Buccal Fat Pads

Chubby cheeks are not just because of weight loss. Sometimes, the culprit can be something called the buccal fat pads. These fat pads are important for facial contour, and their removal creates a more sculpted appearance.

The buccal fat pads are pockets of fat in the middle of the cheeks. Large buccal fat pads can contribute to a fuller and rounder face. Large buccal fat pads could also accentuate the effects of aging. Many people seek buccal fat pad removal since the procedure improves facial contour. 

Ideally, the buccal fat pads’ main function is to support the gliding of muscles and fill pockets of space where there is no deep tissue. However, buccal fat pads also have quite a significant role in the aesthetics of the cheek. The buccal fat pads’ clinical value in terms of facial aesthetics has been continuously increasing for the past few decades.

Today, the prevalence of sculpted cheekbones in pop culture, modeling, and social media has placed an interesting highlight on the buccal fat pad. Several studies cite that during the first discovery of the buccal fat pad, surgeons didn’t consider it important. In many cases, it was just a surgical annoyance. However, the importance and relevance of the buccal fat pad in aesthetics today has drastically changed. Today, many more people are aware of its impact on the face and how it can change facial appearance.

Knowing about the buccal fat pad is especially helpful for people who have struggled with full cheeks their whole lives and can’t slim their face down no matter how hard they try.

Buccal Fat Pad Removal Before/After Source: Richard Zoumalan

Anatomy of the Buccal Fat Pad

The buccal fat pad has a central body and four extensions: buccal, pterygoid, pterygopalatine, and temporal. The most relevant extension is probably the buccal extension because it is the extension that’s responsible for the cheek’s contours. You’ll see that the buccal fat pad represents a significant portion of the cheek and how the buccal extension creates cheek contours in the photo below. As you can see, the buccal fat pad is pretty enmeshed with other parts, which is why there are several extensions of it.

Apart from the extensions, the buccal fat pad’s central body has three lobes: anterior, intermediate, and posterior. Each lobe has an individual membrane encapsulating it. Overall, the buccal fat pad (body and extensions) sits deeply along the posterior maxilla and can extend in several directions.

Generally, the buccal fat pad is around 9.6 mL in volume, on average. It ranges from around 8 to 11 mL. But the buccal fat pad is mostly consistent in size and volume in individuals. The overall body weight of a person is not indicative of how large their buccal fat pad is. Even a person’s fat distribution doesn’t matter much. However, even if that is the case, some people have relatively large buccal fat pads and find it unattractive.

It could be genetics that causes a large buccal fat pad. You may notice that people in the same family often share the same characteristics, face size, and shape included. If you were born in a family with members who usually have rounder faces, the chances are that you will end up with a round face too.

However, the buccal fat pads change in size and shape as we age, but not by a very significant amount. Most of the changes occur during childhood or late adulthood. When you are in your teens, there’s pretty much not going to be many changes to your buccal fat pad, although there will be plenty of physical changes in other areas of your facial appearance.

Problems With the Buccal Fat Pad

The buccal fat pad lends the face youthful plumpness that may be very cute in toddlers or small kids but is less endearing in adults. It’s a complex issue to understand because we associate youthfulness and attractiveness with round, neotenous faces. This observation is especially true in women.

Despite that, there are so many women who think that their face is too plump or that they have ‘chipmunk cheeks.’ There could be plenty of probable reasons why we think of rounder cheeks today as less attractive than very well-sculpted cheeks. However, that doesn’t mean that round cheeks are no longer attractive nor look youthful. It’s just that there’s been a shift in what certain people personally prefer to look like.

Bella Hadid in 2013 and 2019. Source: Who

Of course, there’s a line between plump and youthful n an attractive sense and when it just makes a person look fat or larger than they really are. Issues with the buccal fat pad can range from just plumpness to being responsible for a round face. Sometimes, the buccal fat pad can even be the reason for significant facial asymmetry.

This rise in the prevalence of sculpted cheeks may be due to contouring, for example. We see so many celebrities and models with sculpted cheekbones that look perfect on them. We see so many Instagram influencers that accentuate these features. A good, sculpted cheekbone is even a feature that we most commonly associate with models. Even social media filters today specifically make sure that faces are smaller and less round. All of these things together have just increased our preference for slimmer cheeks as opposed to full cheeks.

The problem with the buccal fat pad doesn’t stop there, though. While the buccal fat pad does contribute to youthfulness because it makes a face look fuller, it also poses an issue as a person ages. As people age, we already understand that the face tends to sag. This sagging happens to everyone, regardless of the size of their buccal fat pad. However, people with larger buccal fat pads might find this to be a problem. As the face sags, the buccal fat pad tends to accentuate any lines from the sagging, making a person look older.

Does Weight Loss or Gain Affect the Buccal Fat Pad?

Generally, the buccal fat pads stay at a relatively constant volume throughout the years. However, according to Zhang et al. (2002), the buccal fat pad’s volume can fluctuate over the years. Despite this, the buccal fat pad does not change much after weight gain or weight loss, which is the most pressing issue.

In several studies, such as this one case study by Weniger and Weidman (2019), the patient noted that her face’s fullness has always been constant and hasn’t changed much throughout the years. People with full faces as children may carry their full cheeks well into adulthood. While we might expect baby fat and fluffy cheeks to shed off after puberty, it just doesn’t for some people.

You might have cheeks that just don’t slim down despite how much weight you’ve lost, or you might know someone with a similar problem. As weight loss in general gears towards achieving a slim figure (face included), it can be challenging to deal with stubborn fat in the face that just won’t go away no matter what you do. In many cases, the problem lies in the buccal fat pads. Since these fat pads don’t get smaller with weight loss, it can be an endless cycle of trying to slim down your face to no avail.

Buccal Fat Pad Reduction or Removal


Before and After of a Buccal Fat Pad Removal. Source: Weniger and Weidman

Many people have turned towards buccal fat pad reduction or removal to help with the stubborn fat on their cheeks as a solution. Unsurprisingly, the procedure brings a lot of satisfaction to the patients who undergo these procedures. After all, finally figuring out how to get rid of your face’s plumpness after so long must be a relief.

A buccal fat pad removal is a good option for people who have full cheeks and can’t get rid of it through weight loss and other methods. It is important to note that buccal fat pad removal should not be the first choice when you’ve gained weight, and your cheeks look fuller. The procedure is no substitute for weight loss. Removing your buccal fat pad will bear little results when it isn’t the reason for your problems in the first place.

Before you seriously consider buccal fat pad removal, make sure that it is the source of the issue and that you’ve tried several other methods to slim down your face. You should be skinny enough that you can see your 6 pack before moving on to buccal fat reduction.

Fortunately, buccal fat pad removal doesn’t take that much time and is relatively low-risk. There are various ways to conduct a buccal fat pad removal, but the most common is probably the intraoral method. Through this method, the surgeon makes an incision on the inside of the patient’s cheeks and slowly extracts the buccal fat pad. It only takes 30 minutes to do this procedure, and the patient can go home on their own without assistance. Overall, a pretty simple surgery and not time-consuming at all.

Do Not Get a Buccal Fat Pad Removal If:

  • You have a relatively slim face or if your full face is due to weight gain. Removing your buccal fat pad then can result in a gaunt appearance instead of the attractive sculpted cheekbones. Remember, there is a thin line between sculpted cheeks looking good and when they just make someone look tired. So if you have a narrow face already, steer clear of buccal fat pad removal. The situation will get even worse as you age and may cause an excessive sinking of your cheeks.
  • You are well into middle age or are showing plenty of signs of aging. Aging can be difficult on the face in any case, regardless of a problematic buccal fat pad. However, the buccal fat pad slowly decreases in volume by the time you turn 50 (on average) (Hasani et al., 2016). Removing your buccal fat pad may affect and worsen signs of aging, so do keep that in mind. In the same way, a large buccal fat pad could also worsen symptoms of aging. In these cases, it’s best to talk it through with your surgeon to see what course of action will be the best for you.
Bilateral Buccal Fat Pads. Source: Weniger and Weidman

The Risks of Buccal Fat Pad Removal Include:

Buccal fat pad removal is a pretty safe surgical procedure. However, just like any other surgical procedure, there are risks that you have to consider, such as the following.

  • Infection. There will always be the risk of infection during surgery, especially if not performed well. However, a buccal fat pad removal is not nearly as risky as many other surgeries out there. You can easily mitigate this risk by researching your surgeon thoroughly and ensuring that you follow every precaution. Ideally, your surgeon will provide you with guidelines on what to do post-op to limit infection risk.
  • Bleeding. Like an infection, there’s always the risk of excessive bleeding in any surgery, buccal fat pad removal included. However, it is highly unlikely for this to happen as the removal will take a relatively short time. Plus, the removal requires only a small incision that’s then stitched up after the surgery.
  • Nerve Damage. A significant portion of the buccal fat pad is covered by nerves, making nerve damage a potential risk. However, just like with the other risks, this also isn’t very likely. Just make sure that you are choosing an experienced board-certified surgeon to do the job.

Other risks include an adverse reaction to the anesthesia provided, facial asymmetry, or an unsatisfactory post-operative result. The most important thing you can do about this is to look for the right surgeon for you and make them talk you through the possible risks of the surgery you are about to go through.

The Role of Buccal Fat Pads in Facelifts

The buccal fat pad, being in the midface, also has significant applications in facelifts. According to Surek et al. (2020), excision of the buccal fat pad in an aging face can improve lower facial contour. As facelifts usually improve and rejuvenate the face, the buccal fat pad plays a role in some facelifts, depending on the patient’s situation.

It isn’t just theory, either. The buccal fat pad’s removal is already pretty prevalent in facelifts, although through a different approach. The most conventional way of removing the buccal fat pad would be through an intraoral means or inside the cheeks. However, facelifts usually remove the buccal fat pad through an external method. This method requires the dissection of the cheek over the buccal area for easy access to the buccal fat pad.

The external method requires a bit more delicacy as facial nerves are covering the fat pad. Through the intraoral method, the contact with the facial nerves isn’t nearly as much because the removal comes from the back end. Certainly, buccal fat pad removal through an external means is a much more complicated method and is significantly riskier.

Of course, the removal of the buccal fat pad isn’t always for everyone. Volume in the face is necessary, especially as one grows older and starts to lose much of the fullness characteristic of youth. However, there are certain situations wherein the removal of the buccal fat pad is extremely beneficial to the patient undergoing a facelift. A good example would be when the buccal fat pad is excessive and only accentuates aging instead of minimizing it.

Buccal Fat Removal Before/After

Other Roles/Applications of the Buccal Fat Pad

The role of the buccal fat pad in surgery is not only limited to cosmetic surgery in itself. It also has applications in oral and maxillofacial surgery, as documented by Hassani et al. (2016) in their study. The buccal fat pad is even useful for managing temporomandibular joint disorder or TMJ.

The most common use for the buccal fat pad is flap reconstruction, or when the procedure involves moving healthy tissue from one spot to another. The buccal fat pad is a prime option in many oral and maxillofacial reconstructive surgeries due to its locality. Plus, the buccal fat pad is pretty easy to remove and subsequently transfer.

For example, some surgeons use the buccal fat pad to fix cleft palates and have been doing so for decades. The ease of removal and the relatively low level of risk that comes with transferring buccal fat to other areas make it such a great option. Some surgeons also use the buccal fat pad for TMJ reconstruction. Research has shown that using the buccal fat pad in TMJ reconstructions results in patients satisfied with their chewing, implying that using the buccal fat pad for TMJ is a pretty valid approach.

The buccal fat pad also has applications in other surgeries like sinus reconstruction. Over the next couple of years, the increase in buccal fat pad applications for other surgeries should only increase. All in all, the buccal fat pad is a versatile part of the body that went from being a nuisance in surgery to a feature that has applications beyond aesthetics.

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