Buccal fat removal (BFR) is a cosmetic procedure designed to reduce the volume of the lower cheeks, creating a more contoured and defined facial appearance. The surgery targets fullness in the midface that often persists despite weight loss. While popular, individuals considering this permanent change must understand the safety profile, including immediate and long-term consequences.
Understanding Buccal Fat Removal
The buccal fat pad is a deep deposit of adipose tissue located between the buccinator and masseter muscles in the cheek. Unlike subcutaneous fat, which fluctuates with body weight changes, the buccal fat pad is a structural fat body that remains stable throughout adult life. Its function includes cushioning muscles and nerves during chewing, and contributing to facial structure and support.
Buccal fat removal involves the surgical extraction of a portion of this fat pad to thin the lower face. The procedure is typically performed on an outpatient basis, often using local anesthesia. The surgeon makes a small incision, usually one to two centimeters long, on the inside of the cheek.
Through this internal incision, the surgeon presses on the outside of the cheek to expose and excise a measured amount of the fat pad. The incision is then closed with dissolvable sutures, leaving no visible external scarring.
Immediate Surgical Risks and Complications
Buccal fat removal carries several surgical risks tied to the anatomy of the midface. A concern is potential injury to the buccal branch of the facial nerve, which controls movement in the cheek and upper lip. This nerve is vulnerable because it can pass directly through or lie adjacent to the buccal fat pad.
Damage to this nerve can result in temporary or, rarely, permanent facial muscle weakness, leading to asymmetry when smiling or moving the mouth. There is also a risk of injury to the parotid duct, which transports saliva from the parotid gland into the mouth, as it is situated close to the fat pad. Duct injury can lead to salivary gland issues.
General surgical risks include infection at the incision site, excessive bleeding, and the formation of a hematoma or seroma (collections of blood or fluid). Prolonged swelling, or edema, is common and can last for several weeks. Another complication is trismus, which is stiffness in the jaw muscles that can limit the ability to open the mouth.
Long-Term Aesthetic Considerations
Beyond the immediate healing phase, the permanent nature of buccal fat removal introduces long-term aesthetic considerations related to aging. The primary concern is the potential for a hollow or gaunt appearance later in life. Facial fat naturally diminishes with age, and preserving volume in the midface is characteristic of a youthful appearance.
Removing the buccal fat pad permanently reduces a structural component of the cheek. This can accelerate the look of volume loss as a person ages, particularly past their forties, potentially making the patient look prematurely aged or skeletal years after the procedure. The loss of this fat, combined with the natural descent and thinning of other facial tissues, can also accentuate the appearance of nasolabial folds or jowls.
The permanent nature of the volume reduction makes reversal challenging. While fat grafting can attempt to restore volume, it is not a direct replacement for the removed fat pad. Patients must be aware that their aesthetic goals may change over decades, but the outcome of the surgery is permanent.
Determining Patient Suitability
The safety and success of buccal fat removal rely on the careful selection of appropriate patients. The procedure is best suited for individuals who have pronounced, full, or round cheeks that do not slim down with diet and exercise. Patients with naturally thin, narrow, or long faces are poor candidates, as removing the fat pad increases the risk of an overly hollow appearance.
Age is a significant factor in determining suitability, with many surgeons recommending that patients be at least in their mid-twenties, as facial structure and fat distribution may still be changing in younger adults. A thorough pre-operative assessment must evaluate the patient’s existing facial volume and projection to ensure the remaining facial fat is sufficient to support facial contours as they age.
Patients must also have stable body weight and be in good overall health, without contraindications like uncontrolled diabetes. Choosing a board-certified surgeon is important, as their experience in assessing candidacy and technical skill minimizes the risk of complications and ensures a result that ages gracefully.