Why is everyone suddenly obsessed with buccal fat and its surgical removal?

NEW YORK – Buccal fat became the talk of some corners of the Internet in December after social media users started speculating about celebrities who might have removed some for an extra-chiselled look.

Buccal (pronounced “buckle”) fat is a type of fat found in the midsection of the face that can, in some people, make a face appear more rounded. Surgically remove some of that fat, and the face will immediately look more sculpted.

Well, almost immediately. Initially, most patients experience some swelling, but once that goes down, it is “hello, cheekbones”.

What exactly is buccal fat?

“There are facial compartments that define the shape of the face, and there are superficial ones and deep ones,” said Dr Andrew Jacono, a New York plastic surgeon best known for giving American fashion designer Marc Jacobs a facelift. “Buccal fat is one of the deep facial fat compartments that kind of give structure to the cheek area.”

It is not affected by weight fluctuation, he said. “We’re born with how much we have.”

He added: “There are some people who have faces that are very sculpted, whether they’re cheekbones or more highlighted. There are some people who have more cherubic faces. Some people call it chipmunk cheeks.”

Dr Jacono pointed to the faces of two cherubs, the round-faced angels on the bottom of the Sistine Madonna by Italian painter Raphael, as examples of prime candidates for buccal fat removal.

Why are we talking about this now?

Blame Twitter and TikTok – and, inadvertently, Lea Michele. The American actress of comedy television series Glee (2009 to 2015) fame posted a glammed-up selfie on Instagram in December which made its way over to Twitter, where users speculated that Michele had the procedure done.

“Wake up babe new surgery just dropped in Hollywood jaw filler and buccal fat removal,” tweeted Ms Agnes Philip, a 21-year-old computer science student in Florida who included images of Michele and other celebrities who Ms Philip believed had buccal fat surgery.

Are people really removing this stuff?

Yes, plenty of them. “I’m doing three times as many buccal fat reductions in 2022 than I was six years ago,” said Dr Jacono, who charges US$40,000 (S$54,000) for the procedure. Other plastic surgeons say the procedure will typically cost between US$7,000 and US$16,000.

American model and cookbook author Chrissy Teigen confirmed in an Instagram story in September that she had buccal fat removed. “Since I quit drinking, I’m really seeing the results and I like it,” she said, tagging her Beverly Hills plastic surgeon, Dr Jason Diamond.

Dr Lara Devgan, a plastic surgeon in Manhattan, said: “I think of it as one of the classic celebrity secret plastic surgeries. These are all tiny tweak surgeries that alter facial features by 1 to 2mm each that are omnipresent among public-facing people.”

What about those who are not public-facing people?

A quick search for buccal fat removal on TikTok will turn up no shortage of people documenting their buccal fat removal experience and their results in the following weeks, months and years.

Ms Tina Lee, a nurse who lives in Los Angeles, travelled to Tijuana, Mexico, in 2020 to have the procedure done. It cost US$600. Her mother went with her and had the surgery too.

“It wasn’t painful and the recovery was super fast for me,” said Ms Lee, 30. “They gave me pain medication, but I didn’t need it.”

She documented the trip on TikTok, where it has been viewed 4.8 million times.

So, what is the procedure like?

Quick, actually. “This operation takes less than a half-hour,” said Dr Alan Matarasso, vice-president of development for the American Society of Plastic Surgeons. “I can do it on a 20-year-old person at 8am, and they can be sitting at their desk at 9.15am with basically no discomfort and feeling like it was less involved than going to the dentist.”

Buccal fat can be removed using a local anaesthetic. A plastic surgeon will use a scalpel to make a small incision inside a patient’s mouth to remove a fat pad the “size of a medium grape”, Dr Matarasso said.

The incision is then closed with dissolvable stitches. For typical patients, post-surgery pain and swelling is gone within a week.

What would a person look like if he or she got it done?

For a rough idea, gently suck in through a straw and look in a mirror. Dr Devgan recommends doing a Zoolander impression.

What are the risks?

Bleeding is the biggest problem, said Dr Matarasso, adding that his patients follow a specific protocol before surgery – which includes not taking aspirin – to minimise this risk. He also noted the potential for nerve injury.

Further risks, according to the Cleveland Clinic, include incision infection, facial numbness and facial asymmetry after the procedure is complete.

Does this surgery age well?

“Back in the olden days, doctors would remove the entire buccal fat pad. And then what would happen as you got older was you would look a little sunken in, like you’re sucking your cheeks in too much,” said Dr Jacono.

“We don’t remove the whole thing, we just contour the excess amount out.”

Still, multiple plastic surgeons have warned that the procedure is not for everyone. If one has only a small amount of buccal fat, removing it can make a face look sunken and appear prematurely aged.

“For the right patient, buccal fat pad excision can be quite beautiful, but if somebody is extremely thin or gaunt, you don’t want to overly hollow the face,” said Dr Devgan. “In addition, if somebody has a moderate to severe degree of skin laxity, removing the buccal fat pad can make that worse.” NYTIMES