How Much Buccal Fat Do You Take Out? Live Surgery With Before and After at End

A growing portion of my practice involves buccal fat pad removal alone or as an adjunct to other facial procedures like rhinoplasty, cheek augmentation, and liposuction. This operation has gained popularity recently, and fat pad removal has become a large portion of my practice. The results of the buccal fat pad removal are variable but subtle in most cases. The subtle enhancement is what draws me to this procedure. I think that small three-dimensional changes in the face go a long way. Despite watching videos that I produced to assuage concerns of hollowing out and prematurely aging the face, patients continue to discuss concerns about whether this will make them look older. In fact, many patients come to me to look older. These candidates tend to be in their late teens and early twenties and feel that chubby cheeks give them a childish appearance that they wish to correct. Many of those patients wish to look as sculpted as possible despite the limitations of the buccal fat pad removal procedure. Other patients who are in their 30s, 40, and 50s are worried that removal of the buccal fat pad will give them an aged appearance. The same rationale – the subtlety of the result, should reassure many patients with these concerns. Still, other patients ask me how much buccal fat pad I think I’ll remove. The volume of the buccal fat pad is very hard to quantify because of injected local anesthesia soft and squishy nature of the fat pad itself.

Here’s a fun little experiment: evaluate the three patients presented here. Look at their faces very closely. The three patients are close in age and have a similar ethnic background. However, the BMI of these patients varies somewhat as does their gender. I want you to carefully study these three faces and guess whose buccal fat pad would be the biggest. All three patients had buccal fat pad removal in conjunction with radiofrequency assisted lipolysis of the neck and jowls. This combination of procedures is very popular. In this video I will perform removal of the buccal fat pads live and analyze the specimens that were excised.

I measure the volume of the buccal fat pads by loosely compacting the fat pad itself into a 5 cc syringe and seeing how much volume it occupies. I do my best to assess the volume down to the 10th of a cc. I am very aware that the local anesthesia placed into the buccal space can change the volume, but I certainly see a recurring pattern. A lot of studies’ estimates range as to how much fat is generally excised with buccal fat pad removal. Really, depending on the article, anywhere from 2.5-7 cc is removed. One thing I have noticed is that there is a striking consistency of the volume removed. Furthermore, when there is facial asymmetry, the fat pad also tends to be larger on one side than the other.

The most interesting outcome of this experiment is that many of you (including myself) may have been wrong in their prediction of who had the largest buccal fat pads. Gender, BMI, hemifacial hypertrophy, ethnicity, and even age does not have as much influence as you would guess on buccal fat pad volume itself. For a moment, assume we all have the same buccal fat pad volume. Therefore, is not the volume, so much as position and interplay with surrounding tissues that defines your candidacy and predicts your result. Sometimes, smaller but buccal fat pad specimens come from patients with the most impressive results, and vice versa. More drastic results, like the before and after shown at the end, can be achieved with simultaneous jawline and cheek enhancement. In this case, fillers were used.