Buccal Fat Removal Years Later: What Happens to the Face Over Time

14 hours ago

5 min read

Buccal fat removal became one of the most requested facial procedures of the early 2020s. The pad sits in the lower cheek, between the muscles of the face, and removing it narrows the lower face. Enough time has now passed for the longer view, and for patients to arrive asking what can be done about it.

Deep plane facelift before and after
Deep plane facelift before and after
Fox eyes lift before and after

Quick answer

Removing the buccal fat pad narrows the lower cheek permanently. Published series report low complication rates for the operation itself. The long-term question is different: the face continues to lose deep fat with age, so volume removed in the twenties is volume that is missed later. Patient selection matters more than technique.

What the pad is and what removing it does

The buccal fat pad is a discrete, encapsulated body of fat in the cheek, separate from the subcutaneous fat layer. It has a main body and several processes extending in different directions. It does not shrink with dieting in the way subcutaneous fat does, which is why some people have full cheeks regardless of their weight.

Removing it through a small incision inside the mouth narrows the lower cheek and slightly increases the shadow below the cheekbone. The change is modest immediately and becomes clearer over two to three months as swelling settles.

What the published data show

According to PubMed:

A single-centre retrospective study of 302 patients operated under local anaesthesia with a standardised protocol reported an overall complication rate of 1.99% (95% confidence interval 0.73% to 4.29%), all haematomas or seromas and all on sides where the pad was only partially removed. No complications followed complete resection. All resolved with aspiration or drainage, without reoperation or permanent nerve injury, and satisfaction at six months was 96% (Shu and colleagues, Aesthetic Plastic Surgery, 2026).
A prospective cohort of 151 patients used the buccal fat pad as a flap to reconstruct defects after permanent filler removal, combined with a deep plane facelift, with 80.7% rating their result very good or excellent and contour irregularities in 10.6%. Satisfaction was 88.5% for primary surgery and 33.4% for revision surgery (Ghoraba and Ismail, Aesthetic Plastic Surgery, 2026).
A case series on salivary duct injury after facial cosmetic procedures, including buccal fat removal, describes endoscopic treatment that preserved gland function in all five patients, and notes that only 27 such patients have been described in the literature (Melo and colleagues, Brazilian Journal of Otorhinolaryngology, 2026).

Two conclusions follow. The operation is safe in trained hands. And the pad has uses beyond being removed.

The long view

The deep fat compartments of the face shrink with age on their own. A face that looked full at 25 is usually noticeably less full at 45 without any surgery. If a pad was removed at 25, the loss at 45 starts from a lower baseline.

This does not mean every patient regrets it. People who were genuinely round in the lower face often remain satisfied for decades. The patients who report problems are usually those who were not very full to begin with, or who had a complete removal when a conservative one would have been enough.

If the result looks hollow

Fat transfer is the usual treatment. It replaces volume with the patient’s own tissue and can be repeated. It restores fullness but not the exact original contour.
Filler gives a temporary answer and is a reasonable way to test how much volume would help before committing to a graft.
A lift does not fix hollowness. If the midface has also descended, lifting and volume are both needed; our article on combining procedures covers how that is planned.

If you are considering it now

Judge your lower face at a stable weight, in flat lighting, not in a photograph taken from below.
Ask whether a conservative partial removal would be enough, and discuss the complication data above, which favour complete removal on one measure and conservatism on another.
Consider your family: look at older relatives with a similar face shape to see how the fullness behaves over time.
Remember that the operation cannot be undone, only compensated for.

What to ask at the consultation

Am I actually full in the buccal area, or is the fullness elsewhere?
How much would you remove, and why that amount?
What will this look like when I am twenty years older?
What is your complication rate and how are duct injuries avoided?
Is there a non-permanent way to preview the change?

Frequently Asked Questions

Does buccal fat removal age the face?

It does not accelerate ageing, but it removes volume that the face would otherwise lose anyway with time. In a young face with full cheeks the effect can be pleasing; in the same face twenty years later, when the deep fat pads have shrunk on their own, the removed volume is missed. The risk is greatest in patients who were thin to begin with.

How common are complications?

Low in published series when the procedure is standardised. According to PubMed, a single-centre retrospective study of 302 patients reported an overall complication rate of 1.99%, consisting of haematoma or seroma, all of which occurred on sides where the pad was partially rather than completely removed; satisfaction at six months was 96% (DOI).

Can it be reversed?

Volume can be replaced, although the original anatomy cannot be restored. Fat transfer is the usual approach. Our article on fat transfer and nanofat explains how much grafted fat survives.

Is the buccal fat pad ever useful in later surgery?

Yes, which is one reason to be careful about removing it. A prospective study of 151 patients used a buccal fat pad flap to reconstruct soft tissue defects after permanent filler removal, combined with a deep plane facelift, with 80.7% of patients rating the outcome very good or excellent (DOI). A pad that has been removed is no longer available for this.

What are the serious risks?

The pad sits near the parotid duct and branches of the facial nerve. Duct injury is rare but significant. A case series on managing salivary duct injuries after facial cosmetic procedures included patients injured during buccal fat removal and after facelift surgery, treated endoscopically with gland preservation (DOI).

Who is a reasonable candidate?

Someone with genuinely full lower cheeks, a round lower face and stable weight, who understands that the change is permanent and that the face will continue to lose volume with age. Someone slim, with prominent cheekbones and hollow midface, is not.

About the Author

This article was written and medically reviewed by Prof. Dr. Suleyman Tas, a plastic, reconstructive and aesthetic surgeon in Istanbul with over 20 years of experience. He is the author of Rhinoplasty in Practice (CRC Press, 2020), has more than 40 peer-reviewed scientific publications and five patents, and teaches facelift and rhinoplasty techniques to surgeons at international courses. Read more about Prof. Dr. Suleyman Tas.

Individual results vary. Before and after photos and videos are shared with patient consent. This article is for general information and does not replace a personal medical consultation.

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