What the research shows
The buccal fat pad sits deep in the cheek. Branches of the facial nerve that move the cheek and upper lip run over it, and the saliva duct from the parotid gland crosses it (Surek 2021). In cadavers, small nerve branches passed through the front part of the pad in about a quarter of sides, so removing the whole pad puts the nerve at risk (Hwang 2005).
Removal reduces lower face volume and satisfaction is high. A 2026 review found complications after about 1 in 25, mostly minor, and one study reported a gaunt look in a small share of patients (Shapiro 2026). A 2025 pooled analysis that also counted swelling, stiff jaw, pain and asymmetry found that about 1 in 4 had some problem after surgery; facial nerve weakness occurred in about 1 in 100 (Albuquerque 2025).
In older faces the pad drops and bulges beside the mouth and jowl, and reducing it is the most common buccal fat procedure done with a facelift (Bellity 2026). Done from the facelift side, it avoids a cut inside the mouth (Surek 2021). In deep plane facelifts with partial removal, nerve weakness was temporary and no patient was left with excess hollowing (Samargandi 2026).
Technique lowers the risk. One surgeon removes only the fat that comes forward with gentle pressure and avoids pulling on the pad (Matarasso 2006). Loosening the pad with injected fluid shortened the operation and lowered pain in a randomized trial (Valencia 2019), and a pressure bandage afterward lowered major complications (Grillo 2022). Earlier fat-dissolving injections in the cheek can leave scar tissue: removal failed more often and complications occurred only in those patients (Sirimahachaiyakul 2023).
Where surgeons disagree
- Remove it or keep it. One view warns that removal for a slimmer face could cause early aging and a distorted midface later (Rohrich 2021), and an older approach removes only the deep part of the pad in selected patients to keep the fat that thins with age (Matarasso 1991). A 2026 review found the pad mostly drops with age and may not shrink until after 60 or 70, which supports reducing it when it bulges (Bellity 2026).
- Remove it or fill it. In patients with hollow cheeks, surgeons add fat to the same space: the result held up to two years (Cohen 2017) and smoothed the curve of the cheek (Zhu 2024).
- The temple. The pad connects to the fat of the temple, so removal can deepen a hollow temple; one technique moves the removed fat into the temple (Lin 2022).
What is new
- Surgeons now tailor which part of the pad they remove to the shape of the face, taking less from the upper part in patients whose lower cheek sags (Kubo 2023).
- A 2026 deep plane facelift series describes removing part of the pad and suspending the rest, with the aim of reducing the return of jowls (Samargandi 2026).
- A 2026 review proposes when to remove the pad and when to move it, and says patients should be told about the risk of nerve injury and bleeding (Bellity 2026).
What is still unknown
- How the face ages after removal. No study in the early reviews measured long-term effects (Moura 2018), and the 2026 review still found follow-up too short (Shapiro 2026).
- Whether the result is predictable. Pooled studies vary widely in what they report (Albuquerque 2025).
Key papers
- Matarasso 1991: set early limits on how much buccal fat to remove and in whom.
- Hwang 2005: mapped the nerve branches and saliva duct around the pad.
- Cohen 2017: added fat to the buccal space in hollow cheeks.
- Moura 2018: review that found no study of long-term effects on aging.
- Surek 2021: described buccal fat removal from the facelift side.
- Rohrich 2021: warned that removal for a slimmer face could bring early aging.
- Albuquerque 2025: pooled complication rates, including swelling and stiff jaw.
- Bellity 2026: reviewed how the pad ages and how to manage it during a facelift.
- Shapiro 2026: latest review; safe in the short term, long-term effects unknown.