Buccal fat removal, also known as a cheek reduction or bichectomy, is a cosmetic surgical procedure designed to slim the contours of the lower face. It targets the buccal fat pads, which are masses of adipose tissue located deep within the cheeks, between the facial muscles. Reducing the volume of these fat pads diminishes fullness in the lower cheeks, creating a more defined, sculpted, or “hollowed” look that accentuates the cheekbones and jawline. This procedure is sought by individuals who feel their faces appear overly round due to prominent buccal fat.
Determining Suitability for the Procedure
The decision to undergo this procedure begins with a thorough consultation to determine suitability. A qualified surgeon assesses the facial structure to confirm that cheek fullness is due to an enlarged buccal fat pad. Ideal candidates often have a round face shape with prominent fullness in the lower cheek area that persists despite maintaining a stable, healthy weight. Candidates must be in good general physical health, understand the permanent nature of the volume reduction, and maintain realistic expectations.
The procedure is not recommended for those who already possess a naturally thin or narrow facial structure. Removing the buccal fat in these cases could potentially lead to a gaunt or excessively hollowed appearance, which can look prematurely aged over time as the face naturally loses volume. The procedure is best suited for younger to middle-aged adults, as surgery could inadvertently exaggerate age-related facial volume loss in older patients. The surgeon will also review the patient’s medical history and current medications to ensure there are no contraindications.
The Surgical Steps
The surgical process for buccal fat removal is straightforward and is often performed in an outpatient setting, typically taking less than an hour. The procedure usually begins with the administration of anesthesia, most often a local anesthetic injected into the inner cheek area, supplemented with oral or intravenous sedation to ensure patient comfort.
Once the area is numb, the surgeon makes a small 1 to 2 centimeter incision inside the mouth on the inner lining of the cheek, near the upper second molar. This intraoral approach ensures no visible external scarring is left on the face. The surgeon then navigates through the underlying buccinator muscle fibers to access the buccal fat pad.
Gentle external pressure is applied to the outside of the cheek, helping the soft, yellowish fat pad to protrude through the internal incision. The surgeon grasps the exposed portion of the fat pad and excises the precise amount of fat required for contouring. This step requires careful judgment, as the goal is to reduce volume without creating an overly hollowed look. The internal incision is then closed using fine, dissolvable sutures, eliminating the need for stitch removal.
Immediate Post-Operative Care and Recovery Timeline
Immediately following the procedure, patients can expect noticeable swelling and minor discomfort in the cheeks, which is a normal inflammatory response to the surgery. Pain medication is prescribed to manage this discomfort, and applying cold compresses to the outside of the cheeks during the first 48 hours helps minimize swelling and bruising. Because the incisions are located inside the mouth, meticulous oral hygiene is necessary to prevent infection and promote proper healing.
Patients must rinse their mouths several times a day with an antiseptic mouthwash or a saltwater solution, avoiding aggressive swishing that could disrupt the internal sutures. Due to the stitches and initial swelling, a soft or liquid diet is required for the first few days to a week. Foods that are difficult to chew or excessively hot, spicy, or acidic must be avoided to prevent irritation to the healing tissue.
The initial downtime is relatively short, with many patients returning to work or light daily activities within one to three days. However, the resolution of major swelling takes longer. Most noticeable swelling subsides within the first one to three weeks, revealing the initial signs of the new facial contour. Strenuous physical activity and exercise should be avoided for approximately four to six weeks to prevent increased blood pressure and subsequent complications.
Final Aesthetic Outcome
The change in facial contour is not immediately apparent due to residual post-operative swelling, even after the major puffiness subsides. The treated area continues to refine and settle over several months as the deeper, internal swelling fully resolves. The final, sculpted aesthetic outcome typically takes three to six months to fully manifest, when the cheek hollows become clearly defined.
The results of buccal fat removal are considered permanent because the removed fat cells do not regenerate. This means the thinned facial contour achieved after healing is long-lasting. However, the face will continue to age naturally, and the longevity of the refined contour can be influenced by significant fluctuations in body weight. Maintaining a stable weight is important to preserve the aesthetic effect, as substantial weight gain can cause remaining fat cells to enlarge, potentially altering the overall facial contour.