Fat pads can be removed through surgery, injectable treatments, or fat-freezing procedures, depending on where the fat pad is and how much reduction you’re after. The most common areas people target are the cheeks (buccal fat pads), under the chin (submental fat), under the eyes (orbital fat pads), and around the knee (infrapatellar fat pads). Each location calls for a different approach, and some have non-surgical alternatives worth considering first.
Buccal Fat Pad Removal
Buccal fat pads sit on both sides of the face along the front edge of the jaw muscle, between the inner cheek and the jawbone. They’re the main reason some people feel their face looks round or “chubby” even at a healthy weight. Removing them creates a slimmer, more contoured cheek hollow.
The surgery is relatively straightforward. A plastic surgeon makes a small incision on the inside of your mouth, on the inner portion of the cheek. The fat pad is gently pressed out through this opening and excised. The incision is then closed with absorbable sutures that dissolve on their own. Because the cut is inside the mouth, there’s no visible scar. The average surgeon’s fee is about $3,142, according to the American Society of Plastic Surgeons, though this doesn’t include anesthesia, facility fees, or other related costs, which can push the total higher.
Recovery takes roughly three weeks before you feel normal again. Expect swelling, bruising, and some numbness around the incision sites during that period. The final, settled result typically takes several months to fully appear as residual swelling continues to resolve. During healing, you’ll want to avoid disturbing the sutures with your tongue until your surgeon clears you.
The Long-Term Risk of Facial Hollowing
This is the part many people don’t hear about before surgery. Everyone naturally loses facial fat as they age. The cheeks gradually hollow on their own over the decades, which is a key reason faces look thinner and more angular in middle age. Removing buccal fat pads accelerates that process. A paper in Plastic and Reconstructive Surgery Global Open titled “Buccal Fat Pad Excision: Proceed with Caution” highlights that no long-term follow-up studies on buccal fat removal outcomes have been published. The largest concern is progressive midface hollowing that makes the face look gaunt years later.
Reports are already appearing on plastic surgery forums from patients who had buccal fat removed in their 20s or 30s and are now seeking fat grafting or filler injections to restore volume to their cheeks. If you’re young and considering this procedure, the result you love at 30 may look very different at 50. Surgeons increasingly urge caution, particularly for patients who are already lean-faced or have minimal buccal fat to begin with.
Under-Chin Fat Pad Removal
The fat pad beneath the chin, called the submental fat pad, is the one responsible for the appearance of a “double chin.” This area has more treatment options than almost any other fat pad because it’s accessible, well-studied, and common.
Injectable Treatment
A synthetic version of deoxycholic acid (a bile substance your body naturally uses to break down dietary fat) is the only FDA-approved injectable for submental fat. When injected into the fat layer under the chin, it destroys fat cell membranes permanently. The body’s immune cells then clear the debris, and the process also stimulates new collagen production, which helps tighten the skin in the treated area.
Treatments are spaced about 30 days apart, with most people needing four to six sessions to see full results. Each session involves multiple small injections across a grid pattern under the chin. The first session typically causes the most swelling, sometimes significant enough that you’ll want a few days of downtime. Because the fat cells are permanently destroyed, results are lasting as long as your weight stays stable.
Fat Freezing
Cryolipolysis uses controlled cooling to kill fat cells without breaking the skin. A small vacuum applicator called the CoolMini received FDA clearance in 2015 specifically for small treatment areas. It’s designed to fit the contour under the chin and in other compact zones like the front armpit area and the small fat pads above the knees. The treated fat cells crystallize, die, and are gradually flushed out by the body over the following weeks. Results are more subtle than surgery or injectables but involve virtually no downtime.
Liposuction
For larger volumes of submental fat, or when you want a one-session result, surgical liposuction remains the most direct option. A tiny cannula is inserted through a small incision under the chin to suction out the fat. Recovery is faster than most people expect, usually a week or two of compression garment wear and mild swelling.
Under-Eye Fat Pads
The puffy bags that form under the eyes are caused by orbital fat pads pushing forward as the tissue holding them in place weakens with age. Lower eyelid surgery (blepharoplasty) is the standard fix, but the approach matters a lot.
Simply removing the protruding fat converts a “bulge” problem into a “hollow” problem. The area under the eye can end up looking sunken and dark, which often looks worse than the original puffiness. For this reason, many surgeons now prefer to reposition the fat rather than remove it. The fat is shifted downward to fill in the hollow groove (the tear trough) that runs from the inner corner of the eye toward the cheek. This smooths the transition between the lower eyelid and the cheek instead of creating a new contour issue. If you’re exploring this surgery, ask specifically whether your surgeon plans to remove or redistribute the fat, and why.
Knee Fat Pad (Hoffa’s Fat Pad)
Not everyone searching for fat pad removal is thinking about cosmetics. The infrapatellar fat pad, also called Hoffa’s fat pad, sits just below the kneecap behind the patellar tendon. It can become inflamed, scarred, or restricted after knee surgery or from repetitive irritation, causing persistent anterior knee pain.
Conservative treatment is the first step. Stretching the quadriceps and the muscles at the front of the hip can relieve pressure on the fat pad. A physical therapist can assess whether the fat pad moves freely by shifting it side to side and comparing its mobility to the uninjured knee. Restricted movement, confirmed by a positive Hoffa test (pain when pressing directly on the fat pad), points to adhesions or scarring that may respond to manual therapy and targeted exercises. Patellar mobility is also checked by gliding and tipping the kneecap at about 60 degrees of knee bend.
If conservative treatment fails, arthroscopic surgery can trim or debulk the fat pad. This is typically reserved for cases where scar tissue from a prior surgery has restricted the fat pad enough to limit knee extension or cause chronic pain. In rare situations where a safe surgical plane between the patellar tendon and the fat pad can’t be established arthroscopically, an open procedure is recommended to avoid damaging the tendon.
Choosing the Right Approach
The best removal method depends on three things: where the fat pad is, how much volume you want gone, and how much downtime you can tolerate. Injectables and fat freezing work well for small, accessible areas like the submental zone but aren’t options for buccal or orbital fat pads, which require surgical precision. Facial procedures carry the added consideration of long-term aging effects that body procedures don’t.
For cosmetic fat pad removal, the single most important factor is choosing a surgeon who regularly performs the specific procedure you need and who can show you before-and-after photos of patients with a similar facial or body structure to yours. Volume matters too. A conservative removal can always be revised later, but replacing fat that’s already been taken out is far more difficult and expensive than leaving a little extra in place.