Buccal fat reduction

The usual complaint is lower-cheek fullness that does not follow body weight. The person may already be lean. Family photographs often show the same lower-cheek volume in a parent. Smiling can push the pad forward and make the lower cheek look suddenly round; at rest the face may still lack a clean line from cheekbone to jaw.

What the operation can do is reduce the contribution of that deep pad to the lower cheek. What it cannot do is slim an entire face, lift tissue that has descended toward the corner of the mouth, or create cheekbone projection that is not there. Those are different structures.

It helps to separate four things that are often mixed together in the same sentence:

• Deep buccal fat — the pad described above. This is the target of buccal fat reduction.

• Superficial fat under the skin of the lower cheek, jawline and under the chin — that is a facial liposuction problem when it is excessive.

• Cheekbone projection — underdevelopment flattens the midface and is treated with fillers or implants, not by taking fat out of the cheek.

• Soft-tissue descent around the mouth — the perioral mound. Further removal from this area is usually the wrong direction; tightening or volume restoration may be more useful.

3D imaging is useful here because it shows why the fullness is perceived, and whether the plan should be buccal fat reduction alone, liposuction of the superficial layer, a combination of the two, or something else entirely. The simulation is a planning tool. It is not a photograph of the healed result.

The better candidates have genuine lower-cheek volume from the deep pad, reasonably good skin quality, and a face that will still look supported after a conservative reduction. A strong cheekbone that is currently masked by that lower fullness is a common and sensible setting.

It is a weaker plan when the face is already lean, when elasticity has fallen, or when the request is for a generally slimmer face rather than a specific lower-cheek pad. In those settings the same operation can look empty later, particularly as the rest of the facial fat thins with age. A borderline indication in a younger face can become a poor indication twenty years on. That is part of the consultation, not an afterthought.

A round facial outline is often not a buccal-fat-only problem. On the older practice pages we have said the same thing directly: for a relatively round contour, reduction of the pad by itself is usually not enough, and a combination with liposuction to the lower face and jawline is more often the honest plan. We would rather say that before surgery than discover it afterwards.

Facial sculpting is the principle of integrated changes in proportion — cheeks, chin, jawline and neck — rather than one isolated gesture. Buccal fat reduction is one instrument in that group.

Combinations that come up often:

• Facial liposuction — when there is also excess fat immediately under the skin of the lower cheeks, jawline or under the chin. The two operations treat different layers. Liposuction of the upper cheek is generally less successful and carries higher risk; the lower cheek, jawline and under-chin are the usual territory.

• Chin enhancement — when the lower third is also under-projected, so the face is built at the chin and reduced in the central cheek rather than asked to look sculpted from one change alone.

• Cheek implants — when the bone is flat and the central cheek is heavy. They are not substitutes for each other.

• Anterior neck lift or a deeper neck contouring operation — when under-chin volume or the neck contour is part of the same lower-face picture.

• Fat transfer — if a previous reduction has gone too far, or if another area needs volume at the same time as the lower cheek is reduced. Over-reduction of the pad can be softened with fat transfer; it cannot restore the original anatomy.

Nonsurgical filling of the cheekbone can sometimes rebalance a face that feels heavy below without touching the pad. That is a different conversation, and 3D planning is the place to have it.

Access is through the inside of the mouth. There is no incision on the skin of the face, and no external scar to hide.

Through that intra-oral opening the lower part of the buccal fat pad is identified and reduced. The upper part of the pad, sitting under the cheekbone, is left. The aim is reduction of the portion that contributes to lower-cheek fullness, not ablation of the whole pad. Taking the entire pad is how a face is skeletonised.

The isolated operation takes about 45 minutes. It can be done under local anaesthetic, under sedation, or under general anaesthetic, according to the person and to whatever else is being done in the same sitting. It is a day-case procedure.

Dissolvable stitches are used in the mouth. When the operation is combined with other facial sculpting — liposuction, chin work, implants, neck contouring — the anaesthetic choice and the length of the day follow the larger plan.

The consultation has to establish which layer is actually responsible for the look the person dislikes. Photographs from the front, the three-quarter views and a smile view are more useful than a single profile. Family photographs help when the fullness is hereditary.

Medical history and the medicines actually taken belong in the same conversation. Blood thinners raise the bleeding risk and need specific management around facial surgery. Raised blood pressure does the same. Both have to be known and planned for; they are not incidental details on a form.

3D imaging and simulation are used to test the target: how much lower-cheek change is wanted, whether the superficial layer also needs to come down, and whether the chin or the cheekbone should move at the same time. The simulation will differ from the outcome. That caveat is part of how we use it, not a disclaimer added later.

Fees are confirmed in writing after the consultation. They follow the plan — isolated buccal fat reduction is a shorter day than the same operation combined with liposuction, a chin implant or neck contouring — so a figure quoted before that plan exists is not a useful figure.

The first concern after buccal fat reduction is the intra-oral wound. Chewing against the suture line can open it and invite infection. A soft diet for the first week is the practical protection — fluids, yoghurt, soups, anything that does not need real chewing, including food put through a mixer. It is not a calorie restriction.

Brushing can put too much pressure on the stitches in the early days. An antiseptic mouthwash several times a day keeps the line clean. A short course of antibiotics is usually given for the first week; probiotics sit alongside that to reduce the chance of an upset stomach. If diarrhoea starts, the antibiotic should be stopped and the practice or the GP told.

Pain is typically limited. There is no tight skin flap and no external wound under tension, and many people barely use the painkillers they are given. Pain that is more than mild in the first days is not the expected course and should be discussed rather than waited out.

Swelling in the cheek after an isolated reduction is usually modest. A more swollen cheek than the one you started with, in the first day or two, can simply be the wound. Marked or one-sided swelling can reflect bleeding and needs a call. Desk work is often realistic within several days; looking completely unoperated is not a promise attached to a calendar date. Strenuous exercise and anything that drives the blood pressure up should wait until the mouth has settled — typically around two to three weeks, longer if other procedures were done in the same sitting.

The shape change is not fully readable on day seven. Deeper settling continues over the following weeks and months. If the plan also included liposuction or other sculpting, the recovery follows the more demanding part of that plan.

Every intra-oral operation carries a risk of bleeding, infection and wound breakdown. The parotid duct and branches of the facial nerve travel in the same region as the pad; injury is uncommon when the reduction is conservative and the anatomy is respected, and it is still part of consent.

The limits that belong on this page rather than in a generic list:

• Asymmetry. Faces are not the same on the two sides before surgery. A reduction can improve balance; it does not erase a difference that was already there, and it can leave a small difference of its own.

• Over-reduction. The change is permanent. Fat transfer can put volume back into a hollow cheek; it does not rebuild the original pad.

• Under-reduction. If the superficial layer was the main problem, the face will still look heavy after the deep pad has been reduced.

• Hollowing later in life. A reduction that looks right in a full, elastic face can look too empty once the rest of the facial volume has thinned. That is why a borderline case, particularly with falling elasticity, is often better left alone.

• Surface texture. Acne scarring on the central cheek can become slightly more visible if the skin is under less tension after the pad is reduced. Scarring toward the side of the nose and the front of the cheek is less affected.

• Dimples. New dimpling is not the expected result in a full lower cheek. If a face has been over-reduced, fat transfer is the usual way to soften the hollow.

Anaesthetic risk is low in a healthy adult and is discussed with the anaesthetist when sedation or general anaesthetic is used. Local anaesthetic alone avoids that conversation but does not remove the surgical risks.