Buccal fat removal (buccal lipectomy or cheek reduction) is a cosmetic surgical procedure designed to reduce the volume of fat pads deep within the cheeks. The goal is to achieve a more contoured facial appearance by thinning the lower cheek area and enhancing cheekbone visibility. While often considered a low-risk, minimally invasive surgery, it involves critical anatomical structures. Patients must understand the specific, potentially serious medical and aesthetic risks inherent to this permanent facial alteration.
Understanding the Procedure
The buccal fat pad is a mass of adipose tissue situated deep within the cheek, resting between facial muscles below the cheekbone. This anatomical position is significant because the pad is adjacent to important facial structures, including major nerves and salivary ducts. The procedure typically begins with a local anesthetic applied inside the mouth to numb the area.
The surgeon creates a small incision, usually less than one centimeter, on the inside of the cheek near the upper molar teeth. Through this intra-oral opening, a portion of the fat pad is gently isolated, excised, and the internal incision is closed with absorbable sutures, eliminating external scarring. Patients can expect initial swelling and bruising for about a week, though final aesthetic results appear only after deep swelling subsides over several months.
Immediate Surgical Complications
Accessing the surgical site through an incision inside the mouth creates an inherent risk of post-operative infection from oral bacteria. Surgeons commonly prescribe prophylactic antibiotics and specialized mouthwash to mitigate this potential complication. Another acute medical risk is excessive bleeding, which can lead to a hematoma, a collection of blood that may require a second surgical intervention for drainage.
The buccal fat pad is intimately associated with delicate branches of the facial nerve, specifically the buccal branch, which controls muscle movement in the lower face. Injury to this nerve can cause temporary facial muscle weakness, resulting in an asymmetric smile or difficulty with expressions. Permanent damage is rare. Furthermore, the parotid duct (Stensen’s duct) traverses the cheek, draining saliva from the parotid gland into the mouth. Accidental damage to this duct is a serious, though infrequent, event that can lead to a salivary fistula or saliva accumulation, necessitating specialized repair.
Long-Term Aesthetic and Functional Concerns
A primary long-term concern is the risk of developing facial asymmetry, which can occur if unequal amounts of fat are removed or if post-operative healing differs between the two sides. This result is challenging to correct and can be a source of significant patient dissatisfaction. The most discussed aesthetic consequence, however, relates to facial aging.
Facial volume naturally decreases over time, and removing the buccal fat pad prematurely eliminates a structural component of the mid-face. Removing too much fat, especially in younger patients, can lead to a gaunt or hollowed-out look years later, a result many patients find undesirable as they age. This outcome is difficult to reverse and often requires subsequent procedures, like fat grafting or dermal fillers, to restore lost volume. Since the excised fat cells do not regenerate, the procedure is permanent and irreversible regardless of future aesthetic preferences.
Mitigating Risk Through Preparation and Selection
Minimizing the inherent risks of this procedure begins with the careful selection of a qualified surgeon. Patients should seek a board-certified plastic surgeon or an oral and maxillofacial surgeon with proven experience in facial contouring. A comprehensive pre-surgical consultation is necessary to determine candidacy, as individuals with naturally thin or narrow faces are often poor candidates due to the increased risk of a prematurely aged appearance.
The surgeon must assess the patient’s facial structure, skin elasticity, and overall health, while discussing realistic expectations for the long-term aesthetic outcome. Post-operative compliance is paramount for a smooth recovery and significant risk reduction. Strictly adhering to the surgeon’s instructions, particularly maintaining meticulous oral hygiene and following the prescribed soft diet, significantly lowers the chance of post-surgical infection and bleeding complications.