Buccal fat removal: What is it, and why do doctors urge caution about this plastic surgery trend?

Across social media, many users, primarily younger women, are buzzing about a plastic surgery technique called buccal fat removal. While the procedure is simple and has been around for years, it’s grown in popularity for those drawn to the look of a narrow, angled facial structure.

The surgery, which is done under local anesthesia, involves incisions being made in the back of the mouth so some of the fat in the cheek area can be removed. It is nearly impossible to reverse, causing some concern among experts. 

Dr. Ira Savetsky, a plastic surgeon in New York City, told CBS News that he has seen an increase in patients requesting the “irreversible” procedure, which is called a bichetomy. 

“The interest in the buccal fat pad really just stems from people’s sort of obsession with having a really defined and countered jaw line,” Savetsky said. “And I think that’s all driven from social media. In this era of selfies and just photos in general … people really started to notice, more than ever, their jawline, and buccal fat is something that is very intriguing to people.” 

The surgery is purely cosmetic and does not have any medical benefits, but some people are better candidates for it than others, said Dr. Rod Rohrich, a Dallas-based plastic surgeon.

“In about one in 10 patients that come to me for buccal fat removal is (the procedure) really indicated,” Rohrich said. “Basically, it’s fat in front of the jawline… If you bite down and pucker, if (your cheeks are still) full, then you are a candidate for buccal fat removal, but most people aren’t.”  

Savetsky and Rohrich were two of several authors of a 2021 paper on buccal fat’s role in facial surgeries where they noted an increase in people requesting the procedure, writing that “social media have triggered a buccal fat pad excision frenzy.” 

Savetsky said the procedure is often “lumped in with Botox and fillers” because of the ease of the operation and its impact on the face, especially among a “younger demographic.” 

However, unlike those temporary enhancements, buccal fat removal has long-term effects. Because people naturally lose fat as they age, “what looks good at 20 or 30 may not look good at 50 or 60,” Savetsky said.

“Fat is very precious in the face,” said Rohrich. “Removing fat at any phase in your life is usually not a good idea. … And it’s hard to put it back in. It’s almost impossible, actually. It’s really important not to remove (buccal fat) if you don’t have to.” 

Savetsky said that for plastic surgeons, it’s important that a person’s future facial features be considered. 

“You can’t be overly aggressive and remove a significant amount,” Savetsky said. “It’s quite easy to remove too much, so you have to be really gentle and only remove the excess and leave a normal amount behind so that as the patient ages, they don’t age prematurely and get an overly hollow lower face.”