Buccal fat removal in Thessaloniki and Athens, Greece

Buccal fat removal (buccal fat pad removal) is a minor facial operation in which I remove part of the buccal fat pad through an incision inside the mouth. The aim is a slimmer look below the cheekbones. It does not involve any cut on the skin, and it is not a way to lose weight.

The buccal fat pad, also called Bichat’s fat pad, is an anatomical structure that lies very deep beneath the cheeks, between the chewing muscles [1, 2]. In some people it is naturally large and gives the face a round, “puffy” look even at a normal weight. Removing part of it makes the area below the cheekbones cleaner and gives the face more sculpted angles.

It is not a weight-loss method. It does not remove the fat under the skin of the face or neck, and it does not correct sagging. It is also different from facial liposuction, which suctions fat from under the skin with a cannula and does not reach the deep buccal fat.

Good candidates are healthy women and men whose cheeks are full because of the natural build of the face, not recent weight gain, with a stable weight and realistic expectations. The fat removed does not grow back, so in a thin or mature face I usually advise against it.

At the consultation I examine your face and decide with you whether removal, another procedure or a combination suits you; you leave with a written plan and cost. Before surgery you need blood tests, healthy teeth and gums, no smoking for 4 weeks before and after, and a review of any blood thinners.

What happens at the consultation?

I examine your face from the front and in profile, looking at the shape of the cheeks, the amount of fat and the cheekbones. I ask about any recent change in weight, dieting or plans for pregnancy. We talk about exactly what bothers you and how your face will look in 10 or 20 years, because the face naturally loses volume with age. We decide together whether you need removal, a different procedure or a combination. You receive a written plan and cost.

What tests and instructions apply before surgery?

You need pre-operative blood tests and, where needed, a cardiac check. If you have a problem with your teeth or gums, it is best treated before the operation. You stop smoking at least 4 weeks before and 4 weeks after. If you take anticoagulants or antiplatelet medicines, let me know; they are only stopped in agreement with the doctor who prescribes them. The date is set after the examination.

Buccal fat removal is done under local anaesthesia or sedation and takes 45 minutes to 1 hour. Through a small incision inside the mouth I remove part of the fat pad, which lies very deep beneath the cheeks. No visible scar is left on the face, and you go home the same day, after a few hours.

The incision is made in the lining of the mouth, on the inside of the cheek. Through it I reach the fat pad, between the chewing muscles, and with gentle handling remove only the part that protrudes. The area is rich in blood vessels and nerves, and branches of the facial nerve and the parotid duct, which drains the salivary gland, run close by. This is why the operation calls for skill and experience from the plastic surgeon [2, 3].

How much fat is removed?

The amount is judged for each face individually. I take a relatively conservative approach and remove only part of the fat pad, because the face naturally loses volume over the years. Over-removal may look good at 25 but can make the face look hollow and aged (gaunt) later on [5]. Conservative removal and strict patient selection are how this is avoided.

Incisions and stitches

The incision is intraoral, inside the mouth, so there is no visible scar on the face. It is closed with stitches that dissolve quickly and easily, with no need to remove them.

Can it be combined with other procedures?

Buccal fat removal can be combined with other procedures that shape the face, such as a chin or cheek implant, for a more balanced result. See the facial contouring page. If a combination suits you, we discuss it at the consultation.

Hospital stay

Your stay is no more than a few hours. You go home the same day, with someone to accompany you. After sedation you must not drive on the same day.

Recovery is smooth and mild. For the first few days you eat only liquids and soft foods, so the area is not put under pressure. Swelling usually lasts 10 to 15 days, when you can return to office work; manual work follows in 3 to 4 weeks. The new look is visible at about 1 month, and the final result within about 3 months.

The stitches are inside the mouth and dissolve. Discomfort is usually mild and controlled with ordinary painkillers. Cold compresses and sleeping with your head raised for the first few days help the swelling go down. Everyday activities are not restricted.

Buccal fat removal is a day procedure: you go home a few hours after the operation, with someone to accompany you, and you must not drive that day after sedation. Plan to stay in Greece for 5 to 10 days in total before flying home.

Hospital: no overnight stay. You leave the hospital the same day, a few hours after surgery.

Flying: from day 5, with no limit on flight length.

Stitches: the stitches are inside the mouth and dissolve on their own, so there is no appointment to have them removed.

Check-up before you leave: at the practice, the day before your flight.

Follow-up from home: by video call at 10 days, 1 month, 6 months and 1 year.

At home, have liquids and soft foods ready for the first few days, cold compresses, and an extra pillow so you can sleep with your head raised. Rinse your mouth after every meal. Office work, including working remotely, can usually resume within 10 to 15 days, once the swelling has settled; manual work in 3 to 4 weeks.

The change shows from the start and becomes clearer as the swelling goes down. At about 1 month the change in your face is visible and the angles look natural; the final result settles within about 3 months. The result is permanent, because the fat removed does not grow back, but your face will keep changing with age.

The buccal fat pad is an anatomical structure that cannot reappear once it has been removed. Removal does not stop natural ageing, though: over the years the face loses volume, which is why I remove fat conservatively. A large gain or loss of weight can also change how the cheeks look. If volume is needed in the area later, the result can be partly reversed with fat transfer (micro fat).

Buccal fat removal is a minor operation, but it is performed in an area with many blood vessels and nerves. Asymmetry and injury to a branch of the facial nerve are very rare. The most important long-term risk is a hollow face in later years, which is avoided by conservative removal and strict patient selection.

Smoking. Stop at least 4 weeks before and 4 weeks after the operation; smoking delays healing of the incision inside the mouth and increases the risk of infection.

Anticoagulants and antiplatelet medicines: let me know before the operation. Stop them only with the agreement of the doctor who prescribed them.

We do not publish prices. The cost depends on the anaesthesia, the hospital and whether buccal fat removal is combined with another procedure, such as a chin or cheek implant. You receive a written quote after the consultation and your examination, so you know what is included before you decide.

• The anaesthesia: local or sedation.
• Post-operative check-ups and medicines.