Buccal Fat Removal
Refine a full, rounded midface by conservatively reducing cheek fat.
Buccal Fat Removal - Our Approach
Buccal fat removal, sometimes called a bichectomy, reduces the buccal fat pad, a deep pocket of fat in the lower cheek. In the right patient it can refine a full, rounded midface and bring out more definition below the cheekbone. It is a small procedure done through a tiny incision inside the mouth, so there is no visible scar. It is not a treatment for sagging or jowls, and it should be conservative, because the face naturally loses midface fullness with age and over-removal can look hollow years later.
InquireThe Ideal Candidate
- A naturally full or round lower cheek in a slim or normal-weight face
- A desire for more definition below the cheekbone
- Younger patients whose fullness is fat, not sagging
- Stable weight and realistic expectations
- Understanding that results are conservative and permanent
Procedure Quick Facts
Surgical Technique
The procedure is usually performed under local anesthesia, sometimes with light sedation. A small incision is made inside the cheek, and a measured amount of the buccal fat pad is gently teased out and removed. Only a conservative portion is taken to avoid a hollow look later. The incision inside the mouth is closed with dissolving sutures, so there is no external scar. Because the facial nerve and parotid duct sit nearby, precise technique and patient selection matter.
Who Is a Good Candidate for Buccal Fat Removal?
The best candidates have a genuinely full lower cheek from fat, a slim to normal-weight face, and a desire for more definition below the cheekbone. It is not appropriate when the fullness is from sagging, when the face is already thin, or when a patient is likely to lose midface volume with age. Final recommendations depend on an in-person exam, facial shape and age, skin quality, and goals. A conservative approach is emphasized because the effect is permanent.
Recovery
Recovery is usually mild. Cheek swelling and some soreness are common in the first days, and soft foods plus mouth rinses are typical because the incisions are inside the mouth. Swelling that makes the cheeks look fuller than the goal is expected early, and the slimming effect appears gradually over several weeks as it settles.
Days 1 to 3
Expect cheek swelling and mild soreness. Eat soft foods, keep the head elevated, and follow mouth-rinse instructions since the incisions are inside the mouth.
Week 1
Swelling peaks and then begins to ease. Many patients return to desk work within a few days to a week. The cheeks look fuller than the final result at this stage.
Weeks 2 to 6
Swelling continues to settle and the slimming effect gradually appears. Avoid vigorous activity until cleared.
Months 3 to 6
The final contour becomes clear as the last swelling resolves. Results are meant to be long lasting.
Buccal Fat Removal Risks & Considerations
Risks include bleeding, infection, prolonged swelling, asymmetry, and injury to nearby structures such as the facial nerve or the parotid duct, which are uncommon in experienced hands. The most important long-term risk is over-removal, which can create a gaunt or hollow look that worsens with the natural volume loss of aging. Adding volume back later is possible but harder than being conservative up front.
- Swelling and soreness
- Asymmetry
- Bleeding or infection
- Injury to the facial nerve (uncommon)
- Injury to the parotid duct (uncommon)
- Over-removal leading to a hollow or gaunt look
- A result that can look thinner with age
- Need for revision
Alternatives to Buccal Fat Removal
If the fullness is actually sagging or jowling, a facelift or neck lift addresses the real cause. If the face looks tired or deflated rather than full, facial fat grafting or fillers add support instead of removing fat. Some patients considering buccal fat removal are better served by jawline and chin balance through a chin implant. When in doubt, the conservative choice is to add definition elsewhere rather than remove fat the face may need later.
Buccal Fat Removal vs Facial Fat Grafting
These are opposite tools. Buccal fat removal takes volume out of the lower cheek to sharpen a full, rounded midface. Facial fat grafting adds volume to areas that look hollow. The right choice depends on whether the face reads as too full or too deflated, and some faces need neither. Removing buccal fat should be conservative, because the face naturally loses midface volume with age.
Facial Fat GraftingBuccal Fat Removal vs Facelift
Buccal fat removal refines fullness in the cheek but does not lift anything. A facelift repositions sagging tissue along the lower face and jawline. If the concern is a heavy or full cheek in a younger face, buccal fat reduction may help. If the concern is descent and jowls, a facelift addresses the actual cause.
FaceliftRelated Procedures
Medical Sources
Buccal Fat Removal - Frequently Asked Questions
- Is buccal fat removal permanent?
- Yes. The removed fat does not come back, which is why the amount taken should be conservative. Over-removal can look hollow as the face naturally loses volume with age.
- Will there be a visible scar?
- No. The incision is inside the cheek and closed with dissolving sutures, so there is no external scar.
- Who is a good candidate?
- Younger patients with a genuinely full, round lower cheek from fat, a slim to normal-weight face, and realistic goals. It is not for sagging or for already thin faces.
- How long is recovery?
- Most patients return to desk work within a few days to a week. Cheeks look fuller than the goal at first, and the slimming appears over several weeks.
- Can it be reversed?
- Not easily. Fat can be added back with grafting if too much was removed, but that is harder than removing a conservative amount to begin with.
- Does it help jowls or a double chin?
- No. Buccal fat sits in the cheek, not the jawline or neck. Jowls and neck fullness need different procedures.
Performed by Dr. Ruben Castro in Newport Beach, California