It seems like every other day there's a new plastic surgery or cosmetic procedure trending on social media. Between brow lifts and baby botox, lip fillers and laser resurfacing, there is no shortage of viral procedures promising to enhance or alter one's appearance.
Right now, it’s all about buccal fat removal. The plastic surgery trend has taken over TikTok and Twitter, where many users are speculating that certain celebrities have gotten their buccal fat removed to achieve an extremely chiseled, hollowed-cheek look.
Some users on TikTok are criticizing the trending procedure for perpetuating unrealistic beauty standards and are urging people to embrace their natural features instead, NBC News reported.
So what is buccal fat removal exactly? What's it like to get your buccal fat removed? We spoke to plastic surgery experts to find out.
Buccal fat (pronounced like "buckle") is basically the medical term for cheek fat, Dr. Basel Sharaf, practice chair of the Center for Aesthetic Medicine & Surgery at the Mayo Clinic, tells TODAY.com.
The face is composed of layers of skin, muscle and fat, including subcutaneous (or under the skin) fat and fat pads — which are plump, fat-containing areas that fit together like a jigsaw puzzle and help give the face shape, TODAY previously reported.
Buccal fat is a naturally-occurring fat pad located under the cheekbone and between the facial muscles, says Sharaf. “If you’re asking someone to blow up their mouth, where the cheek tends to balloon out is where that buccal fat pads tend to be,” Sharaf adds.
Everyone has buccal fat, but some people are born with more than others — so the amount you have is entirely genetic, Dr. Jason Roostaeian, clinical professor in the division of plastic surgery at UCLA David Geffen School of Medicine, tells TODAY.com. People with more prominent buccal fat may have a face that appears wider, rounder or fuller, Sharaf says. This is sometimes referred to as the “cherub look,” Roostaeian adds.
Buccal fat pads are different from the fat in the rest of the face or body. “It’s a deeper, thicker fat that sits in the space between your external cheek skin and your internal lining of the mouth,” says Roostaeian. For this reason, it's very difficult to change the amount of buccal fat you have naturally, the experts note.
It is possible for buccal fat to fluctuate a little with weight loss, says Roostaeian, but most of the time the volume remains consistent even as weight changes. “I think genetic predisposition is more powerful in the sense that you retain that fat, and it’s hard to fluctuate significantly,” Roostaeian adds.
It's for all these reasons that removing or reducing buccal fat typically requires plastic surgery, the experts note.
Buccal fat removal is a procedure to remove the fat pad or a portion of it from the face, the experts explain. This can reduce the fullness of the lower cheeks, highlight the cheekbones and facial structure or slim the lower face to give it a more tapered look, says Sharaf.
Buccal fat removal is not a new procedure — it has been around for about 40 years for both cosmetic and reconstructive applications, says Sharaf. More recently, there has been increased popularity of buccal fat removal to "enhance the visual appearance" of the lower face for people who have fuller cheeks and do not like how this looks, Sharaf adds.
The most common way to remove buccal fat is through the inside the mouth because it is scarless, Roostaeian adds. Surgeons make a small incision on the inner lining of the cheek, careful to avoid the parotid gland (a major salivary gland) and facial nerves, then remove the fat and close up the incision, the experts explain.
“It’s a pretty straightforward, short surgery that can be done under local (anesthesia), but we often do it ... along with a facelift or other facial aesthetic procedures,” says Roostaeian. You'll go home the same day, according to the Cleveland Clinic.
The surgeon will decide how much of the buccal fat pad to remove based on the fullness of the cheeks, says Sharaf, adding that it’s always best to start small and assess the volume of the face. “It’s always possible to remove more, but the key is being conservative and not over-removing the fat because it may create an excessive contour or deformity,” Sharaf adds.
Overall buccal fat removal is a relatively low risk and simple procedure when done by well-trained surgeon, Roostaeian says.
The recovery process usually takes about three weeks, according to the Cleveland Clinic, but it will take several months to see results.
Your provider should share guidance on caring for the incisions, which may include a mouth rinse to prevent infection. You'll also have to change your diet and slowly add soft foods back in once you get the green light from your provider.
After the surgery, you can expect to experience swelling, bruising and numbness where the incisions are. These will fade with time.
Typically, the best candidates for this procedure are determined by a surgeon because “there are many factors that can cause the lower face to be wide, and buccal fat is only one of them," Sharaf says. "Some patients have a very strong jaw or bone musculature."
He adds that it's critical for surgeons to do a comprehensive facial analysis to determine if buccal fat removal will achieve the results a patient is looking for.
The best candidates for buccal fat removal are patients with naturally fuller cheeks due to buccal fat, says Sharaf. “If there’s not a lot of cheek fullness, removal of the buccal fat pad may not be a good idea,” he adds.
Dr. John Mesa, a plastic surgeon in New York City, shared on his Instagram account several examples of buccal fat removal before and after.
Can buccal fat removal make you look older?
One of the main criticisms of the buccal fat surgery on social media is that it may cause people to look older or accelerate the facial aging process.
Fat pads contribute to the fullness of the face — which is often associated with a youthful appearance — and as people age, these pads will naturally atrophy, lose volume and sag due to gravity, TODAY previously reported.
“A lot of aging is you’re seeing the underlying bony or muscular anatomy ... because your (face) is getting more hollowed out, which all has to do with losing fat as you age,” says Roostaeian. As mentioned, buccal fat doesn't usually fluctuate significantly.
“Certain areas (of the face) get more hollow because they’re programmed to lose fat, but the buccal fat is totally different,” says Roostaeian, adding that people who are genetically predisposed to have more buccal fat can still retain a lot of it even as they age.
Although the volume or position of buccal fat may change over time, says Sharaf, there are also many other factors that contribute to facial aging, such as movement of the facial muscles and the skin.
So no, buccal fat removal is not necessarily a glimpse of your face in the future or hitting the fast-forward button on aging — especially if you're the right candidate and the procedure is done conservatively, the experts say.
But any plastic surgery can go too far. “We may lose some of our cheek fat with aging, or it may sag and I think an over-done a buccal fat removal can potentially have some of these long-term effects on the appearance of the face,” says Sharaf.
“It can be a really powerful, great procedure, but can it be overdone — everything in plastic surgery can be overdone,” says Roostaeian.
When the surgery is overdone, it could mean that a very large amount of the fat pad was removed, says Sharaf, which can potentially change the face or fullness of the cheeks in a way that looks very obvious or creates a hollowed out look.
"While that may look fine to the patient and may look good when they're in their 20s or 30s, it's always important to think about the long term effects on their facial appearance," says Sharaf.
“If you are somebody who really didn’t need it to start with, you may look overly sculpted and kind of unusual to other people,” says Roostaeian, adding that even if that's the look a patient wants, he still emphasizes the importance of natural-looking results.
It is possible to fix an overdone buccal fat removal and add fullness back to the cheeks using a fat-grafting procedure, says Roostaeian, which involves injecting the cheeks with fat from other parts of the body. But the goal is not to overdo it in the first place.
“I think if it is done on the right patient and in the right hands, the likelihood of causing these (negative) effects is very low,” Sharaf adds.
Communication is key, the experts note, so that patients understand the surgery and its ramifications in the long-term. "It's important to discuss expectations with the patient as to what they're trying to achieve and whether this procedure by itself can achieve what the patient is looking for," says Sharaf.
On a positive note, the popularity of the procedure on social media may increase awareness and encourage patients to ask their doctor more questions, says Roostaeian — and that's always a good thing.
This article was originally published on TODAY.com