Buccal fat removal — an operation that moves the same way age moves a face

Buccal fat removal takes out part of the buccal fat pad inside the cheek. The incision is inside the mouth, so no external scar remains, and it takes 20 to 40 minutes.

It looks short and simple. What this page wants to record is the other side of it.

First, what is removed does not come back. This site's surgery pages sort reversibility into reversible, partial and permanent, and this one is permanent. It is not an implant that can be taken out, and filling with fat grafting is not the same as restoring that tissue.

Second, and this is the heart of the page — this operation moves the same way age moves a face.

With age, facial fat decreases and descends. Cheeks hollow and shadows appear. What this site's fat grafting and filler pages deal with is usually the opposite direction — putting volume back.

Buccal fat removal takes that volume away in advance. What you want now and how that face will read in fifteen years are two different questions. And what gets settled on the operating table is the second one too.

Third, how much was taken cannot be seen from outside. Because it is removed through the mouth, it takes time to notice when too much has gone — swelling takes months to settle.

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Taking out too much cannot be undone. It is the regret most often raised about this operation. Hollow cheeks and a gaunt face are what remains.

Branches of the facial nerve run close by. Around the buccal fat pad run the nerves that move the facial muscles and the duct of the parotid gland. Damage can affect expression or the flow of saliva. Rare, but the heaviest complication of this operation.

Bleeding and haematoma can occur inside the cheek.

The wound inside the mouth can become infected. Get instructions on oral care afterwards.

Swelling lasts months. The result cannot be judged from the early appearance. And deciding, during that time, that 'not enough came out' and having more taken is the dangerous move.

The two sides will not end up identical. The amount of buccal fat differs between them to begin with.

Opening wide and chewing are restricted for several days.

In a lean build, or with little facial fat, it may not be suitable at all. That is to be established in a consultation first.

Establish the cause first. Cheeks read as wide for several reasons — the buccal fat pad, subcutaneous fat, the size of the chewing muscle (masseter) and the width of the jawbone. Different causes need different things. A large masseter is the territory of botulinum toxin; jaw width is the territory of facial contouring surgery. Buccal fat removal does not settle either.

Talk about age at the same time. Do not decide on today's face alone. Ask where this volume would be better placed in ten or twenty years.

Talk in terms of 'a little'. Too little taken can be added to later; too much cannot be undone. In an operation that only goes one way, going less far is the safer direction.

Wait for the swelling to settle. Three to six months at least. Do not decide on further surgery before that.

Look at the whole face together. Reducing the cheeks alone makes cheekbones and jawline stand out by comparison. Check that is the direction you want.

Expect soft food for several days.

Not smoking helps. It bears directly on healing inside the mouth.

The most important property of this operation is that it cannot be undone. Among the surgery pages here it belongs to the group with short recovery and no way back. A simple operation and a reversible operation are not the same phrase.

Time is not on this operation's side. With most cosmetic surgery, time settles the result as swelling subsides and scars fade. This one moves in the same direction as the facial fat that keeps decreasing.

If you later want to put volume back, that is another operation. Fat grafting or filler. And that is not restoring the original tissue.

Agreeing the result from photographs is hard. How much to take is a judgement in millilitres, and how that reads on a face depends on the bone and the skin.

Talk through deciding this very young. Facial contours keep changing into the mid-twenties.

Whether to have it done is settled with a doctor, and it is better not to settle it on one consultation alone.