August 03, 2026 | Plastic Surgery News
A round, full lower face is one of the most common things people ask me to soften.
The buccal fat pad sits in the hollow of the cheek, and in the right person, removing a portion of it brings out the cheekbones and gives the face a more triangular, sculpted shape. It is a small procedure with a big effect, but only if you are the right candidate. Done on the wrong face, it does nothing good, so the first job is always deciding whether you actually have the fullness to work with.
These are my answers from the exam room, anonymized.
“Am I a Good Candidate, or Is This a Mistake?”
The mistake is doing it on somebody who does not really have the fullness. If you have a genuinely round face with fullness in the lower cheeks, you are a good candidate. If you are thin there already, taking it out will only hollow you as you age. So I look first, and I am honest about whether it will help you.
“Won’t Removing Cheek Fat Make Me Age Faster?”
That is the fear I hear most, and it is misunderstood. The buccal fat pad is not the fat we rely on for support. Look at where we place filler as people age, we add it up on the cheekbone, never down in the buccal area, even in very old patients. The buccal fat just gives you that lower-cheek fullness. Removing the right amount takes away roundness, it does not take away the support that keeps your face looking young.
“Where Are the Incisions?”
Everything is inside the mouth, so there is no visible scar. The buccal fat pad actually starts in the cheek and extends all the way up toward the temple, and I only remove the part that sits in the cheek. I make two small incisions, about a centimeter each, on the upper inside of the mouth, take out the pad, and place sutures. It heals within about five days.
“How Bad Is the Swelling and Recovery?”
It is a very tolerable procedure, under local anesthesia or light sedation, and it takes less than thirty minutes. You go home the same day and can go back to work. The next day you will be a little swollen, a lot like getting your wisdom teeth out. The worst day is the third day, and then it gets better and better. Ice and sleeping propped up help it go down faster. You are essentially back to normal in about two weeks, and most people will not notice anything by day six or seven. I keep you on soft food at first, no chips or spicy food, and no working out for a week so you do not swell.
“Can I Have It Done Before an Event?”
Yes, with the right timing. If you have something important a couple of months out, having it done six weeks or more ahead means you will be seeing your final result by the time you get there, not fighting swelling in photos. I would rather plan it with room to heal than rush it.
“Should I Add Botox to the Masseters?”
For a lot of round faces, this is the perfect pairing. The buccal fat removal targets the fullness in the front of the cheek. Botox to the masseters, the chewing muscle further back at the angle of the jaw, shrinks that muscle so the lower face narrows even more. The two together create a stronger triangle, the buccal in front and the shadow of the slimmer jaw in back. Just remember masseter Botox is not like the Botox we use in the forehead. We are waiting for the muscle to get smaller, so it takes about six weeks to show, and it can be done at the same time, before or after, it does not matter. The injectable side lives at the med spa.
“What If I Want a More Dramatic Result?”
For a more powerful change, I often recommend liposuction of the lower face and neck along with the buccal fat removal. It is a tiny incision behind the ear, and it defines the jawline and pushes the triangulation much further. Whenever I do lipo on the face, I take a pass on the neck too, which sharpens the jawline. The recovery is about the same, you may just get a little bruising on the neck that fades within two weeks and covers easily with makeup, and you wear a light facial garment for the first five days.
“I Have Seen People End Up With Weird Lines. Why?”
Those cable-like lines are fibrosis, and they come from two things, taking out too much fat and skipping the aftercare. That is why I leave a little fat behind rather than overdoing it, and why I insist on lymphatic massages afterward. The massages, which we do here in the office, pull the fluid out and let everything heal smooth. Skip them and you invite the very problem people are afraid of.
“Will It Affect My Cheek Dimple or My Cheekbones?”
Your dimple stays, it is not affected. People actually pay me to create dimples, so that is a feature, not a problem. And I do not touch the fullness up on your cheekbone, that is good fullness we want to keep. In fact, slimming the lower face makes that upper cheek area look even better.
Why I Take Facial Balance Seriously
I am a double board-certified plastic surgeon with a Mayo Clinic fellowship, and I treat the face as one connected unit. Buccal fat, the masseter, the jawline, and the neck all work together. The art is knowing how much to remove and what to leave, so the result looks like a naturally sculpted version of you, not a hollow or overdone one.
For my editorial take, see the companion piece on drworldwide.com. The med spa pairings live with the team at swplasticsurgery.com.
Ready to Talk?
If your lower face has always looked rounder or fuller than you would like, buccal fat removal may be the simple, subtle fix, sometimes on its own and sometimes paired with a little masseter Botox or lower-face liposuction. Come in and let me take a look. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
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