If you purse your lips to whistle or drink through a straw (and look in a mirror) you will usually notice a more chiseled, hollow look. Essentially, you are drawing your cheeks inward and it can be a good look on many people.

However, if you have chubbier cheeks or a rounded look to your face, and are not past age 25 or so, you should consider long and hard before having buccal fat extraction. Most persons in their late 20s to early 30's start to lose fat on their face and begin to naturally see a thinner-cheeked appearance as they age. If you choose to have this surgery and your face naturally thins later on, it may result in a gaunt look.

Research your hereditary facial structure by taking a good look at some of your older relatives and pictures of them when they were young. Did they look like you when they were younger and are they thinner-faced now? If so, you run the risk of looking too thin in an unhealthy way in later years if you have buccal fat pad removal. If your mother and father are still as chubby cheeked as they always were, then your face will probably not get thinner with time.      

Are You a Candidate for Buccal Fat Extraction?

For any cosmetic surgery, you have to be in good health and should not have any active disease or uncontrolled medical conditions. You also have to have realistic expectations of the outcome.  Communication is key in reaching your goal of how you want to look. You must be able to describe to your surgery what your desired results and expectations are. Discuss you goals with your surgeon so that you can reach an understanding of what can realistically be achieved.

You must be mentally and emotionally stable for this procedure. You need patience and stamina to deal with the healing period. A lull or depression frequently follows surgery and if you already have any emotional problems, this low period can develop into serious depression. 

Buccal fat extraction is not a very invasive procedure, but it will cause some pain and swelling. You will have to take it easy for a while to get the best results so consider this before deciding if it is for you.

What to Expect at your Consultation

At your consultation, you will meet with a surgeon and discuss your goals. You will decide if this surgeon can help you meet those goals.

Whatever your desires, just remember that if you are in your early twenties removing too much fat from your cheeks may not be a good idea.  Your surgeon may point out that removing a lot of fat may look good now, but when you begin losing this fat naturally as you get older, your face will look gaunt and haggard if you have too much removed now.

You will discuss your concerns and the surgeon will tell you the amount of cheek fat that can be removed without causing problems. Your surgeon will explain the techniques and incision placements that may be most appropriate for you and should also discuss all the risks associated with buccal fat extraction. In turn, you will disclose all information regarding your health: your family history, your own past diseases and surgeries, if you smoke, and what medications or vitamins you presently take. This last is very important. Your surgeon must have a complete list of all medications you take, including nonprescription medications.

The surgeon will also discuss anesthesia with you. Most buccal fat extraction procedures are performed under light sleep sedation, regional anesthesia with sedation, or local with oral sedation. However, some surgeons may use general IV sedation. You will not have general gas sedation because this procedure is performed through the mouth. All anesthesia has risks. You can read more at our Anesthesia Page.

At the consultation, you look at before-and-after photos of other patients on whom the surgeon has done buccal fat removal.  It is certainly reasonable to ask to see photographic documentation of the type of work your surgeon is capable of delivering. This can help you determine your surgeon's idea of what is aesthetically pleasing and help you get a realistic idea of what can be done.  

Your Preoperative Appointment

This appointment is a chance to ask more questions. You will also go over preoperative instructions and speak about the recovery period and what to expect in the months ahead. You may be given prescriptions for antibiotics and pain relievers.

Preparing for Your Surgery

You will be given information about what you should do before your surgery. Someone from your doctor's office may call you a few days before your surgery to remind you. You will be told not to take anything containing aspirin or ibuprofen for 7 to 14 days before your surgery. You will be given instructions about what to do with any other medications or supplements you take.

You will probably be asked to have blood tests done about a week in advance of your surgery. You may be asked to have a general physical 

How Buccal Fat Extraction Is Performed 

A buccal fat extraction usually takes about an hour. It can be combined with other procedures, including a face lift, but this will add to the length of the operation.

You will be given anesthesia, which may include an oral sedative. Usually, you will have an intravenous (IV) inserted into your arm. This will be used to administer anesthetics or sedatives. The anesthetics usually take effect quite quickly.

You will be injected with a solution of lidocaine (a local anesthetic), epinephrine, and saline. Epinephrine constricts the blood vessels and helps prevent excessive bleeding.  

In a buccal fat extraction, your surgeon will make an incision about 2 to 4 cm long inside your mouth, between your cheek and gums The incision will be towards the back of you mouth above your second upper molar.  He or she will then cut through the buccinator muscle, one of the main muscles of your cheek.  Then, by pressing on the outside of your cheek, the surgeon will cause the buccal fat to push through the incision.  Using a forceps, the fat bad will be pulled out a bit more and a portion of the fat will be removed. For some people, the amount of fat removed is the size of a golf ball, but the amount removed should be what is appropriate to your needs. 

The surgeon then closes your incisions with a nondissolvable type of suture.  He or she may put a piece of antibiotic-soaked gauze between your upper molars and your gums and apply a pressure dressing around the top of your head to underneath your chin. The types of sutures and dressings used varies among surgeons.

You are then awakened and brought to the recovery room where you will be monitored until you are ready to be released, usually in about 2 hours.  Your face may feel tight and tender.  You may even feel emotional or upset, cold, woozy, or nauseated as you come out of anesthesia. This is normal. If you feel as if you will vomit, alert one of the nurses.

You cannot drive yourself home after surgery and must be driven home by a responsible adult. 

The Road to Recovery 

You may be groggy from the anesthetic and/or pain medications for the first day or two.  Take it easy. You will have to sleep with your head elevated on at least two pillows or a foam wedge for the first week after surgery or however long your surgeon suggests.

Your face will be or become swollen in the first 3 days, but this will resolve.  You may have some bruising, which is normal.

You will more than likely experience some discomfort for several weeks. Because you will have incisions inside your mouth, your diet may be restricted.  Eat carefully and avoid very acid foods that will irritate the incisions. To reduce the risk of infection, make sure that all fresh fruits and vegetables that you eat have been washed well. Avoid eating raw fish (sushi) or very rare meats for a couple of weeks. You may be instructed to rinse with a mouthwash or an antiseptic solution several times a day.  Try to keep your tongue away from your incisions and sutures and do not pick at them.

Take your pain medications on time. This will help more than waiting until you are in pain and then taking them. Most discomfort should be alleviated by your pain medication, but if you have excessive pain, pus or other symptoms that do not appear normal, contact your surgeon immediately. 

Take your temperature regularly because a fever can be a sign of infection.  Take your antibiotics on schedule.

In most cases, sutures will be taken out by the surgeon a week to 10 days postoperatively.  Take it easy for the first 3 weeks after surgery, no matter how well you feel.  Be careful not to bend over or lift heavy objects. Do not participate in contact sports until your surgeon gives you the go ahead.

The swelling on your face and cheeks will subside in a few weeks, revealing a more defined facial structure. You may notice a change in your smile, tingling, a sporadic sharp pain, or pulling, burning, and cold sensations. These sensations subside within the first few weeks.

Risks and Complications of Buccal Fat Extraction

Buccal fat extraction and all oral and cosmetic surgery has risks and complications. You could have an infection or a reaction to anesthesia. There is also the chance that some of the nerves of your face may be disrupted for a time. 

Numbness of the cheek and inside of the mouth is possible, but usually subsides within a few weeks. However, it may become a permanent issue.  Puckering of the skin on the cheek may occur, with indentations that are deeper than you wanted. Excess scar tissue and lumps are possible as well. It is also possible that the two sides of your face will not be symmetrical. Sometimes, this asymmetry is temporary because one side of your face takes longer to heal than the other.

There is also the chance that nothing is medically wrong, but you are simply unhappy with the results of the surgery.

As mentioned before, it is possible to look gaunt if too much fat was taken out or if the procedure was performed before you lost much of your facial fat. Please consider this before you commit.  It is possible to correct this with fat grafting, but it is better not to incur the problem in the first place.

Buccal fat extraction