Buccal Lipectomy (Cheek Reduction)

Are You Bothered by a Full Face?

Permanent facial contouring has garnered more attention and curiosity recently. A full or chubby face can be bothersome. Buccal fat removal, also known as buccal lipectomy, is a cheek reduction procedure that forever slims and contours upper cheek and the junction of the mid and lower face. This minor surgical procedure is performed comfortably under local anesthesia in the office. The recovery is swift and the cheek hollows blossom within weeks. Patients often remark that friends and family believe they have lost weight.

How to Pronounce ‘Buccal’

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Patients are commonly uncertain about how to say the word buccal. During the initial consultation, a patient may point to their cheek fullness and indicate that they want it improved but do not know the name. ‘Buhk-uhl’ or ‘Buek-uhl’ are two frequently spoken variants. The actual phonetic spelling of buccal is buk’al, but do not not feel embarrassed about the pronunciation, it’s not a big deal. We understand what you mean and have a solution for you.

Determining If Buccal Lipectomy is the Correct Procedure for You

A patient may be a good candidate for buccal fat removal if they describe their face as chubby, full, round, plump, chipmunk, ballon-like, or oversized. Others may feel like they lack cheek hollows or contour. When the buccal fat pad is contributing to excessive facial fullness, examination and analysis reveal an outpouching or convexity of the cheeks in the area just below the cheekbones. Gently sucking in the cheeks can simulate the potential outcome of buccal fat removal. If this simulation is attractive then buccal fat removal may be the procedure for you.

Anatomy of the Cheeks and Buccal Fat Pad

Buccal is defined as pertaining to, adjacent to, or in the direction of the cheek. The buccal fat pad was first identified and described as Bichat’s fat pad in the 18th and 19th centuries respectively. A complete understanding was achieved in the 21st century. The buccal fat pad lives in the deep space of the cheek. This means, in relation to the inside of the mouth and outside of the body, the fat pad is sandwiched in the middle of the cheek. Buccal fat pads contribute to part of the upper cheek volume. Other components of facial fullness in this region include the teeth, jaw, mucosa, muscles, connective tissue, vessels, nerves, glands, superficial fat, and skin.

The buccal fat is a normal structure found in the cheek and varies in size between individuals. Very chubby cheeks may have an abundance of buccal fat or may have a mild to a modest amount of buccal fat. The actual amount of buccal fat present is determined during the procedure when the fat pad is directly visualized.

The buccal fat procedure is done very comfortably, under local anesthesia. Recovery is quick and results start to become apparent just a few weeks after surgery. Patients often remark that friends and family have thought they’ve ‘lost weight’.

Removal of the Buccal Fat Under Local Anesthesia

At Ideal Face and Body, there is no need to be put asleep or have a breathing tube for this procedure; in fact, the majority of the surgeries involving the soft tissue are performed without the need for general anesthesia. This local anesthesia approach is especially true for cheek reduction or buccal fat removal.

After the patient is thoroughly examined, marked, and given a detailed explanation of the procedure, they are offered light sedation with relaxation medications given by mouth, as well as laughing gas. Due to our excellent numbing technique, sedation is not mandatory and the patient may decline some or all medications.

With the patient resting comfortably on their back, the mouth is cleaned, the planned incisions are marked, and using a practically painless shaking technique the cheeks are completely numbed from the inside of the mouth.

Once the cheeks are numb, small openings are created inside the mouth, one on each side. Careful dissection under direct visualization is performed and the perfect amount of buccal fat is removed from the cheek. To avoid over resection, only the offending cheek fat is removed by expressing it from the intraoral incision. Roughly two to three millimeters of fat are removed from each cheek. This fat volume is equivalent to removing two to three syringes of filler from each cheek. We like to say, “bye-bye buccal.” The procedure is completed by closing the incisions with absorbable sutures. The sutures do not have to be removed because they will dissolve or fall out on their own.

To fuller slim the face, it is not unusual to combine buccal fat removal with other procedures such as PRECISION SCULPT® chin, neck, and jawline, facial fat transfer, and botox to the masseter muscles.

Recovery After Buccal Fat Removal

At the completion of the procedure, a custom facial garment is applied followed by ice packs. The garment supports and compresses the empty buccal space. The cooling effect of the ice helps decrease swelling. The patient is able to walk out of the office and rest in the comforts of their own home. To further decrease swelling, we recommend sleeping on the back with the head elevated on two pillows. The patient is allowed to shower the day after the procedure. The garment is worn most of the time while at home and at night for one week. The cheek swelling is similar to that of dental work such as wisdom tooth removal.

Occasionally one cheek is more swollen than the other. Swelling typically peaks in two to three days and then gradually decreases to a more acceptable level in one to two weeks. To decrease irritation and increase comfort, we recommend maintaining a diet of soft foods and non-acidic cold drinks for two to three days after the procedure. Water is always a good choice because it is hydrating, gentle, and keeps the area clean. Unrestricted exercise is resumed in one to two weeks.

Cosmetic Outcome After Buccal Fat Removal

The results of buccal fat pad removal begin to take shape after approximately two weeks of healing. Over the next couple of months, the cheeks become slimmer and more contoured as the swelling recedes and the scar tissue remodels. A smooth natural aesthetic transition, not an abrupt contour change, develops under the cheekbones and the desire for heavy facial contouring with makeup typically diminishes with time. Men often achieve a more chiseled appearance. The outcome is a beautifully refreshed upper cheek curve, not a gaunt or excessively aged appearance.

Buccal Lipectomy (Cheek Reduction) Photos

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Frequently Asked Questions and Answers Regarding Buccal Fat Removal

If you have large upper cheeks then removal of the buccal fat may be the correct procedure for you. This is determined by a facial analysis during a consultation.

Although the buccal fat has extensions outside of the cheek, all of the cheek buccal fat is removed during the procedure.

Buccal fat removal is essentially scarless because the incisions are inside of the mouth and disappear with time.

There are no scars on the skin of the face. The only incisions are inside of the mouth.

All of the buccal fat in the cheek is removed.

Approximately two to three syringes of filler equivalent are removed from the cheek.

This question has more than one answer. We find that the most common reason is that most surgeons have limited or no experience with the buccal fat and therefore do not offer the procedure. Lacking the surgical skill set and experience regarding the removal of the buccal fat is usually associated with not recommending the procedure. Another factor is the somewhat dogmatic opinion that cheek fat should never be removed from the face. The one-sided opinion is propagated as all-encompassing without distinguishing between thin faces and chubby faces. The reality is that some patients are great candidates and others are not. A thin contoured cheekbone hollow should not be further emptied because this will likely result in a gaunt appearance. On the other hand, a chubby full cheek will take on a more aesthetically pleasing appearance with a fat reduction. Lastly, there is an association with facial fat loss and aging. Therefore, some practitioners think that removal of cheek fat sets the stage for a larger cheek volume deficit in the older years. With proper patient selection the likelihood of this becoming a reality is minimized.

The buccal fat is removed forever and therefore will not return with an increase in weight.

It is thought that the buccal fat may assist in the gliding action of the muscle. Decades of experience have demonstrated no decrease in muscle function or any untoward functional effects with the removal of the buccal fat. The buccal fat appears to be only a cosmetic concern.

Although buccal fat removal is a straight forward procedure, finding the fat pad during surgery is challenging for the novice or inexperienced surgeon. To increase the chances for the best outcome, it is to the patient’s advantage to seek a consultation with a plastic surgeon who has considerable experience with the removal of the buccal fat.

Although anti-septic mouthwashes may be used, we find that it is not necessary and does not enhance healing or recovery.

The cheek is completely numb when the buccal fat is removed. The recovery is described as sore.

Yes, a patient with braces can undergo buccal fat removal.

Yes, it’s common to combine face and body procedures during the same operation.

Patients that are 18 years or older are candidates for buccal lipectomy evaluation.

Fullness around the mouth is not due to the buccal fat so removing the buccal fat will not change the area around the mouth.

The buccal fat lives in the upper cheek and does not contribute to the jawline. Removal of the buccal fat does not change the jawline. The jawline is enhanced with PRECISION SCULPT®, fillers, and/or implants.

The buccal fat does not contribute to the jowls. Jowl fat is a different fat compartment and is addressed by PRECISION SCULPT®, Kybella, sutures, and/or a facelift.

The buccal fat pad is completely removed during the initial procedure so returning a second time will not result in additional fat removal. In the situation where a patient thinks that only a partial or minimal buccal fat resection has occurred by another surgeon, a revision may be undertaken but it typically proves unsuccessful due to the lack of fat and scarred tissue space.

Cheek dimples are related to muscles, not fat. Removal of the buccal fat does not typically interfere with cheek dimples.

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