Buccal fat pad removal is a cosmetic surgery that takes out pockets of fat from the lower cheeks to create a slimmer, more contoured face. The procedure is relatively quick, typically performed through a small incision inside the mouth under local anesthesia, and costs an average of $3,142 for the surgeon’s fee alone. Around 4,900 of these procedures were performed in the U.S. in 2023, according to the American Society of Plastic Surgeons.
What the Buccal Fat Pad Actually Is
The buccal fat pads are two rounded masses of fatty tissue, one on each side of your face. They sit between the chewing muscles in your cheeks: specifically along the front edge of the masseter (the muscle you feel when you clench your jaw) and against the buccinator, the deeper muscle in your cheek wall. The French anatomist Xavier Bichat first described them in 1801 as fat balls wedged between muscle, bone, and skin.
Everyone has them, but their size varies considerably from person to person. Larger buccal fat pads give the face a rounder, fuller appearance in the mid and lower cheeks. They’re also the reason some people retain a “baby face” well into adulthood, even at a healthy weight. The fat pads naturally shrink somewhat with age, which is why facial fullness tends to decrease over time on its own.
How the Surgery Works
The procedure is straightforward compared to many cosmetic surgeries. Surgeons use an intraoral approach, meaning the incision is made inside your mouth rather than on your face, so there’s no visible scarring. The cut is placed in the upper gum line area or along the inner cheek at the level where your teeth meet, carefully positioned to avoid the parotid duct (the tube that delivers saliva from your parotid gland into your mouth).
Once the incision is made, the surgeon separates the buccinator muscle fibers to expose the fat pad. Gentle pressure is applied to the outside of the cheek to push the fat into the opening, where it’s clamped and removed without excessive pulling. The wound is closed with dissolvable stitches. The whole process is usually done under local anesthesia when performed on its own, though general anesthesia may be used when it’s combined with other procedures like a facelift or rhinoplasty.
Who It Works Best For
The best candidates are people with naturally round or full lower cheeks who want more prominent cheekbones and a more sculpted midface. The fullness should come from the fat pads themselves, not from overall body weight. If you’re overweight, the results may be barely noticeable because subcutaneous fat throughout the face will mask the change.
Several facial types are poor fits for this procedure. People with naturally narrow or thin faces risk looking gaunt or hollow after removal. Older adults face a different concern: as skin loses elasticity with age, removing the volume underneath can lead to sagging in the lower face. For older patients, buccal fat removal is sometimes paired with a facelift to prevent that drooping effect.
Recovery and Results Timeline
Expect swelling, bruising, and some numbness around the incision sites in the first few days. You’ll likely be placed on a liquid diet for several days after surgery, and your surgeon may prescribe a special mouth rinse to lower the risk of infection since the incision is inside your mouth, surrounded by bacteria.
Healing time is roughly three weeks, but don’t expect to see your final results that quickly. The cheeks will remain swollen for a while, and the true contour change typically becomes visible over several months as swelling fully resolves and tissues settle into their new shape. Patience during this period is important, because early post-operative swelling can actually make your cheeks look fuller than they did before surgery.
Risks and Complications
Buccal fat removal is generally considered safe, but the anatomy in this area is complex, and complications can be serious when they occur. The buccal branches of the facial nerve run near the fat pad, and damage during surgery can cause facial paresis, a temporary weakness or partial paralysis on one side of the face. This complication is rare but has been documented in case reports, and it underscores the importance of choosing a surgeon with detailed knowledge of the anatomy in this region.
Other potential complications include infection, hematoma (a collection of blood under the tissue), asymmetry between the two sides, trismus (difficulty opening the mouth), and injury to the parotid duct. Over-resection is another risk: removing too much fat can create an excessively hollow appearance that’s difficult to reverse, since the fat pads do not grow back.
The Aging Question
This is the most debated aspect of buccal fat removal. Because your face naturally loses volume as you age, removing fat from your cheeks in your 20s or 30s could leave you looking prematurely gaunt decades later. The concern is logical: you’re permanently removing tissue that would have provided cushioning and fullness as other age-related volume loss occurs.
The honest answer is that long-term data is limited. Published studies have typically followed patients for six months or less, and researchers have explicitly noted that longer follow-up would be needed to evaluate outcomes over time. No large study has tracked patients 10 or 20 years after buccal fat removal to confirm or rule out accelerated facial aging. This is worth weighing carefully, because the procedure is irreversible.
Buccal Fat Removal vs. Masseter Botox
These two procedures both slim the face, but they target completely different structures. Buccal fat removal takes out fat from the cheeks. Masseter Botox involves injecting a muscle relaxant into the jaw muscles, causing them to gradually shrink and soften a wide or square jawline. One reshapes the midface, the other reshapes the lower jaw.
The tradeoffs are predictable. Buccal fat removal is permanent since the fat pads don’t regenerate, but it requires surgery and a few weeks of recovery with noticeable swelling. Masseter Botox requires no downtime and involves no incisions, but results last only four to six months before repeat injections are needed. Masseter Botox can also temporarily affect chewing sensation as the jaw muscles relax, though this is usually mild. Buccal fat removal doesn’t affect muscle function at all, so chewing, speaking, and facial expressions remain unchanged.
Some people pursue both procedures for combined cheek and jawline slimming, but the choice depends on whether your concern is cheek fullness, jaw width, or both.
Cost Breakdown
The average surgeon’s fee for buccal fat removal is $3,142, but that number doesn’t reflect the full bill. You’ll also pay for anesthesia, the surgical facility, prescriptions, and any pre-operative tests. These additional costs vary widely depending on your geographic location and whether the procedure is performed in a hospital, surgical center, or office-based suite. Because buccal fat removal is purely cosmetic, health insurance does not cover it.