Buccal Fat Pad

What is Buccal Fat Removal Surgery?

Buccal fat (Bichat's fat pad) is a specialized mass of fat located below the cheekbone and anterior to the masseter muscle. It develops from early childhood through the 20s, forming the rounded fullness of the face. According to a study in Aesthetic Plastic Surgery (2024, DOI: 10.1007/s00266-024-04245-1), the volume of the buccal fat pad averages 7.8–11.2 mL in males and 7.2–10.8 mL in females, with individual variations.

By removing this fat through a small intraoral incision, cheek fullness is eliminated, the cheekbones appear higher, and the facial line becomes sharper. Unlike non-invasive lifting methods, this procedure physically removes the fat tissue itself, so the results are semi-permanent.

The Mechanism of the Procedure and Its Anatomical Basis

The buccal fat pad exists directly beneath the oral mucosa, on the inner side of the buccinator muscle. In the prestigious journal Plastic & Reconstructive Surgery (2023, DOI: 10.1097/PRS.0000000000009914), Drs. Rohrich & Jalalabadi proposed the "Five Ds" method, which emphasizes a five-step approach prioritizing anatomical safety. The incision is made near the second upper molar, 1 cm below and 1 cm posterior to Stensen's duct (parotid duct), with a width of approximately 1 cm.

Anatomical structures requiring careful attention include the facial nerve, parotid duct, and internal maxillary artery, which are in close proximity. The paper explicitly states: "By avoiding excessive retraction and bluntly dissecting the buccinator muscle, the risk of damage to these critical structures can be minimized." Our clinic adopts surgical techniques prioritizing safety based on these findings.

Procedural Steps

Local anesthesia (lidocaine + epinephrine) or intravenous anesthesia is administered, and the oral mucosa is incised by approximately 1 cm. Using specialized instruments, the buccal fat is gently extracted, the appropriate amount is removed, and the area is sutured with absorbable sutures. Since the incision is inside the mouth, no scarring appears on the outer surface of the face. The procedure typically takes 30–60 minutes for both sides, including anesthesia.

Downtime and Recovery

For 1–2 weeks post-procedure, mild swelling and discomfort inside the mouth may occur. External cheek swelling typically improves within 2–4 weeks. Soft foods can be consumed immediately after surgery, but irritating foods and alcohol should be avoided for about 1 week. Since absorbable sutures are used, suture removal is often unnecessary, and patients can typically return to work or school within 3–5 days. The final results can be fully assessed after swelling completely subsides, typically at 3–6 months post-procedure.

The Importance of Appropriate Patient Selection

The aforementioned paper (Rohrich 2023) emphasizes that "appropriate patient selection is key to preventing an aged or unnatural appearance." Since the buccal fat is also a supportive structure of the face, excessive removal can result in hollowed cheeks. Additionally, in patients with significant age-related skin sagging, removal may worsen anterior cheek laxity. During a consultation with the attending physician, bone structure, fat volume, and skin condition are evaluated to plan the optimal amount of fat to be removed.

Combination with Other Procedures

Buccal fat removal can be combined with other facial contouring procedures such as masseter botox or thread lifting to create more three-dimensional facial lines. Research in Aesthetic Plastic Surgery (2024) reports that combining buccal fat removal with submental and cervical liposuction produces superior improvements in lower facial silhouette. We propose the optimal combination suited to each individual's facial structure.