Buccal Fat Removal Won’t Make Me Look Old? NO!!
I perform hundreds of buccal fat removal (BFR) procedures a year and the fear I encounter most often is whether buccal fat removal can make you look old. I have performed a detailed analysis of the thought process behind this internet rumor and will take the time to break it down below.
THE BOTTOM LINE: Buccal fat removal makes your face skinner. That can be portrayed as more mature when you are young or frail when you are old. While I have had patients who do not obtain a significant change: I have never once had a patient tell me they look WORSE after buccal fat removal.
Why Are there so many Misconceptions?
While buccal fat removal is a technically simple surgery, evaluation and counseling are what sets apart the skilled BFR surgeon. The average surgeon performs just 1-5 per a YEAR and does not deeply study the concepts of buccal fat and beauty nor actively engage in researching about them.
The first description of the procedure was by Dr. Alan Matarasso in the early 1990s. In a plastic surgery textbook, there is not a chapter dedicated to this procedure. Because of these simple facts, much of what is said is done so without much thought or personal experience. I perform HUNDREDs every year and dedicate time to research and anatomical study of the surgery.
Will Buccal Fat Removal Make my Skin Sag?
There is no anatomical connection between the buccal fat and the skin. As we age, skin descends as our collagen transforms and as gravity weathers its effects. The primary support of the midface is via a system of retaining ligaments that attach to the skin. The zygomatic cutaneous ligament, one that is often recreated during a facelift, is the primary midface support structure. A strong bony foundation (long, wide, and high cheekbones) can also contribute. In no way, shape or form does the buccal fat provide support to the midface and theoretically, if anything, it can act as a weight pulling DOWN the midface. MYTH BUSTED
Will I age FASTER?
An aged appearance of the midface occurs when the cheek mound falls. This creates a flattened cheek and jowls. There is a belief that buccal fat removal will eventually create a gaunt appearance. While there is a certain level of truth here, it is not true for everyone.
For most Americans, we progressively gain weight throughout our lives until our metabolism hits a point where we can no longer put on weight. This age is dependent upon genetics, gender, and importantly: ETHNICITY. In general, Caucasians are the most likely to suffer from facial volume loss, and when this point does come (’50s to ’60s), having less buccal fat can initially exaggerate this; however, the end result will be the same.
Will buccal fat removal make me look ‘gaunt’ when I am older?
You will look skinnier. The gaunt appearance comes from a combination of sagging, volume loss, and an over the prominence of the cheekbones. The buccal fat removal does not make up the entirety of the volume of our face. You likely have seen many older people with gaunt faces, and they did not have buccal fat removal. It is a combination of the thinning of the skin and the natural loss of the buccal fat pad that can give a gaunt appearance.
What if I am wrong ?
The truth is that everything I have said has variables. When you are older you may develop a more hollow appearance that you don’t like even if you don’t have buccal fat removal. In any case, we cannot prove that this was from buccal fat removal or not. That being said, volume replacement via Sculptra, filler, or fat grafting is a very common thing. Now, I rarely see injectors fill the area of the buccal fat to rejuvenate (which once again proves my point), but it is possible to do.
Buccal fat removal is going to gently define the lower border of your cheeks. It will make your face thinner. While some aspects of aging are associated with volume loss, buccal fat won’t exacerbate that until way later and that is easily correctable. In addition, buccal
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