What Is Buccal Fat Extraction / Cheek Reduction Surgery?

Reviewed by Steven J. Pearlman, MD

Chipmunk cheeks… they may work on some people, but it's not a look everyone can carry off. Let's face it: Chubby cheeks can make it look like you're storing nuts for the winter. If you have chubby cheeks and want a thinner, more chiseled-looking face, buccal fat extraction or cheek reduction may be an option. (By the way, buccal is pronounced BUCK-ull, just like a belt buckle.)

Considering cheek reduction surgery? Try this easy test: Purse your lips to whistle or drink through a straw, then look in a mirror. Do you like how you look? If so, this procedure may be right for you.

But buyer beware: You may start to lose fat on your face as you age, which can result in a thinner appearance. If you choose to have this surgery and your face naturally thins, you may look gaunt and sickly. While there is no crystal ball to show you how your face will age, your parents can be a good guideline. If your mother and father still have chubby cheeks, yours are probably here to stay also. In this scenario, buccal fat extraction can help.

Keep in mind that if you gain a lot of weight, your cheeks may puff up again.

Consult with a board-certified facial plastic surgeon or board-certified plastic surgeon if you are concerned about your chipmunk cheeks. Your surgeon will explain the various techniques and incision placement options, and discuss the risks associated with buccal fat extraction. In turn, you must disclose all information regarding your health. Your surgeon must have a complete list of all medications you take, including nonprescription medications. Even so-called natural supplements can interfere with your surgery and the results.

You will probably be asked to have blood tests done about a week in advance of your surgery, and you may be asked to have a general physical exam. These tests will ensure you are in good health before your buccal fat extraction.

Buccal Fat Extraction: What to Expect

Buccal fat extraction is done on an outpatient basis with light sleep sedation, regional anesthesia with sedation, local anesthesia with oral sedation or general IV sedation; the choice is up to you and your surgeon. The procedure usually takes about an hour. It can be combined with other procedures, including face lift, but this increases the length of the operation and the potential risks.

During buccal fat extraction, your surgeon removes the fat pads that augment your lower cheeks. These pads, which can be found in your cheeks and along the sides of your face, give your face that rounded look. Some of this buccal fat can be removed surgically through incisions inside the mouth.

To do this, your surgeon will make an incision that is about two to four centimeters in length. The incision is located in the back of your 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, your surgeon will cause the buccal fat to push through this incision. He or she will use a forceps to remove the unwanted cheek fat before closing with non-dissolvable sutures. Your surgeon may put a piece of antibiotic-soaked gauze between your upper molars and gums and/or apply a pressure dressing that spans from top of your head to underneath your chin.

You are then awakened and brought to the recovery room where you will be monitored until you are ready to be released. As you regain consciousness after cheek reduction, your face may feel tight and tender. You may even feel emotional and nauseated as you come out of anesthesia. These are common feelings and will pass. You cannot drive yourself home after surgery and must be driven home by a responsible adult, so make arrangements prior to surgery.

You may be groggy from the anesthetic and/or pain medications for the first day or two. Expect some swelling and bruising. Take it easy for the first few days. Sleep with your head elevated on at least two pillows or a foam wedge for as long as your surgeon suggests.

Eating can be a challenge after buccal fat extraction because you will have incisions inside your mouth. Eat carefully and avoid highly acidic foods such as tomatoes, oranges, grapefruit and cherries. These foods can irritate the incisions. You may be instructed to rinse with a mouthwash or an antiseptic solution several times a day. Keep your tongue away from your incisions and sutures.

In most cases, these sutures will be taken out about a week to 10 days after your buccal fat extraction. Do not participate in contact sports until your surgeon gives you the go ahead.

Buccal Fat Extraction Risks

Buccal fat extraction does have its share of risks and complications. All surgeries do. Risks of buccal fat extraction include:

Anesthesia problems

Infection

Nerve damage

Numbness of the cheek and inside of the mouth

Puckering of the skin on the cheek

Excess scar tissue

Lumps

Asymmetry

Cosmetic dissatisfaction

Buccal Fat Extraction Cost

The price of buccal fat extraction ranges from $2,000 to $5,000. Get an estimate in advance, and ask what the fee covers. Lab fees (such as blood tests) and medications are extra. Insurance rarely covers the cost of cosmetic procedures. If the cost is prohibitive, ask your surgeon about payment plans.

About the Reviewer of this Article

Steven Pearlman, MD, FACS, practices in New York City and is board certified in both Facial Plastic and Reconstructive Surgery and in Head and Neck Surgery. He is a past president of the American Academy of Facial Plastic and Reconstructive Surgery (2004-2005). He is director of the Division of Facial Plastic Surgery-St. Luke's-Roosevelt Hospital, an attending surgeon at Lenox Hill and Manhattan Eye, Ear and Throat Hospitals, and a clinical associate professor at Columbia University College of Physicians and Surgeons. Dr. Pearlman is also founding president of the New York Facial Plastic Surgery Society, which promotes advanced education for facial plastic surgeons in the New York area. He is a graduate of Brandeis University and The Mount Sinai School of Medicine in New York, where he also completed a residency in Otolaryngology-Head and Neck Surgery. He subsequently completed a fellowship in Facial Plastic and Reconstructive Surgery at St. Luke's-Roosevelt Hospital.