generally injected into the more superficial layers of the face, whereas the original buccal fat pad was located deep within the cheek. While fillers can effectively plump the overlying tissue, they may not perfectly restore the deep structural support provided by the excised fat pad. However, for many patients seeking a subtle correction to a slightly over-scooped cheek, this non-surgical approach provides a reliable and adjustable method to restore a more youthful contour.
Surgical Volume Restoration
For a more definitive and lasting correction, surgical volume restoration is the most effective solution.
Autologous Fat Grafting
This procedure, often called fat transfer, involves harvesting healthy fat cells from a donor site on the patient’s body, such as the abdomen or thighs. The harvested fat is meticulously processed to separate viable cells before being injected into the hollowed areas of the cheek. Fat grafting offers a significant advantage over fillers because it uses the patient’s own tissue, which integrates naturally with surrounding facial structures, providing a more permanent result.
However, not all transferred fat cells survive the grafting process, as a percentage is typically reabsorbed by the body over time. Surgeons often account for this unpredictable survival rate by slightly over-injecting the area. Multiple sessions may be required to achieve the optimal long-term result.
Alternative Surgical Techniques
In cases of severe hollowing or structural collapse, more complex techniques may be considered to restore deep support, such as placing a dermal-fat graft or a solid fat graft. Cheek implants can also be used to augment the mid-face, adding volume to the cheekbone area to create a different contour, though they do not replace the fat pad itself. Surgical restoration requires specialized skill, as the area is complex, housing various nerves and ducts, making a precise approach essential for a successful outcome.