For a stretch of 2022 and 2023, buccal fat removal was everywhere. Social media filled with side-by-side photos of sharpened cheekbones, and speculation about which celebrity had “had it done” became a genre of its own. The procedure is quick. A surgeon makes a small incision inside the mouth and removes part of the fat pad that sits in the lower cheek.
The appeal was obvious. The trade-off took longer to show.
A fat pad that does a job
The buccal fat pad sits between the facial muscles and the lining of the mouth. In your twenties it can make the lower face look round, which is why people wanted it gone. It also supports the mid-face as you age, and that support becomes more valuable every year, because the rest of the face loses volume on its own schedule.
FACES+, the San Diego practice founded by plastic surgeon Dr. Steven R. Cohen, states the risk on its website: removing these pads “can lead to a gaunt, skeletal, older look.” A 26-year-old with a sculpted lower face can become a 40-year-old with hollow cheeks, and the fat that would have softened that change is no longer there.
The practice saw it coming. After the trend peaked, FACES+ wrote on its site: “Since last year’s buccal fat removal craze, we predict seeing many more patients for restoration in this area.” The practice also notes that Cohen was one of the first surgeons to publish on restoring fat to the buccal space.
Why regret shows up late
Most people who had buccal fat removed liked the result at first. The problems tend to appear in three ways.
Over-removal. Taking out too much fat, or taking it unevenly, can leave the cheeks hollow or lopsided from the start.
Age catching up. Natural volume loss in the mid-face deepens whatever hollowing the surgery created. The face that looked chiselled at 28 looks drawn at 38.
Changed taste. Beauty trends move. The contoured, angular look that drove demand in 2022 has given way to interest in fuller, softer faces, and some patients want their old face back.
Putting it back
Reversing buccal fat removal used to mean more surgery with larger incisions. Cohen developed a minimally invasive injection technique that restores the fat pad without them. The practice uses the patient’s own fat, placing it into the space where the buccal pad once sat, and lets the result settle over the following weeks.
FACES+ notes that patients face no dietary restrictions after the procedure, a meaningful difference for anyone who remembers the soft-food weeks after an incision inside the mouth.
The practice lists three groups as good candidates: people unhappy with a previous buccal fat removal, people with age-related loss of cheek volume, and people who want fuller contours while keeping definition in the face.
If you are still considering removal
Buccal fat removal suits some faces. The right candidate has a full lower face with good underlying bone structure, and a surgeon who takes a conservative amount. Before you book, ask yourself and your surgeon a few hard questions:
- How will my face look at 45 and 55 with less fat in the mid-face?
- How much fat will you remove, and why that amount?
- What are my options if I want volume back later?
A good surgeon will show you how faces like yours age, and will talk you out of the procedure if your cheeks are already slim.
The broader shift
The buccal fat story fits a pattern Cohen’s practice has built its approach around. Fashionable procedures often subtract. Faces age by losing. The treatments that hold up over a decade tend to restore what time takes rather than remove what youth provides.
FACES+ has practised in San Diego since 1999. Cohen is certified by the American Board of Plastic Surgery and appears on Newsweek’s America’s Best Plastic Surgeons list.
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