Does buccal fat removal really work? Why is there so much satisfaction despite insufficient long-term research?

Buccal fat removal is reported to create a sharper appearance in the lower cheek area, but research supporting this is limited and of low quality[1]. A systematic review found that 84.6% of surgery patients reported their facial contour was "significantly improved," and the remaining 15.4% also reported improvement[1]. However, there are no long-term studies tracking the effects on the face after aging[1][2].

How much thinner did research show the cheeks becoming?

Only one study precisely measured the amount of reduction[1]. Even after reviewing 1,413 papers, only 4 met the inclusion criteria[1].

In that study, cheek fat volume decreased by 3.10 mL, with an average of 2.74 mL (range 1.8–4.9 mL) of fat removed[1]. That is less than one teaspoon. Textbooks also note that the effect is more likely to appear in the middle to lower cheek, and results vary depending on the original fat size[3].

How often do complications occur?

Reported complications are relatively infrequent. In 134 procedures there were 7 complications[1], and in another review, 8.45% of 71 patients had mild complications[2].

Among the studies in the review, no injuries to the salivary duct (parotid duct) or facial nerves were found[2]. However, none of the studies included in the review were clinical trials, and these figures are estimates only[2].

How much concern is there about cheek hollowing in the future?

This is the least understood aspect. There are no studies examining appearance or long-term outcomes after aging, so harm cannot be ruled out[2].

Facial fat descends and decreases in volume with age[4]. It has been shown that when the projecting portion of buccal fat in the cheek shrinks, it accelerates the descent of other cheek fat[4]. For this reason, it has been noted that removal may lead to more visible facial contour Sagging (skin laxity) after aging[1].

Over-removal can result in a hollowed cheek appearance[5]. Even in young people, it is recommended to receive an explanation of the risk of looking older and to plan conservative removal[6].

Which facial types are suitable for this procedure, and which are not?

It is more suitable for people with well-developed cheekbones but whose faces appear round and heavy due to cheek fullness[1][6]. Conversely, those with small cheekbones are said to be unsuitable, as they are more likely to show cheek hollowing after removal[1].

It is common for fat volume and position to differ between the left and right sides[6]. Before surgery, it is important to have the surgeon estimate the amount to be removed and any asymmetry.

What changes if someone has previously had fat-dissolving injections?

Patients who have previously received fat-dissolving injections in the cheeks show a lower success rate and increased complications during surgery[7]. Be sure to disclose any previous injections, including when they were given and how many times

How should I decide based on the research?

Current research shows that short-term satisfaction is high and complications are rare[1]. Long-term changes in facial appearance are still unknown[1][2].

Well-developed cheekbones, round and heavy lower cheeks: may be suitable[1][6]

Small cheekbones, naturally hollow-appearing cheeks: hollowing becomes more noticeable after removal[1][5]

Previous fat-dissolving injections to the cheeks: lower success rate[7]

Concerned about future cheek hollowing: confirm whether a conservative removal plan is being considered[6]

Whether your roundness is due to buccal fat and how much can safely be removed cannot be decided from an article alone. During consultation, have your cheekbone shape, fat volume and asymmetry, and injection history examined, and discuss the option of not removing fat as well.