This said, please take this into account if you should choose to have this surgery before the age of 25.  Oftentimes your face will thin out as facial fat is loss during the aging process.  If you choose to have this surgery and your face naturally thins later on, it may result in a gaunt look.  So please take your genetics into account as well.  Take a look at your mother or father's faces; do they have that rounder facial appearance?  Take a look at their younger photos as well; do you resemble what they had then?  If there is no real change of roundness to thinness later on, and this area is not augmented only by baby fat - you may be predetermined to have round cheeks.  If you study these hereditary aspects you can better determine if it will or will not alleviate itself in time.

Are You A Candidate For Buccal Fat Extraction?
First and foremost, an individual must be in good health, not have any active diseases or pre-existing medical conditions and must have realistic expectations of the outcome of their surgery.  Communication is crucial in reaching one's goals.  You must be able to voice your desires to your surgeon if he/she is to understand what your desired results and expectations may be.  Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo an cosmetic procedure.  This is an operation which requires patience and stability in dealing with the healing period.  There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue.  Please consider this before committing to a procedure.

If you find that your cheeks are round and look as if you've had your wisdom teeth removed recently or if you appear to have the "mumps" or food stored between your cheeks and teeth and you do not appreciate this look, you may wish to consider this procedure.  It is not a rather invasive procedure but it will cause discomfort and swelling and you will have to take it easy for a proper result so consider all of the above before deciding if this may be a viable option.

What To Expect At Your Consultation 
You will discuss your complaints and concerns, the amount that can and should be removed, etc. Your surgeon will explain the technique and incision placement or methods that may be most appropriate for you and should discuss the risks associated with buccal fat extraction with you, as well. 

You will also discuss the available anesthesia that will be used for your procedure.  Most buccal fat extraction procedures are performed under Light Sleep IV Sedation,  or regional - sometimes even local with oral sedation.   However, some surgeons may use General IV Sedation.  Either way, discuss this beforehand as many people are not aware of the risks of Anesthesia.  If you do go under Deep General, ascertain that the anesthesiologist is certified or that a doctor of anesthesiology is present.  Please read the All About Anesthesia Page - the risks regarding anesthesia should be considered for a fully informed choice.  You will of course not have General Gas Sedation as your procedure is performed intra-orally (through the mouth).

You may also wish to view your surgeon's photo books for examples of his patients' results.  It is certainly reasonable to ask to see photographic documentation of the type of work your surgeon is capable of delivering.  Although, this is no guarantee of your own outcome, it can help you determine your surgeon's idea of what is aesthetically pleasing and discuss your surgical expectations.  

If you would like more information on consultations or a list of questions to ask your surgeon please visit the Consultation Help Page.  If you should choose to book or reserve a surgery date you will usually give a deposit to hold your surgery date.  Most times if you cancel a few days beforehand, this amount is non-refundable.  After paying your deposit and scheduling a surgery date, you will also schedule a pre-operative appointment...

Your Preoperative Appointment
This appointment addresses more questions you may not have thought to ask at the initial consultation, such as more surgical details, concerns and even ascertaining that your surgeon is aware of what you desire from your procedure.  Just as your surgeon will make certain that you know what it realistically possible from this procedure and what your expectations are.

You will also discuss your pre-operative instructions and speak about the recovery period instructions and what to expect in the months ahead.  You will be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, prescription anti-inflammatory drugs. Remember, always ask your doctor before taking any of these products. 

Please do not hesitate to address any concerns that you may have during this time and even after your pre-operative appointment.  If you remember something you'd like to ask when you get home, the next day or even the day of surgery - don't be afraid to ask. 

Preparing For Your Surgery 
You should be given a pre-operative information packet that explains everything you should do and know before your surgery date.  The packet should include a list of all the medications you should not take starting usually at 2 weeks before your surgery.  These medications will include, but are not limited to, aspirin containing products, stimulants, seratonin supplements, etc.  Would you like to view a typical Medication & Supplements List? Also, if your surgeon advised that you may take Arnica montana, Bromelain, Vitamin K, etc. for swelling and bruising you should either have this in your packet or begin shopping for your necessities.

It is quite possible that you will have blood work performed.  This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count and check for disease or disorders beforehand.  If you are a female they may take an extra vial for a pregnancy test.  Some surgeons ask that you have physical.  This can be yet another out of pocket expense so ask at your consultation what will be needed when you are quoted a price.

So many things to do... so little time.  Surgery will be here before you know it so visit the Preparing For Surgery page and relax.  This section contains, printer-friendly pre-op lists, tips and advice as well as things you must do to prepare for your big day.

How Buccal Fat Extraction Is Performed  
A buccal fat extraction normally takes about an hour to perform.  First, you will have monitoring "pads" attached to you so that the surgical team can properly monitor your vital statistics before, during and after your operation.  When you are brought to the operating room, electrodes will be "plugged" into these pads which are connected to the monitoring equipment.  

Once you are on the operating room table, you will then be given your choice or your surgeon's preference in anesthesia as discussed prior to your surgery date.  If you had been given an oral sedative or valium prior you will have less anxiety.  They will more than likely insert an IV for a saline drip to keep you hydrated and have a vascular "doorway" for anesthesia, antibiotics, and other medications.  If you haven't been given a sedative, it is more stressful for some patients.  If you feel that you may experience anxiety inquire beforehand regarding an oral sedative.  Having an IV inserted feels sort of like blood being drawn, but for a shorter period of time.  It's the initial placement of the IV that may sting a bit.  Some people get heir IV placed in the crook of the elbow, some the hand - it all depends upon your veins though.  So if your veins are not very prominent this can be a problem. You are then brought to the O.R. if you aren't on the table yet.  After the needle is injected into the vein it is pulled out and a little plastic tube is left in your vein.  This is called a "catheter".  The  catheter is taped to your skin so it is not accidentally knocked or pulled out and is ready to be used as a sort of entryway for anything the surgical team deems necessary for your body.  This is usually done before you get into the actual O.R. - by a nurse - and you have a saline bag hooked up to you.  The medications will usually be given with a drip system with this saline. As said before, the saline will keep you hydrated both during and post-operatively.  

If you have chosen an IV Liquid Sedative, they will insert a hypodermic into your tube that you are attached to or they attach the bag of it with a drip system to add a few drops every few seconds and when they spring open the stopper and it starts heading towards your body.  The the effects of the anesthesia are felt soon after injection or opening the stopper - a few seconds in fact.  It may feel similar to a sensation of "heat" entering your arm or hand at the catheter site.  It then feels as though it is creeping up your arm - then it "jumps" from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized.  The anesthesiologist or surgeon will then determine if you are sedated properly, your stats are stable and if you are ready for the surgery to begin.

"The buccal fat pad has a main body with 4 extensions. The most clinically significant is the largest and most superficial (buccal extension). It accounts for 30-40% of the total weight of the fat pad and imparts cheek fullness. It is excised through an intraoral approach." (Yale Medical Core Curriculum)

You will be injected with a solution of Lidocaine, epinephrine and saline.  The epinephrine is a vasoconstrictor. This will impede  your skin's ability to bleed excessively.  Your surgeon will make an incision about 2 to 4 cm long between the cheek and gums (maxillary vestibule), starting above the second upper molar towards the back of the mouth.  The surgeon uses blunt dissection to expose the fascia and fibers of the buccinator muscle.  Your surgeon will then use the pressure of his or thumb thumb externally against your cheek right under your cheek bone causing the buccal fat to protrude through the incision.  He or she will then "tease" the fat out with forceps a little bit at a time.   Sometimes a collective amount of a golfball is removed, sometimes more.  Whatever your desires, just remember if you are in your twenties excessive removal may not be a good idea.  Although removal of this fat pad may look good now, when you begin losing this fat naturally - your face will look gaunt and haggard if you have removed too much prior. 

The surgical team then performs a sponge and instrument count and your surgeon then closes your incisions with, more than likely, a non-dissolvable type suture.  You may have an antibiotic-soaked piece of gauze placed between your upper molars and your gums and perhaps a pressure dressing placed around your head such as you would see in a face lift patient or a neck liposuction patient.  If you are not familiar with this "look" it involves wrapping a dressing around the top of your head to underneath your chin, sometimes slightly over your ears.  Of course there may be differences in surgical technique depending upon the preference of your surgeon.

You are then gently awakened and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released.  This is dependent upon the individual but may take up to two hours and may be influenced by the type of anesthesia and the length of the surgery if additional procedures were performed.  Your face may feel tight and quite tender as the anesthesia wears off.  You may even feel emotional or upset - this will depend upon your body's reaction to anesthesia.  You may also experience "rigors" or shivering.  This may feel uncontrollable and  is usually from the medications - more than likely epinephrine that is used as a vasoconstrictor.  The recovery nurse usually has wrapped you in a warm blanket but if not, request one.  It certainly makes things more tolerable.

Some patients feel nothing different although if you have had General you may feel a little sick - hopefully your surgeon gave you something to lessen this.  Your prescribed medication should alleviate this pain and discomfort.  However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately.  You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home.

The Road To Recovery  
You may be groggy from the anesthetic and or oral medications and probably won't remember much of the first day or two.  You will have to take it easy and sleep on two pillows to keep your head elevated for 7-14 days - or however long your surgeon suggests.  When you wake up you will notice that your face will look even more swollen in the first 3 days. But, as the days go on the swelling will dissipate.  There may be bruising, but this will go away, as well.  So make a mental note of this or you may be shocked into a depression.  Bruising and swelling are a normal occurrence in most surgeries.

You will more than likely experience some discomfort for several weeks - having had intraoral incisions your diet may be restricted.  You should ascertain all fresh fruits and vegetables have been washed, no raw fish (sushi) or very rare meats or other types of foods that may contain high amounts of bacteria.  Eating foods such as this may increase your risk of infection due to the incisions being in the mouth.  You may be instructed to rinse with Listerine several times a day.  DO NOT PICK or "tongue" your incisions or sutures!

Although any discomfort should be alleviated by your prescribed pain medication if you have excessive pain, redness, pus or other symptoms that do not appear normal, contact your surgeon immediately!  Take your temperature regularly.  An elevated temperature could mean an infection.  Take those antibiotics on time.  Also, don't forget if you are a female taking birth control pills that some antibiotics can interfere so in the event that you do have relations, use another form of protection as well.

Your sutures will more than likely be taken out by your surgeon at a week to 10 days postoperatively.  Even though you may feel better, you must take it easy for the first 3 weeks.  Be careful not to bend over or lift heavy objects.  And be careful not to raise the blood pressure for at least 3 weeks as this could cause internal bleeding at your treatment area.  Your blood vessels dilate to allow increased blood flow when you raise your heart rate.  This may cause problems at internal wound sites.   Do not participate in contact sports for at least 6-8 weeks - although ask your surgeon what he recommends specifically.

Your swelling will subside within a few weeks, defining even more as the months go by, revealing a more defined facial structure.  You may notice a change in your smile, odd sensations of hollowness, tingling, the sporadic sharp pain, or "pulling", burning, and cold sensations.  These usually subside within the first few weeks. 

Risks & Complications Of Buccal Fat Extraction 
Unfortunately, All surgery has risks and complications.  With buccal fat extraction, these include allergic reaction to the anesthetic used and infection.  There is the chance of asymmetry, dissatisfaction, hematoma, seroma, infection, infraorbital nerve and buccal branch dysfunction. 

Numbness is possible, it usually subsides within the first few weeks but it may become a permanent issue.  Puckering of the skin may occur and deeper than desired depressions may result.  Excess scar tissue and lumps are possible as well.

As mentioned before, it is possible to appear gaunt if too much was taken out, or the procedure was performed before you lost much of your facial fat.  This fat decreases with age and you may notice that you appear hollow about the cheeks in later years.  Please consider this before you commit.  Although facial fat grafting is becoming very popular and proving to have quite wonderful results.

* Please note the prices charged for surgeries represented in the documentations of the links above are representative of what an American doctor would normally charge. Of course, our fees are lower but our doctors are more experienced because more patients come to us due to the affordable prices. Thus, the doctors work on more cases (especially oriental patients and many Caucasians).