CHIPMUNK CHEEKS SURGERY: EXPLAINING THE BUCCAL FAT PAD REMOVAL PROCEDURE

High cheekbones, heart-shaped face, voluptuous lips – this is the golden beauty standard nowadays, and we see lots and lots of this on the cover of the glossy magazines, on TV, and even out on the streets.  Those who flaunt such sculpted faces exude confidence, and for good reason.  They’re either blessed with lucky genes or have astute aesthetic surgeons.  We all love chipmunk cheeks in children, but we hate to see them in the mirror. Cheek fat is not fun or sexy, and we can’t even hide it with clothing (like we do with the muffin top!).  

Maybe you’ve tried already to make your face look thinner, failing to achieve spectacular results. Well, you should know that chipmunk cheeks are not always associated with excessive body weight. You can have them even if you have a normal weight. This means that in a vast majority of cases, you can’t get rid of the fatty cheeks with diets and physical exercises. If you’ve had enough of the highlighter, bronzer, and all the other face contouring makeup techniques, it’s time to look into a more permanent solution – the buccal fat removal technique. But let’s start from the beginning!

WHAT ARE “CHIPMUNK CHEEKS”?

Buccal fat contributes to fullness in the lower part of the face. Most people describe it as a very round face shape. This means that there are no sharp angles. When the face has a square shape, it is most likely the masseter muscle or the bony mandible that is prominent rather than buccal fat. Nowadays, most of us want to see more angles and less fat, especially in certain areas of the body, such as the face. Just consider that some of the most wanted Hollywood cheekbones belong to Keira Knightly, Cara Delevigne, and Angelina Jolie. But what is between chipmunk cheeks and those high, plump, perfectly structured cheekbones? Well, it’s just a pad… a fat pad.

THE ANATOMY OF THE FAT PAD

Marie François Xavier Bichat, a French anatomist, and pathologist identified the fat pad for what it truly was (and now the fat pad is known as the Bichat fat pad in medical terms). This was happening in 1801, about seven decades (1732) after Lorenz Heister, a German anatomist and surgeon, described it as a gland¹. The pad serves as lubrication for the muscles that are used to chew and suck and the buccal fat pad is particularly prominent in small children.  

Did you know that the cheek is the first part of the face that develops fat², and this happens as soon as the 14th week of gestation? Buccal fat grows from 4000mm³ to 8000mm³ from childhood to adulthood, and then between the ages of 20 to 50 shrinks again to 7000mm^{3 3}. The total fat pad is about 10-13 ml. However, the reduction of the volume of the cheek fat pad varies from one person to the other. The size of the buccal fat pad is constant in adults and resistant to weight loss in many cases⁴.  Because this fat accumulation is situated between the deep and superficial muscular planes of the cheeks, right under the cheekbones, there is not much one can do to make it go away. And this is why people with chipmunk cheeks resort to plastic surgery to improve the contours of the face. The procedure is called bichectomy (yes, after Marie François Xavier Bichat!), and it can deliver impressive results. 

TRENDS IN FACIAL SCULPTING

Bichectomy is the plastic surgery intervention that entails the partial or (in very rare cases) complete removal of the Bichat fat pad. Usually, it is only about 2-3.5ml of the total fat pad that is removed during the buccal fat removal procedure⁵. So, it’s only partially removed, and overzealous reduction could lead to problems down the line – sunken cheeks, for example,  creating a tired look.

Aside from reducing the buccal fat, an experienced surgeon might advise adding a little volume to enhance the surrounding features at the same time⁶. So, hello, injectable fillers! Fillers can be added to the cheekbones and the chin to create a sculpted, angular look. The fat harvested with bichectomy can also be used to add volume to other areas⁷. Procedures are often combined to achieve more natural results and/ or correct other imperfections at the level of the face. 

BUCCAL FAT REMOVAL TECHNIQUE

Some might say that the buccal fat removal procedure is as simple as 1,2,3 (4):

1. Local anesthesia
2. Incision
3. Find and remove a part of the fat pad
4. Suture incision

When an experienced, board-certified plastic surgeon or facial plastic surgeon performs it, the procedure can take less than an hour (20-30 minutes). It is performed on an outpatient basis, so a walk-in walk-out. After local anesthesia is administered, the surgeon performs a small incision (no longer than 1 to 3 cm, inside the mouth, at the level of the last two superior molars. The fat pad is found, and a part of it is removed, then the incisions are sutured with dissolvable stitches. There are no visible scars left after the procedure is performed, and the patient can leave the medical facility where the intervention was performed almost immediately after the surgery. 

The procedure should be pain-free, and the recovery period is usually a breeze. Patients can resume daily activities upon their return home, with a very low risk of developing complications.

RESULTS OF BUCCAL FAT REMOVAL SURGERY

When it comes to the results achieved with the bichectomy procedure, there is good news and … well, the normal recovery period after the surgical intervention. The good news is that the results are permanent. Once removed, the fat pad is not getting back to your cheeks ever again. Of course, if the patient gains a significant amount of weight after the intervention, the aspect of the face can change, and fat cells can enlarge in other parts of the face.

It’s also important to know beforehand that the final results of the surgery are not visible immediately. The face can be swollen and bruised for a week or two after buccal fat removal. For the first couple of days post-op, the cheeks might look even fuller and rounder than before the procedure. This is a normal side-effect of the intervention and nothing to worry about as, starting with the end of the first week, the swelling and bruising start to subside, and the final results should become more and more visible. 

 Bichectomy is considered a safe procedure, and it’s not an overly complex one. However, the experience of the surgeon is crucial in achieving good results and avoiding complications. When the fat pad is removed, the surgeon needs to avoid damaging the salivary ducts or getting too close to the facial nerves. There is a risk for the patient to experience numbness, changes in sensitivity, or, in rare cases, partial facial paralysis. Other complications associated with the procedure are bleeding, nerve injury, and parotid duct injury (6), infection, trismus, hollowing, and asymmetry. 

The procedure aims to reduce the volume of the cheeks and, as a result, the cheekbones become more prominent. The contours of the face are obviously improved, and the face looks more defined. 

WHAT TO DO AFTER BUCCAL FAT REMOVAL SURGERY

We have already mentioned the swelling that occurs in the operated area. A mild level of pain and discomfort can be experienced when the patient is eating or chewing during the first few days post-op. Applying ice packs on the cheeks can help make the side effects of the procedure disappear sooner. Analgesic and anti-inflammatory medication, as well as antibiotics, can be prescribed in the first week. Always be guided by the individual, tailored advice of your surgeon or healthcare professional. 

When it comes to the diet after the chipmunk cheeks surgery, the recommendation is to try a liquid diet for the first two-three days afterwards. This means that the patient can have soup, juice, tea, water, and other fluids. Starting with the third or fourth day post-op, the patient can introduce soft foods to the diet such as pasta, eggs, pudding, fruit, and veggies purees. During the second week post-op, the patient can resume a normal diet. 

IS BUCCAL FAT PAD REMOVAL RIGHT FOR ME?

Are you interested in:

• A subtle hollowing to cheeks?
• Better defined cheekbones?
• A more heart-shaped face?

In this case, it’s probably time to talk to your surgeon about a buccal fat removal procedure. An increasingly popular procedure amongst younger people, both men and women, bichectomy could definitely help you raise your selfies game to the next level. The subtle but attractive result can be a thing of beauty, boosting confidence when chubby cheeks did the opposite. 

Generally speaking, bichectomy is a plastic surgery procedure recommended for adults who are not pleased with fullness in the lower cheek area. Patients interested in undergoing the buccal fat removal procedure are usually looking for more facial definition. Just like it is the case with any other surgical procedure, the patient should be in good health and emotional condition to be an eligible candidate for this procedure.

Buccal fat removal is a facial contouring procedure that can be used to remodel a very round face. The procedure is also indicated for people who tend to often bite the internal side of the cheeks. In this case, aside from the obvious discomfort, these people can develop degenerative mucous membrane modifications. The procedure could be the optimal solution for patients who lost a lot of weight but are still left with excessive roundness of the face. 

Different causes can lead to chipmunk cheeks, weight gain included. This is the reason why patients who want to lose weight are advised to postpone the procedure until they have reached their ideal weight. When weight loss occurs, the face can look thinner, but this doesn’t necessarily happen to everyone. 

In many cases, bichectomy is the only efficient method that can help you get rid of the chipmunk cheeks. The procedure is fairly simple, and the patient is out and about in a matter of hours. There is no need for prolonged downtime after the buccal fat removal procedure; however, patients are advised to adopt a light, liquid diet for the first few days post-op. The results occur when the swelling subsides – this can take up to one month or more. 

References

1.  https://pubmed.ncbi.nlm.nih.gov/15809604/
2. A review of the gross anatomy, functions, pathology and clinical uses of the buccal fat pad. Yousuf S, Tubbs RS, Wartmann CT, Kapos T, Cohen-Gadol AA, Loukas M. Surg Radiol Anat. 2010 Jun; 32(5):427-36
3. Anatomy of the buccal fat pad and its clinical significance. Plast Reconstr Surg. 1999;103:2059-60
4. Managing the buccal fat pad. Matarasso A. Aesthet Surg J. 2006;26:330-6
5. The excision of the buccal fat pad for cheek refinement: volumetric considerations. Sezgin B, Tatar S, Boge M, Ozmen S, Yavuzer R. Aesthet Surg J. 2019 May 16;39(6):585-92
6. Buccal fat pad removal. Jackson IT. Aesthet Surg J. 2003 Nov-Dec;23(6):484-5
7. Buccal fat pad: an effective option for facial reconstruction and aesthetic augmentation. Kim JT, Sasidaran R. Aesthetic Plast Surg. 2017 Dec;41(6):1362-74
8. Lesions of the parotid duct and buccal artery after buccal fat pad reduction. Vieira GM, Jorge FD, Franco EJ, Dias LDC, Guimarães MDCM, Oliveira LA.J Craniofac Surg. 2019 May/Jun;30(3):790-792