Buccal Fat Removal: Insights and Considerations
Many of us dream of possessing the striking bone structure of a supermodel, yet most of us rely on makeup, facial implants, injectables, or exaggerated facial expressions (think Ben Stiller in Zoolander) to approximate such a look. However, for those who still carry excess fat in the lower face even after shedding other baby fat, there's a surgical solution: buccal fat removal.
"‘Blue Steel’ [from Zoolander] epitomizes the exaggerated buccal fat look – that's the area we're discussing," elucidates Dr. L. Mike Nayak, a board-certified plastic surgeon in St. Louis. By reducing the fat pad in this cheek area, the region "transforms from convex to concave." While this cheek-enhancement procedure isn't suitable for everyone, individuals with naturally fuller faces – like Chrissy Teigen, who previously underwent buccal fat removal – might experience a significant shift in their facial balance.
For the uninitiated: Buccal fat pad removal generally requires local anesthesia (unless combined with other procedures, which might necessitate general anesthesia) and involves a small incision inside either cheek, closed with dissolvable sutures. This procedure comes with some discomfort and swelling.
When performed skillfully, the results of buccal fat pad removal can be remarkably subtle. However, akin to many facial plastic surgeries, less favorable outcomes can make the patient appear older than their actual age – beyond the scope of facial rejuvenation. To better evaluate the results you see on doctors' websites and social media, we consulted board-certified surgeons, who detailed what to look for in high-quality before-and-after images of buccal fat removal surgery.
1. Facial Expressions, Angles, and Lighting
In any set of before and after photos, consistency is key, particularly in how the patient's portrait is captured. Surgeons are expected to follow specific guidelines when creating photo galleries. When reviewing before and after images independently, look for consistent expressions (e.g., a patient shouldn't smile in one image but not the other) and ensure the subject faces the same direction – ideally, at a three-quarter view, which is the optimal angle for assessing a buccal fat removal procedure.
Photo editing can mask numerous surgical flaws, even if the provider isn't intentionally altering the results but rather creating a more balanced image. However, adjusting the lighting post-editing can impact the outcome's appearance more than you might expect. To ensure uniform lighting across both photos, Dr. Nayak recommends observing the patient's pupils. "Sometimes, in a before photo, the eye surface is completely dark due to overhead lighting," he explains. "In an after photo, you might see the reflection of the flash or the ring light or the window they're standing in front of on their pupil."
2. Enhanced Facial Balance
An easy way to determine if you're a candidate for buccal fat removal is to assess your lower cheek area and jawline. If they are disproportionately full for your weight and age – "say, [the patient] is in their 30s and still has this chipmunk-like appearance," notes Dr. Karam – you might be a suitable candidate for this surgery. A good before photo will display a round face shape and plump cheeks, while the after photo will show a more top-heavy face.
"The focal point of the face appears to shift a couple of inches higher [in a good after photo]," states Dr. Nayak. "Instead of the balance resting at the plane between your upper and lower teeth, it now rests at the cheekbone, just beneath the eyes, causing the point of maximum focus to ascend." For this reason, Dr. Nayak often performs buccal fat removal as part of a facial fat rebalancing procedure, widening the upper cheek to create a more harmonious facial appearance.
3. Consistent Positive Outcomes
This applies to any plastic surgery procedure, but especially to buccal fat removal. You need to review numerous examples of a surgeon's work before undergoing this surgery, as once the fat is removed during cheek reduction, it's irreversible – and fillers can't fully restore the lost volume to your facial look.
"It's crucial to understand whether a provider specializes in this type of procedure and performs a significant number of them," advises Dr. Karam. By examining dozens of before and after images from a single expert-level buccal fat removal surgeon, you'll gain insight into the consistency of their cosmetic surgery work despite variations in individual results. After all, "any surgeon can have a successful outcome occasionally," Dr. Karam points out. For a higher chance of satisfaction from your surgery, look for before and after images of patients with a facial configuration similar to yours. This will provide the most accurate indication of what your result might look like.
4. Natural Contours and Highlights
Consider the heavy contouring and highlighting makeup trends around 2016 – makeup enthusiasts carved out cheekbones using a product several shades darker than their skin tone and added dimension by applying a lighter, often shimmery shade to the high point of the cheek. While that extreme makeup trend has waned, buccal fat removal offers a comparable (if not more refined) and permanent result.
"That cheek transitions from full and bright in the buccal area to either flat or slightly concave and dark," remarks Dr. Nayak regarding a favorable result. "You're witnessing the contour change." While a three-quarter view of a cheek contoured with makeup might reveal the wearer's true bone structure, it will precisely showcase the outcome of a buccal fat removal surgery. "The best way to observe it is at the three-quarter view of the cheek that is farther away," says Dr. Nayak. "You can see the cheekbone contour and then its inward curve at the buccal region."
While you might desire a strikingly sculpted cheekbone, you don't want an extreme outcome from buccal fat removal. "In the '70s or '80s, buccal fat removal was highly popular due to the aesthetic ideal of the sucked-in, thin-face, model cheek," recalls Dr. Karam. "It led to numerous deformities from excessive removal of the buccal fat pads." As we age, facial volume naturally diminishes, and if you've removed a significant amount through buccal fat removal, you'll end up looking gaunt and hollow instead of chiseled and stylish.
