Buccal Fat Removal in Brazil: a more defined face safely
If you feel that your cheeks have too much volume, even when at your ideal weight, you have probably heard of buccal fat removal -- also known as bichectomy or cheek reduction surgery. It is the surgery for reducing the buccal fat pads, those fat structures located in the front part of the cheeks that, when voluminous, give the face a rounded appearance.
I am a board-certified plastic surgeon in Brazil, trained at the Ivo Pitanguy Institute, a full member of the Brazilian Society of Plastic Surgery (SBCP) and the American Society of Plastic Surgeons (ASPS). I have been performing buccal fat removal at my clinic in Brazil for many years and can say: when properly recommended and executed with the appropriate technique, it is a safe, quick procedure with a smooth recovery. The procedure lasts about forty minutes and, in my experience, patients are impressed with the simplicity of the recovery.
Are you a good candidate for buccal fat removal?
This is the most important question. Buccal fat removal is not for everyone, and this honesty is crucial for a good result. You may be a good candidate if:
- You have a rounded face even with an appropriate body weight;
- You feel that the volume of your cheeks affects your facial balance;
- You are at least fifteen years old (when the face is fully developed);
- You have a good facial bone structure, especially in the malar region (cheekbones).
On the other hand, buccal fat removal may not be recommended for those who already have a naturally thin face, little volume in the cheekbones, or a tendency to lose facial fat as the years go by. In these cases, removing the buccal fat pad could create a skeletal or aged appearance in the future. Therefore, an in-person evaluation is essential.
Contraindications that I take seriously
In addition to aesthetic cases where buccal fat removal is not recommended, there are clinical contraindications that I need to evaluate rigorously: active infections in the oral cavity, uncontrolled coagulation disorders, decompensated diabetes, and unrealistic expectations regarding the result. I also do not recommend the procedure for patients with a very high body mass index, as future weight loss can significantly alter facial contours.
A word about buccal fat removal being over-recommended
I need to be frank about something that concerns me as a plastic surgeon: in recent years, buccal fat removal has become a kind of "trend," and many surgeons have started to recommend it indiscriminately, even for patients who would not benefit from the procedure. This has led to a wave of unsatisfactory results — faces with a sunken appearance, premature aging, and loss of naturalness. The buccal fat pad has important functions: it protects muscular structures during chewing and contributes to the youthful volume of the middle third of the face. Removing it without criteria is a mistake. My approach is conservative: I only recommend it when I am sure that the result will look natural in the long term.
Buccal fat removal as a complement to Deep Plane Facelift
A particularly valuable application I consider is buccal fat removal combined with a deep plane facelift. In some patients who undergo the facelift, excess buccal fat can accentuate the "bulldog" appearance (the famous jowls, that sagging in the jaw area). In these cases, removing the buccal fat during the same procedure significantly enhances the facelift result, creating more defined and elegant facial contours.
This combination requires experience and a comprehensive vision. It is not simply about "doing two surgeries at the same time," but about understanding how facial structures interact and planning the approach in an integrated manner. The result is a more complete and balanced facial rejuvenation.
Your concerns are normal. Let me address them.
Many patients come to the consultation with concerns about buccal fat removal, usually based on stories they read online or heard from acquaintances. I completely understand. That’s why I make a point of answering every question:
Fear of pain: The surgery is performed under general anesthesia, so you will not feel anything at all during the procedure. In the postoperative period, discomfort is minimal, much less than that of a wisdom tooth extraction, for example. Most of my patients are pleasantly surprised by this.
Fear of swelling: Yes, there will be swelling, especially in the first three days. This is natural and expected. The important thing is to know that it decreases progressively, and within two months you will have about 90% of the visible result. The final result, with all the subtlety of the contours, appears between six and twelve months.
Fear of having a "sunken" or aged face: This is the most common concern, and the answer lies in proper patient selection. I carefully evaluate each patient before recommending the surgery. If I identify that buccal fat removal could compromise facial balance in the future, I simply do not recommend the procedure. I prefer to turn down a surgery than compromise the result for a patient.
Fear of asymmetry: During the surgery, I meticulously compare the amount of fat removed from each side. In addition, the technique I use allows complete visualization of the structure before removal, ensuring symmetry.
What result can you expect?
Buccal fat removal provides a face with more defined contours, enhancing the cheekbones and creating a more elegant and balanced appearance. The result is permanent, natural, and, when properly recommended, ages beautifully along with you.
It is important to have realistic expectations: buccal fat removal slims the front part of the cheeks, but does not completely change the shape of the face. In some cases, other complementary procedures may be necessary to achieve the desired result, and this will be openly discussed during the consultation.
Subscribe to my YouTube channel:
Subscribe on YouTubePre-operative Preparation for Buccal Fat Removal
The Consultation: The Most Important Moment
The consultation is where everything begins, and I take the time to do it thoroughly. There is no successful buccal fat removal without a careful evaluation. During our meeting, I examine various aspects of your face that directly influence the outcome:
Evaluation of the Buccal Fat Pad
I analyze the amount of fat present, its exact location, and how much it actually contributes to the volume of your cheeks. In some cases, what appears to be an excess buccal fat pad may have other causes. I need to ensure that the surgery will deliver what you expect.
Masseter Muscle
Do you grind your teeth? Do you have bruxism? The masseter muscle, responsible for chewing, may be hypertrophied and contribute to the lateral volume of the face. In these cases, botulinum toxin may be an alternative or a complement to buccal fat removal.
Malar Region (Cheekbones)
Here is a detail that many surgeons overlook: it is pointless to reduce the volume of the lower part of the cheeks if the upper part (cheekbones) does not have adequate projection. The result may look unbalanced. If necessary, I recommend dermal fillers with hyaluronic acid or calcium hydroxyapatite to create the ideal balance.
Skin Quality and Sagging
In patients over fifty years old, what seems like excessive volume may actually be facial tissue that has descended over time. In these cases, a facelift may be more appropriate than isolated buccal fat removal, as it repositions the descended tissues (including the buccal fat pad itself) without removing them. In selected cases, as I mentioned earlier, the combination of deep plane facelift with buccal fat removal may be the best strategy.
Neck Fat (Double Chin)
Thinning the cheeks may highlight fat in other areas, such as the submental area. I evaluate the neck in conjunction with the face to ensure a balanced result. If necessary, I can combine a double chin liposuction with the buccal fat removal.
Nose and Chin
A face may appear rounder when the nose and chin have little projection. Sometimes, a rhinoplasty or chin implant may be the ideal complement to achieve the desired facial balance.
Oral Cavity
I examine the inside of your mouth to identify the anatomical landmarks that guide the surgery and check for any condition that may affect the safety of the procedure.
Pre-operative Tests
I request the following tests before the buccal fat removal:
- Complete blood count (CBC);
- PT/INR + aPTT;
- Creatinine;
- BUN;
- Fasting blood sugar;
- Total proteins and fractions;
- Urinalysis;
- EKG;
- Pre-operative cardiac clearance (evaluation by a cardiologist).
Why General Anesthesia?
I perform buccal fat removal under general anesthesia, and there is an important reason for this: comfort and safety. The procedure lasts about thirty minutes, and general anesthesia allows me to work with absolute precision while you rest peacefully. Many surgeons perform it with local anesthesia, but I believe that the patient experience and the technical quality of the procedure are superior with general anesthesia. Board-certified anesthesiologists are present throughout the entire operation in our fully equipped operating room.
How I Perform Buccal Fat Removal Surgery
The technique I use has been refined over years of experience. I start with a precise marking between the parotid duct (Stensen's duct) and the bite line, on the inside of the mouth. Then, I infiltrate a solution with epinephrine that minimizes any bleeding during and after the procedure.
I then make an incision, approximately one centimeter, in the buccal mucosa, and carefully dissect the buccinator muscle to expose the capsule surrounding the buccal fat pad. It is essential to respect the anatomical limits -- the buccal branch of the facial nerve and the branches of the facial artery pass close to the area. With delicate movements, I extract the fat pad totally or partially, depending on the surgical plan established during the consultation. The remaining stump is cauterized to ensure perfect hemostasis, and the closure is done with absorbable sutures.
I repeat the procedure on the other side, always comparing the amount of fat removed to ensure symmetry. This meticulous care is what differentiates a natural result from an artificial one.
About Complications
The medical literature describes possible complications of buccal fat removal, such as nerve injury, bleeding, or infection. However, in all my experience performing this procedure, I have never had a single case of complication. I attribute this to three factors: careful patient selection, refined technique, and meticulous attention to every step of the surgery.
This does not mean that complications are impossible in any context, but it demonstrates that, in the hands of an experienced and careful surgeon, buccal fat removal is a safe procedure.
Scars
The incisions are made inside the mouth, which means there are no visible external scars. The oral mucosa heals very well, and in a few weeks you won't even be able to identify where the incision was made.
Same-Day Discharge
In the vast majority of cases, the patient is discharged on the same day, as soon as they fully recover from anesthesia. You will go home with all the care instructions and my direct contact for any questions that may arise.
Post-operative: What to Expect
The recovery from buccal fat removal is one of the smoothest among facial surgeries. I will be honest about what you will experience:
Swelling: It is most evident in the first three days and decreases progressively. Using cold compresses and keeping your head elevated helps a lot. By two weeks, the swelling is already quite minimal.
Pain: Surprisingly low. Most of my patients report only mild discomfort, easily controlled with over-the-counter pain medication. Many say they expected much worse.
Diet: Liquid and soft diet for five days. This protects the stitches and facilitates healing.
Important Care
- Liquid/soft diet for five days;
- Sleep on your back for a month;
- Rest from work or school for five to seven days;
- Avoid physical exercise for thirty days;
- Strict oral hygiene with antiseptic mouthwash (chlorhexidine) as directed;
- Do not smoke and avoid medications with aspirin or arnica for two weeks before and after surgery.
When Will I See the Result?
This is the question every patient asks, and the answer requires patience. Right after the surgery, you will be swollen, and that is normal. The first follow-up photos are taken at two months, when about 90% of the swelling has subsided. The final result, with all the definition of the contours, appears between six and twelve months.
My advice: do not keep comparing yourself in the mirror every day in the first weeks. Trust the process.
Correction of Unsuccessful Buccal Fat Removal
Unfortunately, I have received patients who underwent buccal fat removal with other surgeons and were not satisfied with the result. The most common problems are:
- Asymmetry: one side is different from the other;
- Excessive Removal: the face looks "sunken" or skeletal.
How I Treat These Cases
For Asymmetry: I evaluate whether it is possible to remove more fat from one or both sides to balance the result. Depending on the case, there may be a small residual difference due to internal scars or natural asymmetries of other facial tissues, but the goal is always to improve as much as possible.
For Excessive Removal: The treatment involves fat grafting to fill the depression caused by excessive removal. As with any fat graft, there is a natural absorption that varies from person to person, and more than one session may be necessary to achieve the ideal result.
If you have undergone buccal fat removal and are not satisfied with the result, schedule a consultation. I will conduct a complete evaluation and present options to improve your situation.
Frequently Asked Questions about Buccal Fat Removal
Does buccal fat removal hurt?
I perform buccal fat removal under general anesthesia, so you don't feel anything at all during the surgery. In the postoperative period, discomfort is minimal -- in my experience, the vast majority of patients report that it is much less than the pain of a wisdom tooth extraction. I prescribe over-the-counter pain medication, and that is usually sufficient.
Does buccal fat removal age the face?
This is the most common question I receive during consultations. When properly recommended, buccal fat removal does not age the face. The risk only exists when the procedure is performed on patients who are not good candidates -- naturally thin faces or those with little cheekbone volume. Therefore, I am quite selective in my recommendations: if I identify that the surgery could compromise facial balance in the future, I simply do not recommend it.
How long does recovery from buccal fat removal take?
I recommend that my patients plan for 5 to 7 days of rest. Swelling is most evident in the first three days and decreases progressively. By two weeks, it is already quite minimal. I usually take the first follow-up photos at two months, when about 90% of the result is already visible. The final result appears between 6 and 12 months.
Does buccal fat removal leave scars?
There are no visible external scars. I make the incisions inside the mouth, in the buccal mucosa. The oral mucosa heals very well, and within a few weeks, my patients can hardly identify where the incision was made.
Who is a good candidate for buccal fat removal?
In my assessment, good candidates are people with a rounded face even when at an appropriate weight, with good facial bone structure (especially in the cheekbone area) and at least 15 years old. I do not recommend it for those with naturally thin faces or a tendency to lose facial fat with aging, as the result could create a sunken appearance in the long term.
Can buccal fat removal be combined with other procedures?
Yes, and in my practice, this is quite common. A combination that I consider particularly valuable is buccal fat removal combined with a deep plane facelift. In patients with sagging in the jaw area, the removal of the buccal fat pad significantly enhances the result of the facelift. I can also combine it with chin liposuction, rhinoplasty, or chin implant, depending on the case.
How long does buccal fat removal surgery take?
The procedure itself lasts about 30 to 40 minutes. In my experience, patients are impressed by the speed. Hospital discharge occurs on the same day, as soon as you fully recover from anesthesia.
What happens if I don't like the result?
I have received patients who underwent buccal fat removal with other surgeons and were not satisfied. For cases of asymmetry, I assess whether it is possible to balance by removing more fat. For excessive removal, the treatment involves fat grafting to fill the depression. That’s why I emphasize: careful patient selection before surgery is the most important step to avoid regrets.
Do I need to follow a special diet after buccal fat removal?
I recommend a liquid and soft diet for five days after the surgery. This protects the internal stitches and facilitates healing. I also advise strict oral hygiene with antiseptic mouthwash (chlorhexidine) as per my prescription. After this period, the diet gradually returns to normal.
Why does Dr. Zamarian perform buccal fat removal with general anesthesia?
I perform it with general anesthesia for two reasons: comfort and precision. With the patient completely relaxed, I can work with the refined technique that the procedure requires, meticulously comparing the amount of fat removed from each side to ensure symmetry. Board-certified anesthesiologists monitor you throughout in a fully equipped operating room. Many surgeons perform it with local anesthesia, but I believe that the patient experience and the quality of the result are superior with general anesthesia.
How much does buccal fat removal cost in Brazil?
The cost of buccal fat removal in Brazil is significantly lower than in the United States or Europe. The final cost depends on whether it is combined with other procedures such as facelift or chin implant. Brazil is a global leader in cosmetic surgery, and patients from abroad benefit from exceptional quality at accessible prices. I discuss all fees during the consultation. Contact our clinic for more information.
Schedule via WhatsApp
If you want to know more about buccal fat removal and find out if you are a good candidate for the procedure, contact Zamarian Clinic and schedule your first consultation. I will be happy to evaluate your case personally and recommend the best path to achieve the facial balance you are looking for.
Patients seeking definition of facial contour often also express interest in genioplasty for chin projection, facial fillers to complement the results, and fat grafting for volume replacement. Learn more about the pricing and pre-surgical preparation.
Ready to take the next step? Schedule now!
Dr. Walter Zamarian Jr.
Plastic Surgeon in Brazil
Rua Engenheiro Omar Rupp, 186
Londrina - Brazil
ZIP 86015-360
Brazil
YouTube Channel: Dr. Walter Zamarian Jr.
Follow on Instagram: @drwalterzamarianjr
Follow on TikTok: @drwalterzamarianjr
Search on our website:
This page in other languages:
Portuguese (BR) | English (US) | English (UK) | Italian | French | Spanish