What happened
This week Jennifer Lawrence told an interviewer that there is one operation she would like to have but will not: buccal fat removal, the procedure that takes a pad of fat out of the lower cheek to sharpen the face. Her reason was not medical. It was that everybody would know. The quote traveled through every entertainment site in two days, and I am writing about it because her instinct is better than most of the marketing around this operation.
Buccal fat removal is one of the most searched cosmetic procedures in the world, and the patients in the published series are, on average, in their mid-twenties. It is also the procedure whose result you cannot take back, on a face that will keep changing for the rest of its life.
The common misconception
The misconception is that buccal fat removal is a small, low-risk way to get cheekbones, and that if the result is too strong, the face will soften back with time.
The operation is small. Two systematic reviews of the published evidence found that the amount removed averages around 3 milliliters per side, that complications in the reported series are uncommon, and that not a single study has followed patients long enough to say what the face looks like ten or twenty years later. That last point is the one to read twice. A procedure performed on twenty-five-year-olds, with no data on forty-five-year-olds, is being sold as if the long-term were known. It is not.
The clinical reality
The fat you remove is the fat that does not come back. Buccal fat is a deep, encapsulated pad, different from the fat under the skin. Once it is excised it is gone; there is no diet, filler or graft that restores it in its original position. Everything else about the operation follows from that sentence.
The popular fear is half right, and the half that is wrong matters. The warning you will read online is that buccal fat shrinks with age, so removing it young leaves you gaunt later. The anatomy studies do not quite say that. Two CT studies, one of 109 patients and one of 120, found that deep cheek fat and the buccal pad itself tend to increase with age and with weight, and to slide downward rather than vanish. What deflates with age is the fat around it: the superficial cheek fat and the deep fat higher on the cheekbone, which is why older faces hollow under the eye and flatten across the cheek. So the regret, when it comes, does not come because the buccal pad disappeared. It comes because the cushion around the hole did. A hollow that looked like a cheekbone at twenty-five reads as illness at forty-five when the tissue above it has thinned.
Who it suits is a narrow group. The published protocols that select patients carefully reserve the operation for people with a genuinely enlarged buccal pad or one that has slipped forward, on a face that is otherwise not thin. If I press on the lower cheek and the fullness is buccal fat rather than muscle, bone shape or skin, and the patient has good volume in the upper cheek, the operation can be right. If the fullness is a round face on a round person, it is not; removing three milliliters from a full cheek changes nothing except the risk column. Most patients who ask me for this operation fall into the second group, and I say so.
It cannot be adjusted afterward. Filler can be dissolved. A facelift can be revised. Fat grafting can be repeated. Buccal fat removal is a subtraction with no addition. If the surgeon takes too much, or takes an even amount from an uneven face, the correction is years of camouflage.
The risks are rare and specific. The pad sits next to the parotid duct, which carries saliva into the mouth, and near branches of the facial nerve. Duct injury is uncommon, but a 2025 review noted it is being reported more often as the operation becomes popular, and it is a miserable complication to fix. Patients who have had fat-dissolving injections in the cheeks before are a special case: a 2023 series of 100 patients found complications only in the group with previous injection lipolysis, because scar tissue makes the pad harder to find and free.
The pad is worth keeping for another reason. Surgeons use the buccal fat pad as living tissue to repair defects inside the mouth and, in some facelift revisions, to fill holes left by removing old permanent fillers. It is a reserve. A young patient who has it removed for a sharper jaw has spent something she may want later.
The practical takeaway for patients
Age is not the criterion; anatomy is. If the fullness is a genuine buccal pad, it bothers you, and the rest of your cheek has volume to spare, waiting until you are older changes nothing except how long you stay unhappy with it, because the pad does not shrink on its own. If the fullness is not the pad, no age makes the operation right. The face loses superficial fat for the rest of its life, which is why the second condition, volume to spare above the pad, matters more than the number on your passport.
If you want a sharper lower face, ask what is actually making it soft. Sometimes it is the chewing muscle, sometimes the position of the jaw, sometimes skin quality, sometimes a small amount of fat under the skin rather than the deep pad. Each of those has a different and usually reversible answer.
If a surgeon agrees to remove your buccal fat, ask three questions: how do you know the fullness is the pad and not something else, how much will you take out, and what happens to my face at fifty. A surgeon who has thought about the third question will not hurry the first two.
Honest limits
I cannot show you a study of buccal fat removal at twenty years, because none exists. The CT studies describe how cheek fat changes with age in people who did not have the operation; what happens to a cheek that lost its pad early is inferred, not measured. It is also true that some patients with a truly large pad and strong surrounding volume are happy for decades. I am not writing that the operation is wrong. I am writing that it is permanent, that its long-term is unstudied, and that the decision belongs to the anatomy of your cheek, not to the fashion of the year.
If you are unsure whether the fullness in your lower face is buccal fat at all, send unedited daylight photographs from the front and both sides to +90 544 772 0772. The surgical team reviews them the same day and tells you what is causing it.
Dr. Mustafa Aydınol is a plastic, reconstructive and aesthetic surgeon in Istanbul and a member of ISAPS.
Sources
- Moura LB, Spin JR, Spin-Neto R, Pereira-Filho VA. Buccal fat pad removal to improve facial aesthetics: an established technique? Systematic review of 8 studies, no long-term data. Med Oral Patol Oral Cir Bucal, 2018. DOI
- Traboulsi-Garet B, Camps-Font O, Traboulsi-Garet M, Gay-Escoda C. Buccal fat pad excision for cheek refinement: a systematic review. Med Oral Patol Oral Cir Bucal, 2021. DOI
- Tower JI, Gordon NA, Paskhover B. Deep cheek fat volumes and midfacial aging, CT study of 109 patients with longitudinal subgroup. Aesthet Surg J, 2020. DOI
- Akşamoğlu M, Bayar Muluk N, Şahan MH. Changes of the buccal fat pad volume according to age, sex and body mass index, CT study of 120 patients. J Comput Assist Tomogr, 2024. DOI
- Gierloff M, Stöhring C, Buder T, et al. Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg, 2012. DOI
- Solano N, Gutiérrez P, Ramos S, Rivera E, Peraza A. Submalar fat pad removal for esthetic purposes: a systematic approach, 44 patients, selection criteria. J Stomatol Oral Maxillofac Surg, 2022. DOI
- Sirimahachaiyakul P, Tansawet A, Wannachamras S. Success rate of buccal fat pad removal in cases of previous injection lipolysis of the cheeks, 100 patients. Plast Reconstr Surg Glob Open, 2023. DOI
- Jaber MM, Soueid A. Neo-duct formation following iatrogenic parotid duct injury during aesthetic filler removal: a case report and review of management. J Plast Reconstr Aesthet Surg, 2025. DOI
- Ghoraba S, Ismail M. The outcome of the reconstructive procedure using buccal pad of fat flap and deep plane facelift after permanent filler removal, 151 patients. Aesthetic Plast Surg, 2026. DOI
- People, 4 September 2026: Jennifer Lawrence on the procedure she wants but will not have. Link
