A cosmetic surgeon on the downsides of buccal fat removal surgery

When the age-old art of facial contouring with make-up went mainstream around a decade ago, a whole category of cosmetics was born alongside a culture of tutorials, demonstrating how to achieve the illusion of a more sculpted face. Meanwhile, advancements in injectable aesthetic techniques made way for more serious means of contouring, and the use of dermal fillers to define facial features became more accessible far and wide.

More recently, another ‘Hollywood secret’ for facial contouring has pierced the zeitgeist, that of the irreversible buccal fat pad removal surgery. With 263 million views of videos tagged ‘buccal fat’ on TikTok, it’s becoming a viral phenomenon to speculate which celebrities may have had the procedure (currently, Chrissy Teigen is the only A-lister to have publicly admitted to it), share one’s own experience of getting the so-coined ‘chubby cheek surgery’, or call out its downsides – of which there are significant ones.

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“Buccal fat removal has become quite the trending topic on social media with the younger population in their 20s talking about how they are undergoing the surgery to get that ‘suck-on-a-straw’ look,” plastic surgeon, and founder and owner of The Soni Clinic, Dr. Ashwin Soni tells me. “The current aesthetic trend is to enhance angularity in the face, and specifically accentuate the definition of both the cheekbones and the jawline, while losing the roundedness of one’s face.” It’s reflective of a wider cultural shift towards a perceived ideal of thinness, in parallel with the current revival of Noughties fashion. While this notion is concerning on various levels, one relating specifically to beauty culture is the normalisation of going under the knife at a young age. “I do feel as though these cosmetic surgeries are becoming normalised through social media platforms, which makes one slightly wary,” Dr. Soni adds. Whether or not this feeds into homogenised beauty standards (or more worryingly, is psychologically damaging for TikTok’s demographic, largely aged between aged 18-24), the surgeon wants to share what people might not know about buccal fat removal – and warn of the dangers – for anyone intrigued themselves.

How buccal fat removal works – and who it’s suited to

“Buccal fat removal is a relatively safe procedure, but only in very experienced hands,” warns Dr. Soni. Mostly performed under local anaesthesia, possibly with sedation, a plastic surgeon will “remove the excess fat from the buccal fat pads which are located deep within the cheeks”. This fat-removal process then reduces the appearance of lower cheek fullness.

“The benefits of buccal fat removal are to lose the roundedness of the face in those who feel as though they have wider and more rounded cheeks. It can also lead to a more defined facial structure, a more sculpted result, by removing this ‘baby-face’ look,” he explains. “The other benefit is that there is no scar on the outside; the scar is inside the cheek so it is hidden from view.”

When it comes to lower cheek fullness, Dr. Soni points out that anyone considering the surgery should be sure that this perceived fullness is due to the buccal fat pads, and not the masseter muscles. “The only way of knowing is to be examined by a plastic surgeon, to establish that the cause is not masseter hypertrophy – which is when that muscle of the jaw increases in size often secondary to teeth grinding or jaw clenching.” Masseter hypertrophy can also lead to a roundedness of the lower cheek, so it is important to differentiate between the two.

The downsides of buccal fat removal

There are of course risks to any surgery, Dr. Soni notes, and in the case of buccal fat removal “the risks include, but are not limited to, nerve damage, bleeding, bruising, infection, and the risks of sedation if sedation is used”. As already noted, this surgery is a permanent procedure, which brings with it a double downside; firstly, that it doesn’t ‘wear off’ like a non-invasive cosmetic procedure, and secondly that it can affect the way one’s face naturally ages. “If performed on a patient in their 20s, it can potentially accelerate facial ageing and cause patients to look very ‘hollowed out’ by the time they get into their 30s and 40s. Buccal fat is one of the few fat pads within the face that has been shown in scientific studies not to degrade as fast as other fat pads, so can be a saving grace for the ageing face. If patients end up looking too hollowed when they age, they may then require procedures such as filler or fat grafting to restore that facial volume that they lost as a consequence of the surgery.” The irony is not lost on me as I approach my 40s with some volume loss, which cosmetic doctors have told me I can remedy with filler (though I’d currently rather not).

It can potentially accelerate facial ageing

Buccal fat removal on social media versus real life

Another thing to note is that this surgery might not give you the results you see on TikTok or Instagram. “Buccal fat removal surgery should lead to a subtle change, and you should not really be able to notice that patients have had it done unless a surgeon removed too much buccal fat,” Dr. Soni explains, reminding us to only trust experienced practitioners who are listed on the General Medical Council online register (also look out for BAAPS and BAPRAS memberships). “Chrissy Teigen has spoken about it on social media, which generated quite the buzz, but what prospective patients seeing this don’t often realise is that many people who have had buccal fat removal have also had cheek and jawline filler in addition, which accentuates their sculpted and defined look.” Given that filler, in experienced hands, can be a very effective method of creating definition, “it can therefore enhance the appearance of the buccal fat removal surgery – so what people may be seeing in the media is often not simply the result of a buccal fat removal surgery, but also non-surgical work in addition to this”.


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