Buccal fat removal (bichectomy) became one of the most discussed facial procedures in recent years — and simultaneously one of the most cautionary tales in aesthetic surgery. The procedure is effective and appropriate for a specific patient profile. In the wrong candidate, it produces premature facial aging that is difficult to correct.
What Buccal Fat Is
The buccal fat pad is a discrete fat compartment located in the lower cheek, between the buccinator muscle and the overlying facial muscles. It contributes to the rounded, full-cheeked appearance of the lower face. Unlike subcutaneous facial fat, it does not significantly change with weight fluctuation — it is a structural compartment rather than a metabolically active fat store. Its removal is intended to reduce lower cheek fullness and improve the appearance of the lateral cheek definition.
The Ideal Candidate
The ideal buccal fat removal candidate has a genuinely full lower face that is structural rather than weight-related, has good overlying skin tone, is in their 20s or 30s, and has a face shape that would benefit from lateral cheek definition. If you already have good cheekbone definition and a normal lower face, removing buccal fat will hollow the cheeks rather than define them. Evaluation must be performed with the face at rest and in motion — not based on aspirational reference photos.
The Long-Term Concern
Facial fat decreases naturally with age. The buccal fat pad contributes to maintaining lower face volume as the face ages. Patients who have it removed in their late twenties may find that by their forties, they have a dramatically hollowed, skeletonized appearance that cannot be corrected without fat grafting or filler. This long-term trajectory must be part of the candidacy conversation.
What Dr. Truesdale Recommends
Dr. Truesdale is selective about buccal fat removal and declines to perform it in patients who are not appropriate candidates regardless of their desire for the procedure. For patients who are genuinely appropriate candidates, the results can be excellent. For patients with borderline anatomy, alternatives such as strategic BOTOX for masseter reduction or targeted contouring with fillers are often preferable options.