Buccal Fat Removal: Insights and Considerations
It's likely that none of us would turn down having the bone structure of a supermodel, yet most of us have to resort to makeup, facial implants, injectables, or overly exaggerated facial expressions (think Ben Stiller as Zoolander) to achieve a similar effect. However, for those with a bit of stubborn excess fat in the lower face even after the rest of the baby fat has vanished, there's a surgical option available: buccal fat removal.
"‘Blue Steel’ [from Zoolander] represents the exaggerated buccal fat look – that's the area we're referring to," explains Dr. L. Mike Nayak, a board-certified plastic surgeon in St. Louis. By eliminating some of the fat pad in this cheek area, the region "transforms from convex to concave." While not everyone is suitable for this cheek-enhancement procedure, those with naturally fuller faces – such as Chrissy Teigen, who underwent buccal fat removal previously – might notice a substantial change in their facial equilibrium.
For the uninitiated: Buccal fat pad removal typically demands local anesthesia (unless additional procedures are involved, which might require general anesthesia), along with a small incision on the inside of either cheek, which is subsequently closed with dissolvable sutures. It brings along some discomfort and swelling.
When executed proficiently, the outcomes of buccal fat pad removal can be extremely delicate. However, as with numerous facial plastic surgery procedures, subpar results can make the patient appear older than their age – and beyond the realm of facial rejuvenation. To better discern the kind of results you're observing from doctors' websites and social media feeds in 2024, we consulted with board-certified surgeons, who detailed precisely what to look for in high-quality before-and-after images of buccal fat removal surgeries.
1. Facial Expressions, Angles, and Lighting
When dealing with any set of before and after photos, you should seek consistency, particularly in how the patient's portrait was captured. In reality, surgeons are expected to adhere to specific guidelines when creating images for a photo gallery. When you're independently reviewing before and after snapshots, look for the same expressions in both (for instance, a patient shouldn't be smiling in one image but not the other) and ensure the subject is facing the same direction – ideally, at a three-quarter view, as this is the optimum angle for assessing a buccal fat removal procedure (more on this later).
Photo editing simplifies covering numerous surgical flaws, even if a provider isn't intentionally attempting to modify the appearance of their results but rather create a more balanced image. Nevertheless, merely adjusting the lighting afterwards using software can impact the outcome's appearance more than you might anticipate. To guarantee consistent lighting in both photos, Dr. Nayak suggests observing the patient's pupils. "Occasionally, in a before photo, the surface of the eye is completely dark because the light is solely from overhead lighting," he elaborates. "In an after photo, you might notice the reflection of the flash or the reflection of the ring light or the reflection of the window they're standing in front of on their pupil."
2. Enhanced Facial Balance
An effortless way to determine if you're a suitable candidate for buccal fat removal is to inspect your lower cheek area and jawline. If they are disproportionately full for your weight and age – "say, [the patient] is in their 30s and still has this chipmunk-like appearance," remarks Dr. Karam – you might be eligible for this surgery. A good before photo will display a round face shape and plump cheeks, and then [the after photo will] present a face that is more top-heavy.
"The focus of the face seems to be a few inches higher [in a good after photo]," states Dr. Nayak. "Instead of the balance of the face resting at the plane between your top and bottom teeth, it's now at the cheekbone, just beneath the eyes, causing the point of maximum focus of the face to ascend." For this reason, Dr. Nayak frequently conducts buccal fat removal as part of a facial fat rebalancing operation, widening the upper part of the cheek to create a more harmonious facial appearance.
3. Consistently Excellent Outcomes
This holds true for any plastic surgery procedure, but particularly for buccal fat removal. You need to ensure you review numerous examples of a surgeon's work when undergoing this surgery because once the fat is removed during cheek reduction, it's permanent – and fillers can't effectively restore the lost volume to your facial look to the same extent.
"It's extremely crucial to understand whether a provider specializes in this type of procedure and if they perform it frequently," says Dr. Karam. By reviewing dozens of before and after images from a single expert-level buccal fat removal surgeon, you'll obtain an idea of how consistent their cosmetic-surgery work is despite individual result variations. After all, "virtually any surgeon can achieve a successful outcome every now and then," Dr. Karam points out. For an even greater chance of satisfaction from your surgery, look for before and after images of patients with a facial configuration similar to yours. It will be the most precise indication of what your result could potentially look like.
4. Natural Contours and Highlights
Think about the intense contouring and highlighting makeup trends around 2016 – cosmetics enthusiasts carved out cheekbones using a product several shades darker than their skin tone and then added more dimension by applying a lighter and often shimmery shade to the high point of the cheek. While that extreme makeup trend has declined, buccal fat removal offers a comparable (if not more subtle) and permanent outcome.
"That cheek transitions from full and bright in the buccal area to either flat or slightly concave and dark," says Dr. Nayak regarding a good result. "You can observe the contour alteration." And while a three-quarter view of a cheek that's been contoured with makeup might reveal the wearer's true bone structure, it will accurately showcase the outcome of a buccal fat removal surgery. "The best way to view it is at the three-quarter view of the cheek that is farther away," says Dr. Nayak. "You notice the cheekbone contour and then its inward curve at the buccal region."
While you might desire a dramatically sculpted cheekbone, you truly don't want an extreme outcome from buccal fat removal. "In the '70s or '80s, buccal fat removal was highly popular due to the aesthetic ideal of the sucked-in, thin-face, model cheek," recalls Dr. Karam. "It led to numerous deformities from excessive removal of the buccal fat pads." As we age, facial volume naturally diminishes, and if you've removed a significant amount with buccal fat removal, you'll end up looking gaunt and hollow rather than refined and stylish.
