Dr. Jacono and The New York Times on Buccal Fat Removal

Dr. Jacono discusses the Buccal Fat procedure which is becoming everyone’s newest obsession.

The New York Times sat down with Dr. Jacono to discuss buccal fat removal, a popular cosmetic procedure. Offering an extra-angular look, this treatment has gained traction on social media. This isn’t a surprise considering that today’s celebrities tout some of the most chiseled faces imaginable.  

But why the sudden craze, and why don’t other surgical procedures seem to do as much to sculpt the face?

“There are so many reasons why buccal fat removal an important cosmetic practice is,” says Dr. Jacono. “It is a versatile procedure that offers dramatic results.”

What Is Buccal Fat?

To understand the recent craze, it’s important to understand what, exactly, buccal fat is. Pronounced “buckle,” buccal fat is an underlying structure that determines the face’s character.

“There are facial compartments that define the shape of the face. There are superficial ones and deep ones,” says Dr. Jacono, best known as Marc Jacobs’ facelift surgeon. “Buccal fat is one of the deep facial fat compartments that give structure to the cheek area. Interestingly, it isn’t affected by weight fluctuation. We’re born with how much we have.”

Because buccal fat isn’t determined by fitness level, it can be notoriously irritating to deal with. Even the most active people can have an excess of buccal fat. Others are not born with this problem and unwittingly reap the rewards.

“Some people have a very sculpted face with high cheekbones and a lack of buccal fat,” says Dr. Jacono. “Other people have more cherubic faces, or ‘chipmunk cheeks.’ These days, that isn’t so desirable.” To illustrate his point, Dr. Jacono points to the faces of two cherubs, round-faced angels on the bottom of the “Sistine Madonna” by the Italian painter Raphael.

While the cherubs are not necessarily overweight, an excess of buccal fat makes them appear as if they could drop a few pounds.

Can Buccal Fat Excess Be Fixed?

For people unhappy with the size of their buccal fat pads, there are cosmetic solutions. Buccal fat surgery either partially removes or entirely excises the buccal fat pads, which makes the face look more sculpted.

The procedure itself is quick. Usually, it takes less than a half-hour and can be performed using local anesthetic. It does not require general anesthesia; patients can be fully awake for the duration. Plastic surgeons use a scalpel to make a small incision within the patient’s mouth. They then remove the buccal fat pads, which are the size of a grape. The incision is closed with dissolvable sutures.

“The surgery is simple,” says Dr. Jacono. “It is minimally invasive and requires very little downtime. In fact, post-surgery pain and swelling last only about a week. It can take a bit longer for results to fully show, but that varies between patients.”

How Popular Has Buccal Fat Removal Become?

Because buccal fat removal is a relatively simple procedure with low risk, more celebrities are opting for it. Chrissy Teigen confirmed in an Instagram story that she’d had the surgery. This is of little surprise, especially considering the procedure’s potential to alter the appearance of the face.

This steep rise in demand is not limited to celebrities. More average people are visiting facial plastic surgeons to see what they’d look like without buccal fat. This is a testament to the procedure’s versatility but is also a reflection of broader social media trends. A quick search for buccal fat removal on TikTok brings up thousands of videos documenting buccal fat removal experiences.

“I’m doing three times as many buccal fat reductions this year than I was five years ago,” notes Dr. Jacono. “It’s quite surprising to see.”

The best news? Buccal fat removal is customizable to patient needs and wants. Years ago, doctors would remove the whole buccal fat pad. As patients got older, however, the effect was that they looked sunken.

“Nowadays, we don’t remove the whole buccal fat pad,” continues Dr. Jacono. “Usually, we contour the excess amount out. In most cases, less is more—it’s rarely good to err on the side of extremity.”

Does Buccal Fat Removal Have Drawbacks?

Under the care of the right surgeon, buccal fat removal patients have very little to worry about. After surgery, swelling and mild pain are to be expected. In some cases, bleeding may become a complication, though it will eventually resolve.

That said, buccal fat excision is not for everyone. If a patient has only a small amount of buccal fat, removing it can make their face look sunken, aging them prematurely. This is why everyone considering buccal fat surgery should consult a board-certified plastic surgeon who has their best interest in mind.

“The last thing I want is to make my patients look gaunt or hollow,” says Dr. Jacono. “Caution is the name of the game. I make sure never to remove too much when it’s not necessary.”

A final piece of advice: if a patient has a moderate to severe degree of wrinkling or skin laxity, removing the buccal fat pad can make things worse. Laxity occurs when the skin loses collagen and elastin, proteins that keep the skin smooth and firm. Aged skin doesn’t “snap” back into place as well as younger skin. For this reason, buccal fat removal doesn’t work as well on older patients.

“It’s integral to take into account all factors before the procedure,” says Dr. Jacono. “Otherwise, there can be unforeseen complications.”

All in all, Dr. Jacono and plenty of other plastic surgeons believe that buccal fat removal is a wonderful procedure. If you want to look more chiseled than you do, why not opt for a fast tweak?