Cheek Reduction Surgery
Buccal Fat Removal
Dr. Jonathan Zelken, MD · Board-Certified · Newport Beach, CA
As an artist and scientist, Dr. Zelken sculpts the midface with precision — removing buccal fat judiciously to slim the face and highlight your cheekbones, naturally.
Approach
Dr. Zelken's Philosophy
Buccal fat removal should refine your face without hollowing it. At the Zelken Institute for Aesthetic Medicine in Newport Beach, board-certified plastic surgeon Dr. Jonathan Zelken approaches cheek reduction as an artist first — removing only the precise amount of fat needed to slim the midface and highlight your cheekbones, never more.
Dr. Zelken is recognized in Newport Beach and nationwide for his expertise and comfort with buccal fat pad removal, also called bichectomy. What was once a reconstructive afterthought in his training has become one of the procedures he performs most, refined around a single principle: small, three-dimensional changes in the face go a long way.
That restraint is what protects your result. Indiscriminate reduction is what can make a face look gaunt — judicious reduction, guided by your anatomy and goals, is what makes you look sculpted, rested, and entirely like yourself.
The Procedure
What is Buccal Fat Removal?
Buccal fat is a distinct, encapsulated pocket of fat that helps shape the lower cheek. You have a buccal fat pad on each side of your face, roughly midway between your ears and mouth, nestled between the cheekbones and jawbones.
Buccal fat removal — also called bichectomy or cheek reduction surgery — reduces or removes these pads to slim the face and bring definition to the cheekbones. Patients typically seek it for one of two reasons: a fuller face they'd like to slim, or well-defined cheekbones they'd like to reveal.
The buccal fat pad is anatomically and aesthetically distinct from the ordinary fat beneath the skin. In surgery it appears as a brilliant yellow, encapsulated pad with its own pedicle — never mistaken for subcutaneous fat. Because its volume is remarkably consistent from person to person, your result depends less on how much fat you have and more on its position and how it interacts with the surrounding tissues of your face.
Tailored to You
How We Approach Cheek Reduction
Buccal fat removal is often performed on its own, but in more than half of cases it is combined with other procedures for more complete, balanced contouring.
- Standalone Bichectomy Cheek reduction on its own to slim the midface and refine the cheekbones.
- With a Facelift or FaceTite Paired with facial rejuvenation to sharpen contour and definition together.
- With Chin Augmentation Combined with the chin for a stronger, more balanced jawline.
- Cheek & Jawline Enhancement Adds striking definition beyond what fat removal creates alone.
- Mucosal Myectomy An adjunct that can enhance results when a more sculpted outcome is the goal.
- Correction with Fat Grafting If more volume is ever desired, results can be softened with fat or fillers.
Benefits of Buccal Fat Removal
Slims a full or round face for a more sculpted profile.
Highlights and defines the cheekbones.
Creates subtle, three-dimensional refinement of the midface.
Eases the soft-tissue weight that deepens jowls and marionette lines.
Produces natural results that stand the test of time.
Can be combined with facelift, chin, or jawline procedures.
Is It Right For You
Who is a Good Candidate?
The best candidates are healthy men and women bothered by a full, round midface or cheeks that hide their bone structure. Many are in their late teens through their thirties who feel fuller cheeks read as youthful or "chubby" and want a more sculpted, defined look.
There is no strict age cutoff. For patients in their forties and fifties who worry that removing buccal fat will look aging, Dr. Zelken favors a more conservative resection — refining the face without hollowing it.
One honest rule guides candidacy: if you already have a natural hollow below the cheekbone, buccal fat removal is probably not for you. For most people, though, judicious reduction slims and often rejuvenates the midface by easing the soft-tissue weight that settles into jowls and marionette lines. The right plan is determined together during your consultation.
What to Expect
The Procedure
Buccal fat removal is performed in Dr. Zelken's accredited surgical suite, with anesthesia options reviewed beforehand so you know exactly what to expect. Through small incisions made inside the mouth — leaving no visible scars — Dr. Zelken exposes each fat pad and carefully removes part or all of it, guided by your anatomy and aesthetic goals. The procedure is gentle, precise, and typically brief.
Healing Timeline
Recovery
First Few Days
- Follow a liquid diet while the incisions inside your mouth begin to heal, then gradually add soft foods.
- Mild swelling and tenderness are normal and expected.
First Weeks
- Swelling, bruising, and numbness near the incisions settle over several weeks.
- Most patients return to normal eating and daily activities quickly.
Final Results
- You'll notice a difference right away.
- It takes several months of healing for the sculpted, final contour of your midface to fully emerge.
The Outcome
Results & the Aging Question
The results of buccal fat removal are subtle by design — and lasting. Rather than deflating the face, judicious reduction offloads the mobile weight of the cheek that presses into the jowls and marionette lines, so many patients look not only slimmer but subtly lifted and refreshed. Dr. Zelken considers it a cosmetically safe procedure that stands the test of time as the face ages.
Its effect is best seen in three dimensions. A flat, side-by-side photo rarely captures the change — but in conversation, when you smile and animate, the refinement becomes clear. That is also why fears that bichectomy makes everyone look gaunt or prematurely aged are usually just that: rumors. Dramatic hollowing comes from over-resection, weight loss, and aging — not from a carefully judged procedure. If more volume is ever wanted, fat grafting or fillers can restore it without returning to the operating room.
Dr. Zelken explains why there are so few before and afters for buccal fat pad removal surgery.
Transparency
Risks & Considerations
As with any surgery, buccal fat removal carries some risks — swelling, bruising, temporary numbness, and, rarely, asymmetry or infection. The most discussed concern is over-resection, which can accentuate a pre-existing hollow. Dr. Zelken's conservative, anatomy-guided approach is designed to avoid this, and he reviews every consideration openly during your consultation so your decision is fully informed.
Explore More
Related Procedures
Begin Your Journey
Ready to Refine Your Profile?
If you're considering buccal fat removal, contact us to schedule a consultation with Dr. Jonathan Zelken and find out whether cheek reduction is right for you.
Common Questions
Buccal Fat Removal FAQ
Answers to the questions patients ask most about buccal fat removal.
Buccal fat pads sit in the lower cheeks. Removing or reducing them slims the face and highlights the cheekbones — either to slim a fuller face or to reveal bone structure.
Not when it's done judiciously. Over-resection can accentuate a hollow, but a conservative, anatomy-guided reduction slims and often subtly rejuvenates the midface instead.
It depends on your anatomy and goals. Studies cite roughly 2.5–7 cc, but position matters more than volume — small, precise changes drive the result.
Few patients consent to share photos, and it's often combined with other procedures. The change is also three-dimensional — clearest when you talk and smile, not in flat photos.
Dr. Zelken doesn't believe her recent look came from bichectomy. He attributes it more to a facelift, a lip lift, lighting, and her natural anatomy.
No. Incisions are made inside the mouth, so there are no visible external scars.
Yes. It's frequently paired with a facelift, FaceTite, chin augmentation, or rhinoplasty for more complete, balanced facial contouring.
A short liquid-then-soft-food diet while incisions heal, with swelling and numbness easing over weeks. The final contour emerges over several months.