Cheek reduction (Buccal fat removal)

This article covers the reduction of the buccal fat pad for cheek fullness, patient selection, the care of the incision inside the mouth, and the risks. The operation is not regarded as one that slims every part of the face or lifts sagging tissue. The decision rests not only on the early appearance but also on the fact that the removed tissue does not come back and that the face changes with age.¹

What is cheek reduction (buccal fat removal)?

Cheek reduction is the surgical reduction of the part of the buccal fat pad that contributes to cheek fullness.² It is also known as bichectomy. The target is the fullness beneath the cheekbone; not all the fat seen in the face is the same structure.²

The buccal fat pad: Also called Bichat's pad. It is a body of fat in the cheek closely related to the chewing muscles, with its own capsule and extensions; it is not the same as the widespread fat beneath the skin.³

Subcutaneous cheek fat: This lies immediately under the skin in distinct compartments. Reaching the buccal fat pad does not mean this superficial fat is removed as well.⁴

Malar fat: This is the name used for the superficial fat compartments of the cheekbone and anterior cheek region; it is not another name for the buccal fat pad.⁴ Nor should malar fat be thought of as a third plane entirely separate from the subcutaneous fat. The distinction is between the deeply placed buccal fat pad on the one hand and the superficial compartments, and what those compartments are called around the cheekbone, on the other.⁴

Cheek reduction therefore does not share the aim of a midface lift, in which malar fat is repositioned upwards, or of chin surgery, which changes the shape of the point of the chin. A face looking wide does not by itself show that there is excess buccal fat; bone structure, muscles and the other fat compartments also play a part in the appearance.⁵

Who is it suitable for?

Assessment can be made in people who are troubled by cheek fullness, whose general health is suitable for surgery, whose weight is stable and whose expectations match the change that can be achieved.⁶ Suitability is not determined only by a person's wish for a slimmer face. At the examination, the source of the fullness and the contribution of the tissue to be removed are assessed together.

Assessment is generally made after the age of 18. This does not mean everyone who reaches that age is suitable for surgery. Cleveland Clinic's information states that people whose face is narrow, or who are above a certain age, may not be suitable candidates for this procedure.⁷ How fullness in youth may change in later years, and whether an irreversible decision is accepted, are also part of the assessment.

Removing fat may not be appropriate in a face that already looks narrow, thin or hollow. The American Society of Plastic Surgeons (ASPS) states that in narrow faces the procedure can produce a more gaunt appearance with age.² People with an underdeveloped cheekbone have been reported to be poor candidates for this procedure, which may further emphasise a hollowed cheek appearance.⁵

Not having surgery, or postponing the decision, is also among the options. A round face is not in itself an illness or a feature that has to be corrected. Deciding with the aim of obtaining someone else's appearance or conforming to a single ideal facial shape is advised against.⁶

What does the examination assess?

Where the fullness lies: Whether the fullness is beneath the cheekbone, along the jawline or across the face as a whole is assessed. The contributions of fat, muscle and bone structure are considered separately; a wide appearance in a photograph does not by itself decide which tissue is to be removed.

The two sides of the face: The starting cheek volume and any difference in shape are recorded. The buccal fat pad is stated to differ in size between the two cheeks of the same person.² Removing the same amount from both sides without regard to the starting difference is not accepted as an aim of symmetry.

Skin and volume loss: Skin laxity, any existing hollowing around the cheekbone and the person's weight changes are assessed. Whether the wish to reduce volume in fact concerns the position of sagging tissue is clarified.

The mouth and facial movement: Sores inside the mouth, complaints about the teeth and gums, difficulty opening the mouth, cheek swelling that changes with eating and any existing differences in facial movement are reported. The baseline examination is recorded so that a pre-existing condition can be distinguished from a new finding developing after surgery.

Previous procedures and health history: Previous facial operations, fillers or fat injection, medicines, allergies and health problems are assessed.⁸ Where fat has been removed from the cheek before, its timing and extent are reported together with the operative records if available. The aim of a new procedure is not assumed to be independent of the previous one.

How is the operation planned?

Does the fullness really come from buccal fat?

Wanting a narrower face and reducing buccal fat are not the same decision. If the fullness arises from another structure, removing this fat pad may not produce the expected change; minimal change is among the reported problems with the result.⁹ The aim is defined in relation to the region identified at examination rather than slimming the person's whole face.

How much fat is removed, and what sets the limit?

No single target in grams or volume is set for everyone. The starting fullness, the difference between the two sides and the volume that needs to be preserved are assessed together. The surgical approach paper explains that pulling the fat tissue more than necessary is linked to over-resection and to injury of the neighbouring structures.⁵

The aim is not to remove the whole fat pad at any cost. Taking more tissue does not mean a more appropriate result. What tissue will be preserved is explained before surgery as much as how much will be reduced; the decision is not taken on the assumption that this loss can easily be reversed later.

Where is the incision made and how is it closed?

The incision is made only inside the mouth, on the inner surface of the cheek. The planned part of the fat pad is reduced through this access and the incision is closed with absorbable stitches.¹⁰ No incision is made in the cheek skin on the outside. This access differs in that it leaves no scar visible from the outside; that does not mean the wound inside the mouth needs no care.¹¹

The point where the parotid duct opens into the mouth, and the neighbouring branches of the facial nerve, are taken into account in surgical planning.⁵ A small incision does not mean the risks to neighbouring structures have disappeared.

How does it differ from a face lift, a midface lift and chin surgery?

A face lift is assessed for the position of loosened facial and jawline tissue; a midface lift for the repositioning of cheek tissue. Chin surgery addresses the bone structure of the point of the chin or the volume added to it. The aim of this article's operation is the reduction of buccal fat tissue; it is not accepted as taking the place of those procedures.

Fat injection has the aim of adding volume and is a separate decision. The suitability of non-surgical options is likewise assessed according to the change that is wanted. None of these means the removed fat pad can be put back with its former anatomy. Where combined procedures are considered, the aim, the additional risk and the effect on recovery of each are explained separately; it is not assumed that they will be done together.

How are anaesthesia and discharge planned?

The operation is carried out under local anaesthesia and takes 20-30 minutes. Discharge is planned for the same day. These times are the clinical framework approved for cheek reduction alone; if another operation is added, the same timetable cannot be used automatically.

Choosing local anaesthesia does not make the assessment of medication and allergy history unnecessary. The medicines to be used on the day of surgery and the preparation instructions are explained beforehand. Any discomfort during the procedure needs to be reported; enduring discomfort in silence is not expected.

How do you prepare for surgery?

Smoking and nicotine: Smoking is a risk factor for wound healing problems after surgery. Direct surgical data on nicotine products other than cigarettes are scarcer. The practice reference of the American Society of Plastic Surgeons notes a lack of clinical data on e-cigarette use and surgical risk, but states that because nicotine is known to reduce blood flow, e-cigarettes and other nicotine products are regarded as a potential risk factor.¹² Stopping smoking, vaping and other nicotine-containing products at least 1 month before the operation, and not using them after surgery until healing is complete, is therefore advised. The studies below concern smoking cessation; their results do not establish the same reduction in risk for every nicotine product. A review pooling 6 randomised and 15 observational studies showed that every week of abstinence added benefit, and that studies with at least 4 weeks of abstinence produced markedly better results than shorter ones.¹³ A study appraising systematic reviews together reported that cessation interventions beginning at least 4 weeks before surgery and combining multiple behavioural support sessions with pharmacotherapy reduced complications. The same study notes that interventions with only one component, even when started more than 4 weeks before surgery, raise quit rates without reducing complications.¹⁴ Shorter intervals are not useless either: in a meta-analysis of 55 studies covering adults undergoing a range of operations, the risk of pulmonary complications was 27 per cent lower in relative terms among those who stopped at least 2 weeks before surgery, and 29 per cent lower among those who stopped at least 4 weeks before, compared with those who continued smoking.¹⁵ The benefit therefore grows as the interval lengthens; being late does not make stopping pointless. The interval applied and the nicotine policy can vary from surgeon to surgeon.

Coexisting illness: Diabetes and blood pressure are expected to be under control before surgery. Where there is an active infection in the body, surgery is postponed.

Medication: Blood thinners and some herbal products can increase bleeding. Every medicine and supplement you take needs to be declared. Prescribed medication should not be stopped on your own decision.

Tests and anaesthetic assessment: The tests required are determined by general health and by the anaesthetic assessment. Any previous problem with anaesthesia or drug allergy should be declared. The instructions given about fasting and about how to take medication on the day of surgery are followed.

Home and transport: Someone is arranged to accompany you home on discharge. The timing of check-ups, the help you may need in the first days and the plan for time off work are organised beforehand. Follow the surgical team's guidance on preparing the operation area; do not shave or prepare the incision area at home on your own initiative.

Preparing the mouth: Any complaint about the teeth or gums, sores inside the mouth and previous mouth or facial procedures are reported. The mouthwash and spray to be used, the eating arrangement and the timing of check-ups are explained beforehand. No medicine is started independently at home. Any part of the instructions given that is not understood is clarified before surgery.

What is recovery like?

The periods below are the clinical timetable approved by the surgeon. Returning to daily life and the end of all cheek swelling are not the same stage. The timetable is assessed together with the examination and the course of healing; the arrival of a particular day does not mean every activity can be undertaken unconditionally.

The first check-up is within the first week. Because absorbable stitches are used, no routine day for stitch removal is planned; the incision and the stitches are assessed at the check-up. 3 days are expected for a return to desk work. A return to driving can be assessed on the same day. 1 week is expected for a return to sport and 2 weeks for a full return to daily life.

Bruising is expected to settle in 7-10 days and marked swelling to subside in 1 week. Residual slight swelling can last 1-2 months; the shape also becomes assessable within 1-2 months. Being able to assess it does not mean everyone's swelling will have gone completely on the same day.

The check-up looks not only at the shape of the face but also at the incision inside the mouth, pain, mouth opening and cheek movement. A new or increasing complaint is not explained by the timetable alone. To understand the pace of healing, what matters is less the appearance on the first day than whether the findings are decreasing or increasing.

What to pay attention to after surgery

Where the care instructions you are given differ, your surgeon's instructions are followed. Because an incision inside the mouth is not a wound visible from the outside, it is not regarded as an area a person can fully assess alone. Check-ups are not limited to situations where stitches have to be removed.

Incision care: The stitches should not be played with using the tongue or fingers, and the incision line should not be pulled or strained.¹⁰ No tape, silicone or other wound product is placed inside the mouth at home. The products to be used and the manner of cleaning are arranged according to the care plan given.

Sleeping: Rest with the head elevated. Your surgeon decides how long that position and the avoidance of physical strain are continued. A sleeping position that puts no pressure on the incision is preferred. Returning to sleeping on the side or front is assessed according to the state of the incision and the swelling.

Cold application: Cold is applied to the operated area without pressing on it. The form and duration of the application are determined by your surgeon's instructions.

Showering, wound and dressings: When you may shower depends on the dressing used. If there is a skin incision, once allowed you can shower without rubbing the wound and pat the area dry gently. Baths, swimming pools and the sea wait until the wound has closed completely.

Eating: The eating arrangement varies with the type of operation; usually soft food is taken during the first week. The consistency of food and the return to normal eating are determined by the surgeon's instructions. This arrangement does not mean the same period of liquid feeding or the same day of transition for every procedure.

Beginning with liquids and moving on to soft food can be arranged according to the surgeon's instructions; this approach is also described in the procedure-specific patient information.⁷ How long liquid feeding continues is determined by the surgeon's instructions. If a person cannot eat according to the plan given, or cannot take fluids, the surgical team is informed.

Mouth care: Where there is no intraoral incision, no special mouth care directed at such an incision is needed; ordinary oral hygiene continues. Where there is an intraoral incision, a mouthwash and a spray are used. How, how often and for how long they are used varies with the type of operation and the surgeon's instructions. Cleaning the teeth is carried out without straining the incision line, according to the care plan given.

Movement: Strain such as bending the head down, straining and heavy lifting is limited in the early period. Movements that stretch or rub the incision area are avoided. Even if you feel well, do not return to strenuous activity suddenly. Activity and rest through the day are organised according to the plan given on discharge.

Pain: There can be pain and tenderness around the incision inside the mouth.⁷ The painkillers given are used as instructed. Pain that increases instead of decreasing, settles markedly on one side, or worsens despite the treatment given is reported. If a new painkiller or additional medicine is to be used, the surgical team is informed.

Returning to work and sport: 3 days are set aside for a return to desk work; where the physical demands of the job are greater, suitability is assessed separately. 1 week is expected for a return to sport and 2 weeks for a full return to daily life. For activities that could involve a blow to the cheek, pressure, or marked strain on the incision line, suitability is assessed separately. The return is not increased abruptly merely because the timetable has run its course.

Driving: A return to driving can be assessed on the same day. That does not mean taking the wheel as soon as the procedure ends. There must be no dizziness, and no medicine affecting attention and reflexes or causing drowsiness must have been used. You should be able to turn your head, follow the traffic comfortably and make sudden manoeuvres without pain. Where these conditions are not met, driving is not undertaken. The companion arranged in advance for the journey home on discharge is kept.

Sexual activity: A return can be assessed once everyday movements no longer cause marked pain and you feel comfortable. Pressure on the head and the cheek area, movements that stretch the incision line, and marked straining are avoided. Rather than a fixed day, the course of healing and the surgeon's advice are taken as the guide.

Smoking: Smoking impairs wound healing after surgery as well; cigarettes and nicotine products should be avoided until healing is complete.

Findings that are normal: Swelling and bruising in the cheek, and tenderness or numbness around the incision, can occur.⁷ What matters is less the presence of a mild finding than how it changes. Swelling that increases instead of decreasing, progressing pain, new discharge or the wound opening are not waited out as ordinary healing.

How does the incision inside the mouth heal?

Because the facial skin is not cut in this operation, which is carried out only through the mouth, no scar visible from the outside is formed.¹⁰ The incision inside the mouth nevertheless heals and this area needs to be protected.¹¹ The absence of an external scar does not mean the operation is without a wound or without risk.

Absorbable stitches dissolve on their own; they do not routinely have to be removed.¹⁰ Feeling a stitch does not call for pulling it out by hand. The state of the incision line is assessed at the check-up; any discomfort related to the stitches, opening of the wound or new discharge is reported.

Because there is no external skin incision in this operation, silicone gel and massage are not advised. This care is not applied to an incision inside the mouth. The scar care used in chin surgery where there is an external incision is not carried over to the mucosa inside the mouth. Rather than rubbing the healing incision area or tugging at the stitches, the mouth care given is followed.

Risks and complications

In assessing the risks, what matters is not only lasting damage but also how findings such as temporary swelling, pain and difficulty opening the mouth have been counted in the research. The abstract of Albuquerque and colleagues' review of 12 studies reports that 81 of 308 people experienced a complication, with an overall prevalence of 25 per cent and a 95 per cent confidence interval of 4-46 per cent.¹⁶ Oedema, trismus and pain were included in that assessment; the 25 per cent is not a rate of lasting damage.¹⁶

There are also studies reporting more favourable results. The abstract of Shapiro and colleagues' 2026 review covers 10 studies and a total sample of 1,123 people; among the 921 procedures for which complications were reported, there were 39 complications, given as 4.2 per cent.¹⁷ Most of these were stated to be minor, but short follow-up and low-level evidence were said to limit any long-term interpretation.¹⁷ These figures are not a direct comparison using the same unit of analysis and definition of complications; their difference does not show that the procedure has become safer over time. Nor are they combined to produce a single risk range for one person.

Problems with shape, symmetry and over-resection

Asymmetry, failure to achieve the expected change, or a need for further correction can develop.⁹ Early swelling and the difference in shape remaining after healing are not settled at the same stage. Where correction is considered, the problem is assessed not only by external appearance but together with the starting difference and the amount of tissue removed.

Over-resection can lead to a more hollow cheek appearance than intended; excessive traction on the tissue or firm dissection is reported to be able to result in removal beyond the buccal extension of the fat pad, which may contribute to this appearance.⁵ Whether such an appearance belongs only to the early period, and what volume loss with advancing age may add to it, are assessed. Removing more fat does not secure symmetry or a more suitable facial shape.

The buccal branch of the facial nerve

The buccal branches of the facial nerve are related to the muscle movements around the mouth and cheek and are neighbours of the buccal fat pad.⁵ Injury to these branches can lead to temporary or permanent muscle weakness.⁹ A new difference in the smile or weakness in lip movement is not the same finding as numbness around the incision alone.

Temporary involvement of the buccal branch has also been reported; the available data, however, do not yield a recovery period for everyone or a reliable individual risk percentage.³ Where a new difference in movement develops, assessment is requested without waiting for the scheduled check-up. Nor is every early change assumed to be permanent.

The parotid duct and problems related to saliva

The parotid duct is also known as Stensen's duct; it carries the secretion of the salivary gland in front of the ear into the mouth. Because of its close relationship with the fat pad, it can be injured during surgery.⁵ After injury, saliva collecting within the tissue can produce a sialocele, or discharge from the incision site.⁵

One-sided fullness lasting beyond the expected period of oedema, clear discharge from the incision site, and swelling or discharge that increases with sour or spicy food may call for assessment for a duct problem.⁵ These do not always mean a duct injury; they are distinguished from other causes at examination. No attempt is made to empty the swelling by squeezing it at home or to insert anything into the incision line. The investigation and treatment needed are determined by the findings.

Bleeding, wound problems and infection

Bleeding, haematoma, infection and poor healing of the incision are among the reported risks.⁹ Where there is rapidly increasing, particularly one-sided swelling in the cheek, or bleeding inside the mouth that does not stop, the scheduled check-up is not waited for. Fever, increasing pain and discharge also call for assessment.

A single treatment plan naming a medicine and a dose is not valid for everyone. Prevention and, where needed, treatment are determined by the person's condition and the examination findings. Treatment that has been given is not altered on the person's own decision; a new complaint is not dealt with by adding a medicine or increasing the frequency of care independently.

Restricted mouth opening and everyday function

Temporary restriction in opening the mouth, that is trismus, has been reported after surgery.³ For that reason not only the appearance of the face but also the ability to eat and to maintain oral hygiene is monitored. Rather than forcing the jaw open, the movement and eating instructions given are followed.

Where difficulty opening the mouth is increasing, fluid intake has fallen markedly or swallowing is affected, the completion of the healing timetable is not simply waited for. A mild and decreasing restriction and a progressing loss of function are not assessed in the same way.

Anaesthetic and general surgical risks

Being carried out under local anaesthesia does not remove the need to assess the risks related to anaesthesia; anaesthesia risks also appear in the ASPS list of risks specific to this procedure.⁹ Previous drug reactions and allergies are reported. General surgical risks are assessed according to the person and the extent of the procedure; the rate for another facial operation is not transferred to this one.

Blood clots: A clot forming in the leg veins and travelling to the lungs is serious. One-sided leg pain and swelling, sudden shortness of breath or chest pain need urgent assessment.

The approach to preventing clots is decided according to the person's risk and the operation planned. The measures to be used are explained in the discharge and care plan. No blood thinner is started without being prescribed, and existing treatment is not altered on the person's own decision.

Does the removed fat come back, and how does the result change with age?

The operation is not regarded as reversible. The removed part of the fat pad does not grow again to form its former structure; the decision should therefore not be taken on the assumption that the same tissue can later be put back.¹ Assessing the later addition of volume to a region is not the same as putting removed tissue back with its former anatomy.

The face changing with age is different from the operation reversing. In the abstract of Boehm and colleagues' imaging study of 19 people, which examined natural ageing and not the outcome of bichectomy, a significant decrease in superficial and deep midface fat volume was reported over a mean of 11.3 years.¹⁸ The authors reported that the change in buccal fat volume was not statistically significant.¹⁸ This does not establish that buccal fat did not decrease at all. The finding of a single small study shows neither that buccal fat changes in everyone at the same age or by the same amount, nor that it does not change.

Reducing volume early or excessively in a young face can, combined with later natural volume loss, contribute to unwanted hollowing in the future.¹ It cannot be said that this will happen in every person or appear at a particular age. The wish to reduce today's fullness and the facial volume to be preserved in the long term have to be weighed together.

Long-term evidence on this is limited. A 2021 systematic review assessed 3 case series and 1 randomised study; it stated that no adequate long-term patient follow-up could be found.³ A recent review likewise reported that long-term outcomes were poorly assessed because follow-up was limited.¹⁷

Because the available reviews rest on small series and low-level evidence, no year or percentage carrying certainty can be given about the appearance that will develop with age.³¹⁷ Healing without problems at first does not prove that the long-term shape will not change. This uncertainty places patient selection and the amount of tissue to be preserved at the centre of the decision.

What can be expected from the result?

The change expected is a reduction of the fullness identified at examination as having a contribution from buccal fat.² No promise is made of the same degree of slimming in everyone, of full symmetry, or of a facial shape selected in advance. The structure of the cheekbone and jawbone, the muscles and the superficial fat compartments are not treated as though they had been altered at the same time.

Swelling can obscure the early result; where the expected change is not achieved with a single operation, further assessment may be needed.¹⁹ The shape becoming assessable within 1-2 months and slight swelling persisting over the same period are not in conflict. The return to daily life is not taken to mean the appearance has reached its final state.

The decision is not completed by the words "slimmer cheeks" alone. What is expected to change and where, that excessive slimming can also be an unwanted outcome, and irreversibility all have to be acceptable. Where the expectation does not match the limits of the operation, the option of not operating is preserved.

When should you contact a doctor?

Do not wait for the scheduled check-up in the following situations:

• Rapidly increasing swelling and tightness in the cheek, the floor of the mouth or the neck
• Swelling that obstructs breathing or swallowing
• Pain that increases rather than settling, or becomes marked despite the pain treatment given
• Fever, spreading redness or discharge from the incision line inside the mouth
• Bleeding that does not stop, opening of the wound, or difficulty opening the mouth that prevents taking fluids
• A newly developed difference in the smile, weakness in lip movement or marked loss of sensation
• One-sided cheek fullness lasting beyond the expected period, swelling that increases with sour or spicy food, discharge from the incision site, or an unusual taste

Early contact is advised for bleeding, signs of infection and an unusual taste in the mouth.⁷ Fullness lasting beyond the expected period of oedema, discharge from the incision site, and swelling that increases with sour or spicy food are among the described signs of duct injury.⁵ These findings do not all have to occur together; where one of them is present, residual slight swelling is not left to settle first. No attempt is made to relieve these signs at home by firm massage or by squeezing the incision line.

One-sided leg pain and swelling, sudden shortness of breath or chest pain are also emergencies. Where breathing or swallowing is obstructed in particular, urgent assessment should not be delayed while trying to reach your doctor.

About the numbers in this article

The operating time, same-day discharge and the point at which driving can be assessed, the return to work and sport, and the periods for bruising, oedema and shape are the clinical timetable approved by the surgeon. Eating, the mouthwash and spray, and not applying silicone to an incision inside the mouth are care instructions. They are not standard periods drawn from another centre's research.

The Albuquerque and Shapiro data are reported only within the limits of the abstracts that could be accessed.¹⁶¹⁷ The number of patients, the number of procedures and the number of complications are not the same unit. Reviews containing different definitions of complications and different follow-up are not made into comparison groups for each other in order to show that the safety of the procedure has risen or fallen over the years.

The results of the smoking cessation studies cover a range of operations; the relative reductions do not amount to a risk percentage specific to cheek reduction, or to an effect shown separately for every nicotine product.¹³¹⁴¹⁵

References

1. British Association of Plastic, Reconstructive and Aesthetic Surgeons. Stay well padded: surgeons urge caution on cheek fat removal craze. 12 June 2023. Accessed 7 September 2026. Institutional text ↩ ↩² ↩³

2. American Society of Plastic Surgeons. Buccal Fat Removal. Accessed 7 September 2026. Institutional text ↩ ↩² ↩³ ↩⁴ ↩⁵

3. 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;26(4):e474-e481. doi:10.4317/medoral.24335 ↩ ↩² ↩³ ↩⁴ ↩⁵

4. Wan D, Amirlak B, Rohrich R, Davis K. The Clinical Importance of the Fat Compartments in Midfacial Aging. Plast Reconstr Surg Glob Open. 2013;1(9):e92. doi:10.1097/GOX.0000000000000035 ↩ ↩² ↩³

5. Weissler JM, Mohamed O, Gryskiewicz JM, Chopra K. An Algorithmic Approach to Managing Parotid Duct Injury Following Buccal Fat Pad Removal. Aesthet Surg J Open Forum. 2022;4:ojac032. doi:10.1093/asjof/ojac032 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷ ↩⁸ ↩⁹ ↩¹⁰

6. American Society of Plastic Surgeons. Buccal Fat Removal Candidates. Accessed 7 September 2026. Institutional text ↩ ↩²

7. Cleveland Clinic. Buccal Fat Removal. Updated 17 June 2022. Accessed 7 September 2026. Institutional text ↩ ↩² ↩³ ↩⁴ ↩⁵

8. American Society of Plastic Surgeons. Buccal Fat Removal Consultation. Accessed 7 September 2026. Institutional text ↩

9. American Society of Plastic Surgeons. Buccal Fat Removal Risks and Safety. Accessed 7 September 2026. Institutional text ↩ ↩² ↩³ ↩⁴ ↩⁵

10. American Society of Plastic Surgeons. Buccal Fat Removal Procedure Steps. Accessed 7 September 2026. Institutional text ↩ ↩² ↩³ ↩⁴

11. American Society of Plastic Surgeons. Buccal Fat Removal Recovery. Accessed 7 September 2026. Institutional text ↩ ↩²

12. American Society of Plastic Surgeons. Managing the risks of smoking in plastic surgery patients. Practice reference, 9 October 2024. Accessed 5 September 2026. plasticsurgery.org ↩

13. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8. doi:10.1016/j.amjmed.2010.09.013 ↩ ↩²

14. Fiddes RA, McCaffrey N. Preoperative smoking-cessation interventions to prevent postoperative complications: a quality assessment and overview of systematic review evidence. Anesth Analg. 2025;140(6):1377-1387. doi:10.1213/ANE.0000000000007187 ↩ ↩²

15. Tang E, Rodriguez RM, Srivastava A, et al. Impact of short duration smoking cessation on post-operative complications: a systematic review and meta-analysis. J Clin Anesth. 2025;106:111967. doi:10.1016/j.jclinane.2025.111967 ↩ ↩²

16. Albuquerque MC, Arruda KAR, Xavier Junior GF, Cerqueira ACDSG, Massignan C, Rocha FS. Prevalence of complications of buccal fat removal: A systematic review and meta-analysis. J Craniomaxillofac Surg. 2025;53(4):363-369. doi:10.1016/j.jcms.2024.12.014 ↩ ↩² ↩³

17. Shapiro J, Zgardau A, Pundkay G, et al. Aesthetic Outcomes, Complications, and Reported Long-Term Effects of Buccal Fat Pad Reduction: A Systematic Review. Facial Plast Surg. 2026. Online ahead of print, 3 June 2026. doi:10.1055/a-2875-0465 ↩ ↩² ↩³ ↩⁴ ↩⁵

18. Boehm LM, Morgan A, Hettinger P, Matloub HS. Facial Aging: A Quantitative Analysis of Midface Volume Changes over 11 Years. Plast Reconstr Surg. 2021;147(2):319-327. doi:10.1097/PRS.0000000000007518 ↩ ↩²

19. American Society of Plastic Surgeons. Buccal Fat Removal Results. Accessed 7 September 2026. Institutional text ↩