Aug 2, 2023
Mar 7, 2023
Permanent surgeries are irreversible. To prevent disappointing results, patients need to have specific reasons for undergoing the surgery, and not be carried away by the trends.
In 2022 and moving into 2023, buccal fat pad removal surgery has taken social media by storm. On platforms such as TikTok, Snapchat and Instagram, young women and men engage in social conversations surrounding turning to this surgery as a "shortcut" for a more sculpted and defined cheekbone.
Buccal fat pad removal surgery is designed to "thin" the cheeks for those who want to get rid of round cheeks or for those who don’t like their cheeks being ‘fat’ for a more sculpted, "chiselled", and modelesque appearance – which is weird, seeing as the rest of the older population is trying to plump theirs up! And this is one of the issues with this surgery, as we’ll find out later.
Interest in this surgery has significantly increased among the younger population, largely influenced by the "snatched look" of social influencers and celebrities they follow. Chrissy Teigen, a Hollywood actress and model, publicly shared that she had the surgery.
We asked Dr Ivan Puah, an aesthetics and liposuction doctor at Amaris B. Clinic in Singapore – and someone with over 17 years of facial and body sculpting experience – for a more medical view of the trend.
Basically, it’s the removal of the cheek pad (the word buccal comes from the Latin ‘bucca’ meaning cheek) – and young men and women, in particular, are increasingly turning to it as a shortcut to remove face fat in order to achieve a slimmer face.
"Buccal fat pad removal surgically removes the buccal fat pad (Bichat's fat pad), an encapsulated fat mass in the cheek to create more definition and angularity in the face. Bichat's fat pad is an important anatomical structure that affects facial aesthetics and facilitates muscle movement. Buccal fat pad develops significantly between ages 10 and 20. However, it gradually shrinks in size over the next 30 years as we age," explains Dr Puah.
Dr Puah describes the buccal fat pad as a unique and essential piece of facial structure. “It fills the deep tissue spaces and acts as a gliding pad when the masticatory and mimetic muscles (for chewing and showing expression, respectively) contract.”
And it profoundly impacts the look and shape of the face. The buccal fat pad develops significantly between the ages of 10 and 20 before gradually shrinking in size over the following 30 years.
Buccal fat pad removal is not a new procedure. Historically, it is performed in tandem with other facial rejuvenation surgeries. However, with the continued craze around the "snatched" look, the demand is picking up amongst patients in their 20s and 30s, who don't necessarily have extensive buccal fat but want to achieve the same chiselled look as that of their favourite celebrity or social influencer who had it done.
"The ideal candidate has prominent cheekbones that are obscured due to prominent cheeks. Buccal fat pad removal reduces cheek fullness and, in turn, highlights the cheekbones. However, it is not suitable for all patients. If you have malar hypoplasia (underdevelopment of the cheekbones) or an already gaunt face, it will just result in a hollowed appearance, making you look much older than your peers. For others, they must consider how this area naturally diminishes over time anyway, and how that will also impact the look.," explains Dr Ivan Puah.
The buccal fat pad is removed permanently during the surgery, and the effect is irreversible. Over-resection may occur when the plastic surgeon is overzealous or is not skilled or precise. A study has also concluded that there is a 26.3% chance of injury to the buccal branch.
"I have seen patients who had this form of facial plastic surgery done by other doctors and regretted it as they grew older. They requested treatments to replace the facial volume loss. What looked good then has led to an overly hollow appearance as time passed. Their objective has now shifted from looking chiselled and modelesque to desperately wanting to "reverse" the effects of the worn-out look. In such cases, dermal fillers or facial fat grafting may help to restore facial volume loss to the cheeks area," explains Dr Ivan Puah.
The buccal fat pad is a unique and essential facial structure. It fills the deep tissue spaces, acts as a gliding pad when masticatory and mimetic muscles contract, and profoundly impacts the look and shape of the face. If you want to slim down a bulky jawline (which could be due to an overactive masseter muscle), injectable neurotoxins can easily rectify this, says Dr Puah.
“I would perform facial liposuction for patients with excessive fullness in the lower face and cheeks. This not only addresses the issue of excess facial fat, but it also can effectively sculpt the jawline and lift and tighten saggy skin. Facial liposuction targets localised superficial fat while leaving the buccal fat pad – a critical support structure for the face – untouched.
It is easy to be carried away by the hottest trends and follow suit because everyone wants to look good. Believing too profoundly in an unrealistic view of ideals, in this case of one's appearance, can adversely affect an individual. Once the buccal fat pad is removed, it is permanent and irreversible. Therefore, you should have very specific reasons to remove the tissue, and it shouldn't be done just to look good on social media.
Dr Puah explains that facial liposuction delivers different results and is done for different indications compared to buccal fat removal . “It can eliminate excess fat from the cheeks, jowls, chin and upper neck,,” he says. “It also allows a skilled doctor to sculpt and recreate a more defined jawline and chin. Best of all, facial liposuction, if done in a specific way, helps to lift and tighten facial skin.”
Facial liposuction is, therefore, suitable for patients who wish to look slimmer and achieve facial skin tightening and a more defined jawline without affecting the buccal fat pad.
“Facial fat volume and distribution are essential in sustaining facial contours and youthfulness,” says Dr Puah. “Losing and removing too much facial fat will do the opposite and lead to facial hollowing that will only worsen with age.
“Once the buccal fat pad is removed, it’s permanent. It’s therefore critical to do as much research and understand the results that different surgical techniques and modalities can achieve before committing to permanent cosmetic surgery – as the effect is irreversible.”
 Benjamin M, Reish RG. Buccal Fat Pad Excision: Proceed with Caution. Plast Reconstr Surg Glob Open. 2018 Oct 16;6(10):e1970. DOI: 10.1097/GOX.0000000000001970. PMID: 30534506; PMCID: PMC6250453.
 Schultz, K. P., Raghuram, A., Davis, M. J., Abu-Ghname, A., Chamata, E., & Rohrich, R. J. (2020). Fat Grafting in Plastic Surgery: Fat Grafting for Facial Rejuvenation. Seminars in Plastic Surgery, 34(1), 30-37. https://doi.org/10.1055/s-0039-3402767