“I had never been happy with my face shape, specifically my jawline. I look just like my older family members and our face shape doesn’t age well. My buccal fat was giving me jowls, and it would have continued to obtain worse,” an anonymous friend, let’s call her Layla, proclaimed when discussing the rise of cosmetic procedures and her decision to splurge on buccal fat removal alongside a nose job in 2019.

It appears as though while we were sleeping, blissfully unaware of the term buccal fat, celebrities were getting the fat removed from their cheeks. In 2021, Chrissy Tiegan shared that she had gotten buccal fat removal on her Instagram stories. “No disgrace in my Dr. Diamond game,” she wrote as she pointed out her freshly contoured cheek area. And while nothing is confirmed, Mindy Kaling, Zoe Kravitz, and Lea Michelle look noticeably different and the internet has theorized that it is a result of buccal fat removal. Plastic surgery can be a touchy topic and most individuals select to continue silent about the work they have gotten done. To this day, the Kardashians are sowever trying to convince us (does anybody remember when Kim got an x-ray of her butt?) that their bodies are a result of health nut salads and intense workout sessions at Dogpound. When your career hinges on your looks, it makes sense that you would go to extreme lengths to create and maintain a particular aesthetic.

Three years later, after 2 weeks of downtime, Layla is more than happy with her buccal fat removal and sympathizes with why celebrities may want a gaunt appearance. "There is a difference in how individuals treat me now," she admits. It's no surprise the 27-year-old-stripper felt the pressure or necessity to sculpt her face. With her looks correlating with her paycheck, Layla reveals, "My income has risen significantly after my nose and buccal combo," smiling with a more svelte face from her one-bedroom apartment in Manhattan.

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According to Spate, on average, there are currently 105.9K monthly searches in the US for buccal fat removal. “The buccal fat pad is a pocket of fat that is located inside the cheek. Surgical removal of this fat helps to improve lower cheek contour making it appear slimmer,” says New York based, double board-certified plastic surgeon Konstantin Vasyukevic, MD.

As someone with a capital R round face, this “trend” (if you can call thousand-dollar surgical treatments a trend) has sent me into somewhat of a panic. Our culture has always been obsessed with looking as frail as possible, but it really looked as though matters were turning around. We should have known that the return of butterfly clips and low-rise jeans would finally lead us back to this madness. While I’m not necessarily against plastic surgery, I do wish there was more of a collective focus on doing the work required to feel secure (or even neutral) about one's looks as they inherently are. “Plastic surgery cannot create you secure in how you look, as corny as that is. You will find little matters to obsess over and try to correct, but a major insecurity that makes you not want to take photos or live your life is worth fixing if you are able and really want to for yourself,” says Layla. “No one really ‘needs’ plastic surgery unless it’s gender-affirming or reconstructive, but we don’t need a lot of matters we spend money on.”

If you, too, are curious about buccal fat removal, here’s everything you need to know about this under-the-radar aesthetic procedure.

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What is buccal fat removal?

As formerly mentioned, buccal fat removal is a cosmetic surgical procedure in which excess fat from the buccal fat pads is removed. The in-office procedure is done in approximately 30 minutes under native anesthesia and involves removing the fat through a little incision on the inside of the cheek. “The buccal fat pad is a deeper construction just below the cheek and near the jawline that tends to give fullness to the area. If an individual has an excessive sum of buccal fat pad or [suffer from] drooping, they tend to have a more rounded or jowly appearance,” explains Beverly Hills plastic surgeon Babak Azizzadeh, MD. “[This procedure involves] removing the fat pad to give a more angular and heart-shaped appearance to the face,” he states.

What are the benefits?

The leading benefit of buccal fat pad removal is slightly more definition in the cheek area and a more chiseled facial shape. This procedure helps slim the region between the upper cheek area (malar region)and the lower jawline. And here, I naively thought I could accomplish these same results with daily Gua Sha and KKW beauty contour sticks.

It is important that buccal fat excision not be thought of in isolation. “I use buccal fat pad repositioning during my deep plane facelift procedures to not only help with the facial shape but also to support the deeper layers of my facelift. This has significantly impacted the naturalness and longevity of my outcomes as well as reducing the recurrence of jowling (the excess skin on the lower face) in my patients,” explains Dr. Azizzadeh.

How long is the downtime?

When performed as a standalone procedure, the downtime is fairly quick, and “patients are able to return back to normal social activity within 7 to 10 days,” says Dr. Azizzadeh. Buccal fat removal can also be performed in conjunction with a facelift, in which the downtime varies and may take longer to complete. Following the treatment, the aftercare is relatively simple. Dr. Azizzadeh recommends a clear liquid diet for 48 to 72 hours due to stitches inside the mouth and to avoid a risk of infection.

Dr. Vasyukevic agrees, “patients would begin with [a] liquid diet for the first 1-2 days and then progress to soft foods and then regular diet within 1 to 2 weeks post surgery.” Heavy physical exertion should be avoided for at least 2 to 3 weeks.

How much does it cost?

With so much expertise and precision needed, buccal fat removal doesn’t come cheap: It ranges from $5,000 to $20,000 per treatment, depending on where you’re located, the surgeon, their level of expertise, and the level that they are in demand. The cost of buccal fat pad removal also depends on if it’s performed in conjunction with a facelift or as a standalone procedure.

How to select a surgeon

Currently, there are no doctors who solely focus on buccal fat removal. Your first selection should be to find a facial plastic surgeon who specializes in facial rejuvenation and has done a lot of facelift work. When looking at credentials, Dr. Vasyukevic suggests “looking at Doctors training in facial surgery as well as a board certification such as American Board of Facial Plastic and Reconstructive Surgery.”

The drawbacks

Like any surgery, there are risks. Double board certified, Beverley Hills, California-based, plastic surgeon Dr. Kelly Killeen explains, "The leading risk of this surgery is bleeding and injury to nerves." However, she adds, "Nerve damage is very infrequent with experienced surgeons."

If you don't go to an experienced surgeon and the procedure is not done correctly, over-resection can be quite disfiguring and “can create significant hollowness in the middle portion of the face that can negatively impact one’s aesthetics,” says Dr.Azizzadeh. “Extreme care should be used in the sum of buccal fat pad that’s removed and if the patient actually needs it or not.”

It’s also important to remember that removing cheek fat decreases the volume of the face. “This might be beneficial for patients of younger demographics but could lead to premature aging later in life,” warns Dr. Vasyukevic. If your TikTok feed of taught faces has you itching to create an appointment with a plastic surgeon, keep in mind that the procedure is permanent and not reversible. “Adding filler of fat grafting could help to restore volume, but would not lead to a complete reversal,” says Dr. Vasyukevic.

Another thing to note is the mental toll it takes on you when you decide to go under the knife. It’s necessary to go in with a clear mind, as this procedure is irreversible. That means if you recently went through a breakup, you need to stay far, far away. Altering your face shape won’t bring them back. Stick to traditional coping mechanisms like dyeing your hair platinum blonde, getting bangs, or doing both. Layla shared, “When individuals see photos of me now versus then, they just visualize it’s normal baby fat loss. The original shape of my face is sowever generally maintained. Every now and then I suffer from cognitive dissonance because I don’t look like my old self anymore. But I am at peace with how I look and genuinely happy with how it turned out. I’ve reached neutrality and I think that’s the best anybody can hope for.”