What is a buccal fat removal?

Buccal fat removal refers to the removal of a portion of the buccal fat pad. The buccal fat pad refers to an encapsulated fat mass between the buccinator muscle and the masseter, zygomaticus major, and zygomatic minor muscles. It is also referred to as Bichat’s fat pad. Its absence or paucity generates a hollowed check. An excess of it generates a fat face, or “chipmunk cheeks”. Removing the extra fat can powerfully slim the face.

How long does the surgery take?

The surgery is often combined with facial fat transfer, rhinoplasty, or chin augmentation surgery. But it can also be performed alone. If it is performed by itself, it may take fifteen minutes to forty five minutes depending on a number of factors. This factors may include whether or not the surgery is being performed under local or general anesthesia, or the difficulty in finding the fat pad. Sometimes it is readily found; other times it takes up to five to ten minutes to free it from its capsule and tease it out.

Can it be performed under local anesthesia?

Yes. In patients who can tolerate keeping their mouth open and being completely still, the procedure can be performed with the patient awake. Topical and local anesthetic agents will be used to assure a pain free surgery.

How large are the incisions?

The incision is about 1.5 cm in length.

Where are the incisions made?

The incisions are made within the mouth, just behind the parotid duct which you may be able to feel with your tongue. The duct sits just outside the 2nd upper molar. The incision may be made either above or below the duct. Sometimes, it may be made both under and over the duct if the encapsulated mass is too difficult to free with one approach.

How much fat is removed?

For most people, a substantial portion of fat is removed — but not the entire wad. Removing the entire buccal fat pad may render the cheek too hollow.

I’ve read that some doctors don’t like doing it because it can make you look older. Is that true?

Plastic surgery involves proper diagnosis, just like any other medical field. In the appropriate patient with the appropriate amount of fat removal, the results are striking. If too much fat is removed (and in the wrong person), the results can make the face look too gaunt or older. However, because patient selection is key to a successful outcome, be certain to go to an experienced board certified plastic surgeon for this procedure.

What other procedures are commonly combined with buccal fat removal?

Facial fat transfer, rhinoplasty, and chin augmentation are often combined with buccal fat removal. The combination of adding fat to the upper cheek bone area with fat and removing fat from the lower face can drastically slim faces and create model-like faces with very little downtime or risk. Chin augmentation also frequently improves jawline definition to help “frame” the more hollow cheek with a more full the cheek bone.

Is it safe?

In skilled hands, buccal fat extraction is one of the safest surgeries performed. If the anatomy is familiar as it should be to a qualified board certified plastic surgeon, then the risks of parotid duct injury or nerve injury are exceptionally rare.

Can you describe how it is done?

About 3 cc of lidocaine with epinephrine is injected into the mucosa of the mouth about 1.5 cm behind and above the parotid duct. A 1.5 incision is made with a needle tip electrocautery device and the mucosa and buccinator muscle are entered. From here, no sharp instruments enter the buccal space — this is to protect one from nerve injury or duct injury. Then, the tissue is spread until the capsule is identified and opened. The buccal fat at this point will either erupt through the incision or it will be slowly teased out. An estimated amount is mobilized into the mouth without yet removing it, then the same procedure is performed on the other side. Again, a portion of the fat pad is mobilized into the mouth. In this fashion, the results of such a removal can be determined before actually excising the fat. The face is then examined in multiple angles to now determine how much of this mobilized fat will be removed and how much of it will remain. Once this is determined the fat is cauterized to remove the proper amount and the incisions are closed with dissolvable stitches.

What is the downtime?

Most people will develop some swelling in the cheeks for up to 10 days. After this, minor residual swelling may persist for a few weeks. By 6 weeks, the cheeks should noticeable slimmer.

What is the cost?

The cost ranges from $4,500 and up depending on the type of anesthesia and whether or not other surgeries are combined.

How do I know if I am a candidate?

Dr. Neavin can often tell by photos if a physical exam in prohibitive based on location. The buccal fat generally feels like a sponge, or Tempur-Pedic mattress.

Why do you sometimes do fat transfer when you are taking fat out?

Beautiful faces are about harmony. Both addition and subtraction of volume are important in many cases to harmonize the face.


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