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  
After checking a few surgeons' backgrounds and credentials, you will make some consultation appointments.  It is best to get at least 3 opinions.  You will meet with these surgeons and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take, etc. -- this is very important.  See the Medication & Supplements List for more information. 

You will discuss your complaints and concerns and discuss the various looks one can achieve, the amount that can and should be removed, etc.  Your surgeon will explain the technique and incision placements 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 Sedation, Twilight or regional - sometimes even local with oral sedation.  However, some docs 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.  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 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 and perhaps a box or directions for gaining a bottle of Arnica montana.  Perhaps you will be instructed to obtain Bromelain or other types of remedies, although many surgeons would rather have you not take ANYTHING other than your prescription medications, please do not go against your surgeon's wishes.

Would like to know more on the benefits of Arnica montana?  Or Bromelain?  

If you would like more information on Consultations or a list of questions to ask your surgeon please visit the Consultation Help Page.

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? We have a printer-friendly version as well.  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 preliminary 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 (CBC, complete blood count) which can ultimately clue them in to 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 A Buccal Fat Pad Extraction Procedure Is Performed 
A buccal fat extraction normally takes about an hour to perform.  First, you will 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 usually could care less what they are sticking in you.  They will more than likely insert an IV for a saline drip to keep you hydrated and have a vascular doorway should the need arise.  If you haven't been given a sedative, it is more stressful for some patients.  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.  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, which is taped to your skin so it is not knocked out and is ready to be used as a sort of entryway for anything the surgical team deems suitable 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 I said, the saline will keep you hydrated both during and post-operatively.

Some people get their IV placed in the crook of the elbow, some the hand. I dislike the hand ones as it's a nasty place for a bruise to be, at least with the arm you can hide it -- 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.

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 effects of the anesthesia are felt soon after injection or opening the stopper -- a few seconds in fact.  It feels like heat going into you veins then 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 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)

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 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 or surgical tweezers, 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 this 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.  Unless of course, your genetics program you to always have chubby cheeks.

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 wakened gently 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.  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 to 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), very rare meat 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 to 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 Pad Extraction 
Unfortunately, All surgery has risks and complications.  With buccal fat extraction, these include allergic reaction to the anesthetic used and infection.  There could be asymmetry, general dissatisfaction, hematoma or seroma.

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.

Last but not least, 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!   However buccal fat is contained within membranes and once you take these out you can't replace these.

The Least You Need To Know

• What: buccal (pronounced like buckle) fat extraction

• Why: usually to aid in defining an overly fatty lower cheek area sometimes referred as "chipmunk cheeks"

• When: from mid to late 20's to usually 40's. Earlier than that is not recommend and later than this is usually not needed.

• Who: A skilled cosmetic or plastic surgeon with a good background and experience in performing this operation.

• Where: Accredited Surgical Suite or hospital

• Risks: Please see above

• incisions/scars: non-visible, intra-oral incisions

• Anesthesia: Light Sleep IV Sedation or General IV - possibly oral sedation with regional/local. Read All About Anesthesia

• Duration:  1 hour, depending upon extent of work to be done.

• Pain Factor: mild to moderate, pain meds should alleviate any discomfort. If not, call your surgeon immediately.

• Swelling: Mild to moderate - depending upon individual's health, and habits such as smoking, protein consumption, iron level, etc.

• Bruising: mild, depending upon individual; 

• Post-operative instructions: Have someone there to help care for you during your recovery, keep elevated -- even when sleeping.  A recliner works best.

• 1st Post-op visit:  usually to remove sutures at 7 to 10 days post, sometimes earlier.

• 2nd Post-op visit: check up usually at 3 weeks for exercise/activity release

• Return to work:  usually within 3-5 days - but depends upon type of wok. Sedentary (desk job) with little or no amount of talking. If your job requires high impact activity you may need more time off, please ask your surgeon.

• Activity: No exercise until at least 3 weeks post-operative.  Be careful not to raise your blood pressure for several weeks, you don't want to inhibit proper healing.  Check with your surgeon.

• Sun exposure: n/a

• End result: usually can be seen within 4 months

• Loss of Sensitivity: It is possible to lose sensation along the incision lines, on the central cheeks and jawline.  Long term or permanent loss of sensitivity is possible. 

• Other complications: Possible eyebrow and eyelash loss from medications.  Possible asymmetry as well.

• Longevity:  permanent

• Special Notes:   Disclose all your medical background.  If you are a smoker, if you are taking medications, or if you have any other medical concerns. Be realistic in your expectations.  No plastic surgeon can perform miracles, he or she can only try and improve upon what you have beforehand.

• The average prices for: buccal fat extraction may be from $2000 to 5000US and depends upon the surgeon and region as well as if the surgeon has his or her own surgical suite. With procedures performed in a hospital or under General with a certified anesthesiologist, prices are usually be higher.

References 
Merriam-Webster Medical Dictionary
Yale Medical Core Curriculum
Ramirez, Oscar M,. M.D. "Buccal Fat Pad Pedicle Flap for Midface Augmentation" Annals of Plastic Surgery- August 1999, Volume 43, Number 2