Buccal Fat Pad
Buccal fat pad surgery is designed to refine facial and cheek contours by removing or repositioning the buccal fat pads.
What is Buccal Fat Pad Surgery?
Buccal fat pad surgery refines facial contours by selectively removing or repositioning the buccal fat pad, a distinct pocket of fat located deep in the midface. This fat pad naturally provides youthful fullness, but in some individuals, excessive volume or drooping fat pads can create overly rounded or heavy cheeks, disrupting facial balance.
In younger patients, the procedure — performed through a discreet incision inside the mouth — creates a more sculpted, contoured appearance without visible scarring. In more mature patients, age-related sagging of the buccal fat can widen the lower face and soften jawline definition. In these cases, combining buccal fat removal with a deep plane facelift offers a more comprehensive rejuvenation.
Achieving elegant, natural results requires both surgical precision and a deep understanding of facial harmony. Over-removal can lead to premature hollowness, which is why the most refined outcomes may include combining this procedure with fat grafting or strategic fillers to restore subtle volume and maintain a timeless, balanced look.
What concerns does buccal fat pad address?
- Facial Contouring and Definition
- Reduction of “Chubby Cheeks”
- Aging and Facial Fullness
- Improvement of Jawline and Cheekbone Visibility
The Dr. Azizzadeh Difference
Dr. Babak Azizzadeh has pioneered advanced techniques for buccal fat pad modification, achieving balanced and natural results that preserve youthful fullness. Dr. Azizzadeh developed the concept of the “Facial Anatomic Subunit Analysis”, which views the face as a collection of interconnected regions working together to achieve overall harmony, with the buccal fat pad playing a central role.
When applied to buccal fat pad surgery, this innovative approach ensures that adjustments to the cheek area complement and enhance other facial features, preserving balance and natural aesthetics. Furthermore, the buccal fat pad is intimately associated with the facial nerve, making a deep understanding of facial nerve anatomy essential when addressing this area, particularly during a deep plane facelift. As the leading expert in facial nerve anatomy, Dr. Azizzadeh’s unmatched expertise ensures patient safety and optimal results while minimizing risks to this delicate structure.
Dr. Azizzadeh’s meticulous attention to detail and emphasis on individualized planning ensure that buccal fat pad modifications enhance facial contours while maintaining a natural appearance that ages gracefully. His nuanced approach has garnered attention in Elle, Glam, and other prominent publications, highlighting his expertise in creating effective and aesthetically pleasing results.
Dr. A's Insider Tips
“Simultaneous repositioning with limited removal is the most effective approach for prominent or drooping buccal fat pads. This technique refines “chubby cheeks,” accentuates high cheekbones, and softens deep nasolabial folds. “
Buccal Fat Pad
Non-Surgical Alternatives
Non-surgical alternatives to buccal fat pad removal are limited, with no truly comparable option available. Deoxycholic acid (Kybella™) injections, while sometimes suggested as an alternative, are not precise for targeting buccal fat and can potentially affect surrounding fat regions and nerves in this sensitive area. Given the complex anatomy of the cheeks, including numerous nerves and fat compartments, using fat-dissolving injectables in this region carries significant risks and is generally not recommended as a substitute for surgical buccal fat removal.
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FAQ
It’s normal to have questions before a procedure. If you have additional questions or concerns, book a consultation today.
There is no specific “ideal” age for buccal fat pad surgery, as candidates can range from younger to older individuals depending on their unique anatomy and facial concerns. However, several factors determine the appropriate timing for this procedure. For younger patients, it is generally advisable to wait until the facial features, including the fat compartments, have fully matured. This typically occurs around 23–25 years of age, when natural changes in facial fat distribution have stabilized. Performing the surgery before this point may yield suboptimal results as the face continues to develop and change. For older patients, buccal fat pad surgery is often part of a more comprehensive facial rejuvenation plan, such as a deep plane facelift. Aging can cause the buccal fat pad to descend or lose its structural support, leading to drooping or fullness in undesirable areas. Repositioning the buccal fat pad in these cases can enhance facial contours and restore a youthful balance without compromising essential volume.
Ultimately, the timing of buccal fat pad surgery depends on the patient’s goals, anatomy, and stage of life. A consultation with a skilled surgeon, such as Dr. Azizzadeh, is essential to determine whether buccal fat pad surgery—or an alternative approach—is the best option for achieving natural, long-lasting results
Ideal candidates for buccal fat removal are individuals with noticeable fullness in the cheeks or drooping fat pad leading to poor facial shape. This procedure is most suitable for a subset of patients, primarily those with significant facial roundness who desire a more contoured appearance. For younger patients, buccal fat removal may be performed as a standalone procedure if the fat pad contributes to excessive cheek fullness. However, it is crucial to carefully assess the long-term impact, as removing buccal fat in younger individuals can accelerate facial aging. For older patients, especially those with drooping or displaced buccal fat due to aging, repositioning the buccal fat pad as part of a deep plane facelift is often more beneficial. This approach not only reduces cheek fullness but also preserves or enhances volume in key areas like the midface, ensuring a natural, youthful appearance.
Buccal fat removal is generally considered a safe procedure when performed by an expert surgeon; however, it does carry certain risks, including nerve damage, bleeding, bruising, infection, and complications related to anesthesia or sedation if required. One of the most significant concerns is the potential for premature aging, particularly in younger patients. Unlike other facial fat pads, buccal fat resists age-related degradation, and its removal can leave the face looking hollow or gaunt as natural fat loss occurs over time.
That said, when the procedure is performed with precision and judicious consideration, it can offer significant aesthetic benefits, even for younger individuals in their 20s with a naturally rounded face. In such cases, the advantages of achieving a more sculpted, contoured appearance often outweigh the potential risk of volume loss in the future, provided that the surgeon tailors the approach to the patient’s unique anatomy and long-term goals.
For patients undergoing a deep plane facelift in conjunction with buccal fat modification, the surgeon’s expertise in facial nerve anatomy is paramount. The buccal fat pad is closely associated with major branches of the facial nerve, and its repositioning or partial removal requires meticulous technique to avoid nerve injury. This underscores the importance of choosing a highly skilled and experienced surgeon to ensure safe, natural-looking, and long-lasting results.
Yes, buccal fat pad removal and chin implant surgery are commonly combined procedures, as they work synergistically to enhance facial contours and create a more balanced, sculpted appearance. Buccal fat pad removal reduces fullness in the lower cheeks, slimming the face and emphasizing the natural angles of the jawline. Meanwhile, a chin implant enhances chin projection, improves facial harmony, and strengthens the profile, particularly when there is a recessed or weak chin. Together, these procedures address complementary areas of the face, providing a cohesive improvement that enhances the overall aesthetic. Combining these surgeries is also convenient for patients, as it minimizes downtime and allows for a single recovery period while achieving comprehensive facial contouring results. This approach is particularly appealing to individuals seeking a sharper, more defined facial structure that looks both natural and proportional.
Yes, buccal fat pad removal and a deep neck lift are often performed together because they address complementary areas of facial and neck contouring, creating a cohesive and rejuvenated appearance. Buccal fat pad removal slims the mid-to-lower face, reducing cheek fullness and enhancing definition in the jawline, while a deep neck lift tightens and sculpts the neck, addressing sagging submandibular glands, excess fat, and muscle banding. When combined, these procedures harmonize the transition between the face and neck, delivering a well-balanced and youthful aesthetic. An added benefit is that these procedures can often be performed with almost no visible incisions, making them particularly appealing to younger patients with good skin elasticity who do not require a deep plane facelift to reposition facial tissues or remove excess skin. Chin augmentation may also be included in this combination for patients with recessed chins seeking further enhancement of the jawline and profile, as it strengthens chin projection and complements the slimming effects of buccal fat removal and the refinement of a deep neck lift. This strategic combination maximizes results, reduces overall recovery time, and is ideal for individuals aiming for comprehensive contouring of the lower face and neck.
Yes, buccal fat removal is a permanent procedure. Once the fat pads are removed, they cannot regenerate or be replaced naturally. This permanence makes careful patient selection and meticulous surgical planning crucial, particularly for younger individuals who may not fully consider the long-term effects on their facial appearance as they age.
As the aging process continues, other facial fat compartments naturally atrophy, and bony resorption in areas like the jawline and midface can occur, potentially altering the structural balance of the face. Combined with the inevitable loss of skin elasticity and increased laxity, these changes can accentuate hollowing in the cheeks and contribute to the development of jowls. Additionally, once the buccal fat pad capsule is encroached upon during surgery, it becomes part of a gliding plane that, if not properly supported or suspended intraoperatively, can descend toward the jawline, further affecting facial contours over time.
These factors underscore the importance of selecting a highly skilled and experienced surgeon for buccal fat removal. Expertise in facial anatomy and aging dynamics is essential to ensure the procedure is performed in a way that maintains long-term balance and harmony, preventing complications or undesirable outcomes such as an overly gaunt appearance or facial asymmetry. A surgeon with the right knowledge can also integrate techniques like fat pad suspension or repositioning to preserve support and optimize results.
Buccal fat removal can significantly impact how the face ages, particularly if not performed with careful planning. As natural facial volume diminishes with age, removing the buccal fat pad can exacerbate hollowing in the cheeks, leading to a prematurely aged or gaunt appearance. Younger patients may notice these effects in their 30s or 40s, often requiring fillers or fat grafting to restore lost volume.
Even when not removed, the buccal fat pad can shift and droop with age, widening the lower face, obscuring the jawline, and contributing to jowls. If the buccal fat pad capsule is disrupted during surgery and not properly supported or repositioned, it can descend further, affecting facial balance and contours. Additionally, age-related atrophy in other fat compartments, bony resorption, and skin laxity can amplify these changes, leading to sagging and loss of facial definition.
Choosing an experienced surgeon is crucial to mitigate these risks. A skilled surgeon can preserve long-term harmony by integrating techniques like fat pad suspension or repositioning, ensuring a natural, youthful result that ages gracefully.
Buccal fat does not grow back after removal, as the procedure permanently removes a portion of the fat pad. However, substantial weight gain could cause the remaining fat cells in the area to expand, potentially altering the appearance of the cheeks.
Preparation
For the best results and swiftest recovery, we recommend the following leading up to your procedure.
Preparation for buccal fat pad surgery is essential to achieving optimal results and ensuring a smooth recovery. Dr. Azizzadeh and his team tailor each patient’s preparation plan to their unique needs and health history. Below is a step-by-step guide to help you prepare effectively.
Begin your preparation by discontinuing smoking, vaping, or using nicotine products, as they can impair healing and compromise your surgical results. Focus on maintaining a healthy lifestyle through a balanced diet, hydration, and regular exercise to optimize your overall health. If you have recently undergone non-surgical treatments, such as dermal fillers or botulinum toxin injections, discuss these with Dr. Azizzadeh to ensure they will not interfere with your procedure. This is also a good time to plan your time off work, arrange post-operative care, and gather any supplies you’ll need for a smooth recovery.
At this stage, you may need to complete pre-operative tests such as blood work or an EKG, particularly if your procedure involves general anesthesia. For buccal fat pad surgeries under local anesthesia, testing may not be necessary. Discontinue the use of aspirin, anti-inflammatory medications, and certain herbal supplements to reduce the risk of bleeding during and after surgery. Take care of personal grooming, such as waxing or facial treatments, since these activities may not be allowed during the recovery period.
Attend a preoperative visit with Dr. Azizzadeh to finalize your surgical plan and address any lingering questions. This meeting is an opportunity to thoroughly discuss expected outcomes, potential risks, and detailed post-operative care instructions. Use this time to stock up on essential supplies, including prescribed medications, cold compresses, and comfortable pillows. Make arrangements for someone to drive you home after the procedure and assist you during the first 24-72 hours of recovery.
If your surgery requires general anesthesia, avoid eating or drinking after midnight. For procedures performed under local anesthesia, follow the specific dietary guidelines provided. On the morning of the surgery, shower with antibacterial soap if instructed, avoid applying makeup or skincare products, and wear loose-fitting clothes that button or zip in the front. Arrive at the surgical facility on time and prepare for a positive experience, knowing you are in expert hands.
By following these preparation steps and consulting closely with Dr. Azizzadeh and his team, you can ensure a smooth surgical experience and recovery, maximizing the benefits of buccal fat pad surgery.
Recovery
During this initial phase, swelling and bruising are most noticeable but will begin to subside. If you are having an isolated buccal fat pad procedure under local anesthesia, the incisions are inside the gums and Dr. Azizzadeh may recommend a clear liquid diet for 48 hours to prevent risk of infection. Your swelling will be similar to wisdom teeth removal in the jowl region. You should rest but also take short walks in shaded areas outdoors to help you recover more quickly. You can usually start resuming daily activities, work, and errands towards the end of this period. For buccal fat pad removal in conjunction with a deep plane facelift, you need to follow the guidelines of the deep plane facelift section.
You will start looking presentable and can attend social events. However, some swelling may persist. You can return to normal exercise and physical activity three weeks after surgery.
Most soft tissue healing occurs during this time. Refinement of the cheeks will continue to take place and your face will look more natural. Numbness around the ear and face will normalize if you had a face or neck lift.
If you had a deep plane facelift, the incisions will fully heal within 12-18 months, resulting in thin, nearly invisible scars. Treatments such as scar gels, lasers, and sometimes steroid injections may be used during this time to make the incisions undetectable.
Pain Management: Avoid ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) as they can increase the risk of bleeding and bruising. If you experience severe pain, contact your surgeon immediately.
Medications and Supplements: To ensure optimal healing and reduce the risk of complications, avoid blood thinners and certain medications for 2 weeks before and 2 weeks after surgery. These include Aspirin, NSAIDs (such as ibuprofen, Advil, and Naprosyn), fish oil, herbal supplements, and vitamins. Additionally, refrain from smoking, vaping, all nicotine products, cannabis/marijuana, and illicit drugs during this period.
Swelling and Bruising: In the first 72 hours after surgery, use cold compresses for 20 minutes per hour while awake to reduce swelling and bruising. After this initial period, switch to warm compresses applied for 20 minutes, three times a day, to help alleviate bruising and promote healing. Additionally, you will be given arnica and bromelain to help reduce swelling and bruising. Arnica is a natural remedy known for its anti-inflammatory properties, and bromelain, an enzyme found in pineapples, helps decrease swelling and bruising. At the time of surgery, you will also receive a dose of steroids to minimize swelling. In some cases, a short course of steroids may be prescribed after surgery to manage excessive swelling. This regimen helps manage discomfort and accelerates the recovery process.
Nausea and Diet: If you are having an isolated buccal fat pad procedure under local anesthesia, you will not experience any form of nausea and since the incisions are inside the gums and Dr. Azizzadeh may recommend a clear liquid diet for 48 hours to prevent risk of infection. If you are undergoing buccal fat pad with a deep plane face and neck lift, you will require IV sedation or general anesthesia. With modern anesthesia methods and our special protocol, post-operative nausea is much less common and very manageable. During surgery, your anesthesiologist will administer intravenous anti-nausea medications and specialized anesthetics that limit gastrointestinal issues. Additionally, you will be prescribed Emend™ to take three hours before surgery to prevent nausea and Ondansetron (Zofran®) for breakthrough discomfort. Avoid complex or heavy foods 24 to 48 hours after surgery. Consume clear liquids and bland, easy-to-digest foods such as broth, plain toast, or crackers. Gradually reintroduce solid foods to ease digestion and minimize discomfort. Hydration is crucial in the post-operative period. If submandibular gland modifications are performed, follow a bland diet, avoid spices, and opt for soft foods to minimize discomfort and swelling in the neck area.
Incision Care: If you are having an isolated buccal fat pad procedure, the incisions are inside the gums and there is minimal incision care. The sutures are dissolvable within a few weeks and you only need to avoid manipulating it with your tongue. If you are having buccal fat pad removal with deep plane facelfit, gently clean your incisions in the first week with half water and half hydrogen peroxide once a day for the first 7 days. After cleaning, apply an antibiotic ointment, such as Neosporin or Mupirocin, over all incisions three times daily to prevent infection and promote healing. After the first week, discontinue hydrogen peroxide and antibiotic ointment. Steri-strips or silicone gel will be recommended to support further healing. For areas with crusting, applying Vaseline can keep the skin moist. Minor irregularities behind the ear are normal and may be treated with massage, scar gel or, occasionally, steroid injections.
Hair Management: There is no hair issue if buccal fat is removed as a stand alone procedure with gum line incision.
Additional Support: We recommend considering an aftercare facility following your Buccal Fat Pad procedure only if you are undergoing simultaneous deep plane facelift. These specialized facilities offer comprehensive post-surgical care with skilled nurses, ensuring you receive the highest level of attention and support during your recovery. By choosing an aftercare facility, you can enjoy a smooth and stress-free post-operative period, allowing optimal healing and peace of mind.