Buccal Fat Removal Risks: Is It Right for Your Face?
By Dr. Sushrut Tated, plastic surgeon
Buccal fat removal risks include swelling, stiffness of the jaw, bleeding, infection, uneven cheeks and, rarely, injury to a facial nerve branch or the saliva duct. The biggest long-term concern is looking hollow or older years later, because cheeks naturally thin with age. It suits a carefully chosen few with genuinely full lower cheeks. See buccal fat removal.
Dr. Sushrut explains buccal fat removal
What is buccal fat?
The buccal fat pad is a pocket of fat deep in each cheek, between the cheekbone and the jaw muscles. It helps give the lower cheeks their fullness. Removing part of it, through a small cut inside the mouth, can slim a round lower face and sharpen the line under the cheekbones. The procedure has become popular on social media, which has also made it easy to underestimate its downsides.
Who is a good candidate?
Buccal fat removal tends to suit people who:
- have genuinely full lower cheeks from prominent buccal fat, not from weight, jaw muscles or loose skin;
- are at a stable weight;
- are young to middle-aged adults whose faces are not already thinning;
- have realistic expectations of a subtle change.
It is usually not a good choice for:
- a naturally slim or long face;
- older adults, where cheeks are already losing volume;
- fullness caused mainly by large chewing muscles (masseters), jowls or general weight;
- anyone hoping to change their face shape completely.
Buccal fat removal risks
| Risk | What it means | How common |
|---|---|---|
| Swelling and bruising | Expected; can last a few weeks | Very common |
| Jaw stiffness (trismus) | Difficulty opening the mouth wide for a while | Fairly common, usually temporary |
| Bleeding or haematoma | Collection of blood in the cheek | Uncommon |
| Infection | Usually settles with antibiotics | Uncommon |
| Asymmetry | One cheek different from the other | Uncommon |
| Facial nerve branch injury | Weakness of part of the smile, usually temporary | Rare |
| Saliva (parotid) duct injury | Swelling or leak of saliva | Rare |
| Over-removal | Hollow, gaunt or older look, sometimes years later | The main long-term concern |
Most complications are temporary and treatable. The long-term change in face shape is the reason surgeons remove buccal fat conservatively.
Why can it make you look older later?
Facial fat naturally reduces with age, especially in the cheeks. A face that looks pleasantly slim at 25 after removal may look hollow at 45. This is why many surgeons take only part of the pad, avoid it in older adults, and discuss how your face might age.
What happens during the procedure?
- Assessment: your face is examined at rest and smiling to see what is causing the fullness.
- Anaesthesia: usually local anaesthesia, sometimes with sedation.
- Procedure: a small cut inside each cheek; the fat is gently teased out and a measured amount removed; dissolving stitches close the cut.
- Time: usually under an hour; you go home the same day.
Recovery timeline
| Time | What to expect |
|---|---|
| First week | Swelling, soft diet, antiseptic mouthwash, sleep with the head raised |
| 2 weeks | Stitches dissolve; most return to work within days |
| 1 month | Swelling largely settled |
| 3 to 6 months | Final contour visible |
Alternatives for a slimmer lower face
| Concern | Options |
|---|---|
| Fat under the chin or jaw | Neck or chin liposuction; see liposuction surgery |
| Large jaw muscles | Muscle-relaxing injections by a qualified doctor |
| Loose skin or jowls | Facelift or mini facelift |
| General facial fullness | Gradual weight change |
| Flat cheekbones | Adding volume with fat or fillers instead of removing it |
Myths about buccal fat removal
- “It suits everyone who wants a sharper face.” Many faces are better served by another option or none.
- “It is a tiny procedure with no real risk.” It is a real operation near nerves and the saliva duct.
- “Results show the next day.” Swelling hides the change for weeks.
- “More removal gives a better result.” Over-removal is the commonest cause of regret.
When should you see a doctor?
Before deciding, to find out what is actually causing your facial fullness. After surgery, seek help for swelling that keeps increasing, fever, pus, weakness of the smile or swelling when eating.
What to ask
- Is my fullness from buccal fat, muscle, weight or skin?
- How much would you remove, and how might my face age?
- What are the alternatives in my case?
- What happens if I am unhappy with the result?
For assessment and the procedure, see buccal fat removal. If volume is lost later, read fat grafting vs fillers or see fat grafting.
Frequently asked questions
Is buccal fat removal permanent?
The removed fat does not grow back. That is why careful selection matters: the cheeks also thin with age, and too much removal can look hollow later.
Does buccal fat removal leave a scar?
No visible scar. The fat is removed through a small cut inside the mouth, which heals in a couple of weeks.
When will I see the result?
Swelling hides the change for the first few weeks. The cheeks settle gradually, and the final contour is usually judged after about three to six months.
Can buccal fat removal make me look older?
It can if too much is removed or if it is done in someone whose cheeks are not truly full. Older adults and people with a thin face are usually not suitable.
Can the result be reversed?
Lost volume can be partly restored later with fat grafting or fillers, but it is better to remove conservatively in the first place.
References
- Buccal Fat Pad Reduction (StatPearls). NCBI Bookshelf, StatPearls Publishing.
- Buccal fat pad removal to improve facial aesthetics. PubMed Central (NIH).
- Buccal fat reduction: indications, surgical techniques, complications. PubMed.
- Prevalence of complications of buccal fat removal: a systematic review. PubMed.
