In patients in whom the soft tissue of the cheek itself is thick and round, the cause of a prominent lower cheek may be excess volume within the buccal fat pads rather than enlarged underlying bone.
Genetics plays the biggest role in buccal fat pad prominence, and its plumping effect is most noticeable in those who have an otherwise slim face. The function of buccal fat is not understood, but its removal is not known to cause functional problems.
Buccal fat excision, known as buccal lipectomy, can reduce the chubbiness of the lower cheeks and slim the facial contour to a more chiseled look. The effect can be mimicked by sucking on a straw.
The buccal fat pad is a large fat pocket sitting between the inside of the mouth and the skin. While it can be removed by liposuction, direct excision is not difficult and may be safer.
An 1 1/2 inch incision inside of the mouth is made along the lining of the cheek just above the second molar. After cutting through a thin layer of muscle, the buccal fat is exposed, teased out, and excised with scissors, after which the remaining stump is cauterized. While the amount of fat removed varies patient to patient, it is typically about the size of an egg yolk. The incision is closed with sutures.
In selected patients, the buccal fat pads can be approched and reduced from the skin side during a subcutaneous facelift dissection.
Removal results in a flattening or depression of the area beneath the cheek bones but above the corner of the lips. Typically, the result is subtle.
Immediate risks include infection, nerve damage, internal scarring, puckering, and asymmetry. Not always considered is the late term risk of facial sinking. Since fat is naturally lost from the face beginning in the early 30s, there is a risk that the cheeks may appear too gaunt over time, especially if the operation is performed aggressively at a young age.