Buccal fat removal, also known as a cheek reduction, is an elective plastic surgery that modifies the lower face to create a more sculpted, hollowed-out look below the cheekbones. While many people inquire about the financial aspects of this procedure, coverage is complex and heavily restricted by medical insurers. Most standard health insurance policies do not cover the cost of buccal fat removal, classifying it as an aesthetic enhancement rather than a treatment for a medical condition.
Defining Buccal Fat Removal
The procedure focuses on the buccal fat pads, which are masses of fat located deep within the lower cheek area. The size of these fat pads varies significantly from person to person, and larger pads contribute to a rounder, fuller facial contour, sometimes described as “chubby cheeks.” Buccal fat removal is a surgical technique designed to thin the face by permanently removing a portion of this fat tissue.
The surgery is typically performed on an outpatient basis using local anesthesia to numb the inside of the mouth. A small incision, usually about 2 to 4 centimeters, is made inside the cheek near the upper second molar. Through this incision, the surgeon gently excises the desired amount of the fat pad tissue. The incisions are then closed with dissolvable sutures, leaving no visible external scarring and resulting in a more defined, angular facial structure.
Insurance Coverage Status
Health insurance plans operate on the principle of medical necessity, meaning they cover treatments required to diagnose or treat an illness, injury, or functional impairment. Buccal fat removal, which is performed solely to improve appearance, is classified by insurance companies as a purely cosmetic and elective procedure. This classification is the primary reason why coverage is almost universally denied under typical health plans.
The distinction between a cosmetic and a medically necessary procedure is the sole determinant for insurance approval. Procedures are generally considered cosmetic when the goal is aesthetic improvement, such as achieving a slimmer face. Since the size of the buccal fat pads does not affect a person’s health or ability to function, it does not meet the criteria for medical necessity.
In the rare event a patient attempts to seek coverage, the physician’s claim would require a Current Procedural Terminology (CPT) code and extensive documentation to demonstrate a functional impairment. For instance, if the size of the fat pads caused extreme, documented interference with chewing or speaking, a case for medical necessity might theoretically be attempted. Standard insurance policies explicitly exclude procedures performed solely for aesthetic reasons, leaving the patient responsible for the full expense.
Navigating Out-of-Pocket Expenses
Since insurance coverage is highly unlikely, prospective patients must prepare to pay for the procedure entirely out-of-pocket. The total expense for buccal fat removal includes several components beyond the surgeon’s fee, such as the costs associated with anesthesia and the surgical facility. The average cost in the United States typically falls within a range of approximately $2,000 to $5,000, though prices fluctuate widely based on geographic location and the surgeon’s experience level.
A comprehensive quote from a surgical center will itemize the surgeon’s professional fee, the anesthesia provider’s fee, and the facility or operating room charges. The total cost may also include pre-operative lab work, post-operative garments, and prescription medications for pain management. Furthermore, the initial consultation with the plastic surgeon usually requires a non-refundable, out-of-pocket fee to cover the time spent on examination and discussion of the procedure.
Many surgical practices offer financial alternatives to help patients manage the lump sum payment required for elective surgery. Payment plans may be offered directly through the surgical center, or patients can utilize third-party medical financing companies, such as CareCredit. These financing options allow the patient to spread the cost over a defined period, making the procedure financially accessible without relying on health insurance benefits.