Short answer
The American Society of Plastic Surgeons (ASPS) lists a projected 2024 surgeon-fee range of $3,000 to $5,500 for buccal fat removal, and says a surgeon's fee is only part of the total price. The procedure reduces lower cheek fat through a small cut inside the mouth. Swelling takes weeks to settle and most reported complications are minor, but reviews found no long-term follow-up studies. It suits persistently full cheeks, not narrow faces.
What is buccal fat removal, and how is it done?
Buccal fat removal reduces the buccal fat pad, a pocket of fat deep in the lower cheek, to sharpen the line from cheekbone to jaw. At ANEWU, Dr. Arshia Payman, MD, a board-certified physician specializing in aesthetic medicine, performs it in the office through a small incision inside the mouth, using local anesthesia, so no scar shows on the skin.
The pad's size varies widely from person to person and has little to do with how much you weigh. A 2018 systematic review, citing a 1991 paper, describes only a weak relationship between body fat and pad size, and says the pad holds a relatively fixed size even as other fat changes. That is why diet and exercise rarely change this fullness.
On the buccal fat removal page, Dr. Payman numbs the cheek, makes the incision, reduces the pad and closes the incision, and you stay awake throughout. A 2021 systematic review describes the usual technique the same way, as an incision of about 2.5 centimeters inside the mouth closed with an absorbable stitch. In the one study in that review that measured it, the mean volume of tissue removed was 2.74 mL, with a range of 1.8 to 4.9 mL.
Who is a good candidate for buccal fat removal?
A good candidate has lower cheek fullness that persists at a stable, healthy weight, realistic expectations, and enough cheekbone structure that a slimmer cheek will still look balanced. Cleveland Clinic says you may not be a good candidate if your face is narrow, and ANEWU's page treats a narrow face as a reason to leave the pad alone.
The 2021 systematic review adds a structural test. It notes that the procedure is said to suit people with strong cheekbones hidden behind prominent cheeks, which gives the face a round, heavy look, and that it should be avoided when the cheekbones are underdeveloped, because removing fat there can overcorrect the face. Cleveland Clinic also lists age, since buccal fat naturally diminishes over the years.
One plastic surgeon quoted by the American Society of Plastic Surgeons (ASPS) offers a family check: if your older relatives still have round faces, you may be a reasonable candidate for a reduction. Treat the family check as one surgeon's rule of thumb, not a validated test. ANEWU's page lists the same fit: lower cheeks that look full at a stable weight, fullness that diet and exercise have not changed, good general health, and an understanding that this is a structural refinement, not a dramatic change. Dr. Payman confirms candidacy at a free consultation.
Why do some doctors not recommend buccal fat removal?
The main concern is aging. Facial fat is lost as people get older, and some surgeons worry that removing cheek fat early leaves a face that looks hollow later. A 2021 paper in Plastic and Reconstructive Surgery called the possibility of premature aging and midface distortion in the long run disconcerting, and systematic reviews found no long-term follow-up studies.
The evidence is thin and points two ways. The 2021 systematic review notes that the pad shrinks with age, so removing it may accentuate low-lying jowls and speed up facial changes linked to aging. The 2018 systematic review, citing older anatomical work, argued the opposite: a large pad keeps its volume, so removal may look better over time. Both reviews found no study that followed patients long enough to test either idea, and the authors of the 2021 review concluded that cheek removal for appearance should be approached with caution until long-term data exist.
Surgeons who see patients for this say much the same. A plastic surgeon quoted by ASPS in 2024 said that excess removal in the wrong candidate can accelerate aging by creating a gaunt appearance, and that she prefers reducing the pad to removing all of it. An author of the Plastic and Reconstructive Surgery paper told ASPS in 2021 that, among the patients he sees who want the pad removed, only about one in five really needs it, because a defined jawline often depends on more than cheek fat. That is one surgeon's estimate from his own practice, not a measured rate.
Restraint is the practical answer. ANEWU's page says Dr. Payman removes a measured amount rather than as much as possible, because volume taken from the cheek cannot be put back. Ask any surgeon how much they plan to remove and why.
How risky is buccal fat removal?
Reported complications are mostly minor, but they are not zero. A 2021 systematic review found 7 complications in 134 procedures, a weighted mean of 3.3% with a wide 95% confidence interval of 0% to 10.5%. Injury to the facial nerve or a salivary duct is possible, and the review covered only four studies and 121 patients.
Only one of those four studies was a randomized trial, and it was rated high risk of bias. An earlier 2018 review of 71 patients counted 6 complications (8.45%): trismus, facial asymmetry and bleeding. It also noted that parotid duct and facial nerve injuries can occur, and it cited a case report of massive bleeding after the procedure. Treat the percentages as rough guides, because small studies produce wide ranges.
The ASPS risk list for the procedure adds anesthesia-related risks, infection, hematoma, numbness, prolonged swelling, asymmetry, a result that is minimal or suboptimal, and the possibility of revision surgery. Its list also includes injury to branches of the facial nerve, which can cause temporary or lasting muscle weakness. Ask any surgeon how often they perform the procedure and how complications are handled.
| Reported complication | Cases | Share of 134 procedures |
|---|---|---|
| Trismus (difficulty opening the mouth) | 3 | 2.24% |
| Transient paralysis of the buccal branch of the facial nerve | 2 | 1.49% |
| Fever | 1 | 0.75% |
| Facial asymmetry | 1 | 0.75% |
How long does it take to heal after buccal fat removal?
Most people return to normal activities after a few days to a week, while healing takes about three weeks and the final contour takes several months. Swelling and bruising are expected and fade gradually. Cleveland Clinic gives that timeline, and ANEWU's page describes the same pattern of swelling that eases over days to weeks.
Your own timeline comes from your own surgeon. ANEWU's page advises planning for a few quiet days, and Dr. Payman gives you written aftercare instructions before you leave and schedules a follow-up as needed. Because swelling has to settle before the contour shows, the lower face can look fuller before it looks slimmer. Follow the written instructions from your surgeon rather than a general timeline.
Final results can take longer than the early weeks suggest. In a 2022 study of 30 patients, the surgeon measured lower face volume in 3D at 12 months, and wrote that patients unhappy at that point should wait, because the final result might take longer to appear. That is one surgeon's view of one small group, but it fits the several-month timeline above.
- A day or two: a liquid diet while the incisions start to heal, then soft foods as your provider allows.
- Early days: swelling, bruising, numbness near the incisions, and possibly a mouth rinse to prevent infection.
- A few days to a week: most people return to normal activities when their provider says it is okay.
- About three weeks: healing time is usually about this long.
- Several months: the final result becomes clear.
How much does buccal fat removal cost?
The American Society of Plastic Surgeons (ASPS) lists a projected 2024 surgeon-fee range of $3,000 to $5,500 for buccal fat removal. ASPS says a surgeon's fee is only part of the total price, which can also include anesthesia, operating room facilities and other expenses, so a total can be higher. Cost varies by case and location.
ASPS changed how it reports fees in its 2024 statistics report, moving from a single average to a projected range based on averages submitted by surveyed members. ASPS says a surgeon's fee depends on experience, the type of procedure used and the location of the office. Its cost page still shows a single average of $3,142, so you may see both numbers online. These are national figures from plastic surgeons, not ANEWU prices.
ANEWU does not publish a price, because a figure quoted before anyone has seen your face is a guess. ANEWU gives you a figure at a free consultation, and cost depends on your anatomy and on whether the procedure is done alone or alongside another facial aesthetics treatment. Facial aesthetics procedures are not typically covered by dental or medical insurance. ANEWU accepts CareCredit and Proceed Finance, and the financing options page lists the details.
Does buccal fat come back, and does the result last?
Nobody yet knows how a face looks 10 or 20 years later, because the systematic reviews found no long-term follow-up studies. A 2023 surgical paper says the cheek fullness does not regenerate after the pad is resected, but that is the author's statement, not a measured result, and the rest of your face keeps changing with age.
The 2021 review measured volume at 6 months, and the 2022 and 2023 studies followed patients for 12 months, so none of it speaks to results years later. What can change is the rest of the face. In the 2023 paper, one patient's jawline relapsed after buccal fat excision as she gained weight, which the author attributed to loosening skin and increased jowl fat. She later had a mini facelift. That is a single case, not a rate.
The 2018 review also notes a 1986 theory that severe weight loss after removal could hollow the cheeks, though the studies it included did not find this. The 2021 review adds that because the pad shrinks with age, additional procedures such as fat grafts might be needed later to rejuvenate the face. Since the reviews found no studies that followed patients for years, ask any surgeon how they would handle a face that looks hollow later.
Which is better, Jawtox or buccal fat removal?
Neither is better in general, because they work on different tissue. Buccal fat removal reduces fat in the lower cheek. Jawtox, the nickname for Botox injected into the masseter chewing muscle, relaxes an overactive muscle at the angle of the jaw. Some people who ask for cheek slimming turn out to have a muscle question instead.
A 2025 comprehensive review calls botulinum toxin injections the standard non-surgical treatment for masseter hypertrophy. It reports reduced muscle activity lasting 3 to 4 months in electromyographic studies, and notes that no randomized trials compare treatment protocols. Its listed side effects include temporary asymmetry and altered chewing. A plastic surgeon who co-wrote the Plastic and Reconstructive Surgery paper told ASPS in 2021 that fullness can come from an overactive masseter rather than fat, and that he treats that with Botox.
ANEWU's Botox page describes treating the jaw muscles for clenching and TMJ-related tension, and its dermal fillers page describes adding volume to refine contour. Dr. Payman looks at your facial structure, asks what you want changed, and explains what reducing the pad would and would not do. To talk it through at the Buckhead, Cumming or Dawsonville office, you can book a free consultation.
| Buccal fat removal | Masseter Botox (Jawtox) | Dermal filler contouring | |
|---|---|---|---|
| What it changes | Reduces fat in the lower cheek | Relaxes the masseter muscle | Adds volume to reshape the contour |
| How long it lasts | One procedure; long-term results are not yet studied | Temporary, needs repeat treatment | Softens over time, needs maintenance |
| Reversible | No, removed volume cannot be put back | Yes, the effect wears off | Hyaluronic acid fillers can be dissolved |
Sources and further reading
- Buccal fat pad excision for cheek refinement: A systematic review Medicina Oral, Patologia Oral y Cirugia Bucal, 2021
- Buccal fat pad removal to improve facial aesthetics: an established technique? Medicina Oral, Patologia Oral y Cirugia Bucal, 2018
- The Role of the Buccal Fat Pad in Facial Aesthetic Surgery Plastic and Reconstructive Surgery, 2021
- Aesthetic Values of the Buccal Fat Pad Excision in Middle-Aged Patients Aesthetic Surgery Journal Open Forum, 2022
- Buccal Fat Pad Excision for Facial Rejuvenation: The Relationship Between the Resected Position and Its Influence on Facial Shape and Volume Aesthetic Surgery Journal Open Forum, 2023
- 2024 Plastic Surgery Statistics Report: Average Surgeon/Physician Fees (archived copy) American Society of Plastic Surgeons, 2024 data, Internet Archive copy saved June 2025
- Buccal Fat Removal Cost American Society of Plastic Surgeons
- Buccal Fat Removal Risks and Safety American Society of Plastic Surgeons
- Facial fat: The good, the bad and the confusing American Society of Plastic Surgeons, 2024
- Facial fat is precious: Why your plastic surgeon shouldn't be too aggressive with buccal fat removal American Society of Plastic Surgeons, 2021
- Buccal Fat Removal Cleveland Clinic, updated 2022
- The Role of Botulinum Toxin for Masseter Muscle Hypertrophy: A Comprehensive Review Toxins, 2025
This article is general information about dental and facial procedures, not a diagnosis or medical advice. Every jaw and every health history is different, so the right plan for you can only be set after an exam and imaging with a surgeon.