Kare Plastic Surgery & Skin Health Center · Santa Monica & Beverly Hills, Los Angeles
Buccal Fat Removal in Los Angeles
Precision cheek contouring surgery with a conservative, anatomy-first approach — performed by UCLA-trained board-certified plastic surgeon Dr. Raffy Karamanoukian
Schedule a Consultation (310) 998-5533
UCLATrained Plastic Surgeon
FACSDouble Board-Certified
20+ YrsFacial Surgery Experience
RealSelf 100Top Surgeon Designation
Santa Monica5,000 Sq Ft Surgical Center
The Procedure
Buccal Fat Removal: Midface & Jawline Sculpting
Buccal fat removal — also called buccal lipectomy, bichectomy, or cheek reduction surgery — is a surgical procedure to reduce the volume of the buccal fat pads: discrete, encapsulated deposits of adipose tissue that sit deep in the midface, between the buccinator muscle and the overlying facial musculature, directly beneath the cheekbones. Their reduction creates a slimmer lower cheek contour, accentuates the zygomatic arch, and imparts the more chiseled, defined midface profile that many patients seek.
Unlike superficial cheek fat, which responds partially to diet and exercise, the buccal fat pad is a structurally distinct compartment that does not reduce with weight loss. It is also anatomically inaccessible to liposuction. Surgical excision through a small, well-concealed intraoral incision is the only effective method of reduction — and when performed correctly, it leaves no visible external scars and produces a natural, lasting improvement in facial contour.
At Kare Plastic Surgery & Skin Health Center in Santa Monica, Dr. Raffy Karamanoukian brings more than two decades of facial surgical expertise to every buccal fat removal procedure. His approach is defined by anatomical precision, conservative volume reduction, and an unflinching commitment to candidacy — meaning he is equally committed to advising against the procedure when a patient's facial anatomy does not support it as he is to performing it excellently when it does.
What Buccal Fat Removal Can Achieve
- Slimmer, more sculpted lower cheek contour
- Accentuation of natural cheekbone structure
- Reduction of "chipmunk cheek" or overly round midface appearance
- A more angular, defined lower facial third
- Shadow contrast between cheekbone and jawline
- Facial proportions that feel more aligned with the patient's overall physique
- Permanent results — removed fat cells do not regenerate
- No external scars — incisions are entirely intraoral
- Outpatient procedure — typically under one hour
- Combinable with other facial procedures for comprehensive contouring
Surgeon Expertise
Dr. Raffy Karamanoukian: A Surgeon's Approach to Facial Contouring in Los Angeles
Dr. Raffy Karamanoukian, MD, FACS is a double board-certified plastic and reconstructive surgeon and Fellow of the American College of Surgeons, trained at UCLA — one of the foremost academic medical centers in the United States for plastic surgery education. With more than twenty years of experience in cosmetic and reconstructive facial surgery, Dr. Karamanoukian has performed hundreds of buccal fat removal procedures and is recognized among the leading facial contouring specialists in the greater Los Angeles area.
What distinguishes Dr. Karamanoukian's approach is his insistence on surgical honesty. In an era of social media-driven demand for the "snatched" midface look, he is one of the Los Angeles surgeons who speaks plainly about the long-term anatomical realities of buccal fat removal — particularly the risk of premature facial hollowing in patients whose anatomy, age, or facial fat distribution makes them poor candidates. He does not perform the procedure on patients who are unlikely to benefit from it long-term, even when those patients come specifically requesting it.
His surgical technique reflects the same philosophy: conservative, calibrated volume reduction that honors the three-dimensional architecture of the face rather than chasing a transient aesthetic trend. He works within the deep anatomical planes of the midface with a precise understanding of the facial nerve branches, parotid duct, and buccinator musculature — structures that demand surgical-level knowledge and skill to navigate safely. This is not a procedure that belongs in the hands of providers without formal surgical training.
"Buccal fat removal is one of the most permanently consequential procedures in facial aesthetics. The fat does not grow back. A face that looks sculpted at 28 may look hollow and gaunt at 42. My job is to be honest about that — and to operate only when the anatomy and the long-term projection genuinely favor a beautiful outcome."
Dr. Karamanoukian's practice in Santa Monica serves patients from throughout Los Angeles — Beverly Hills, Brentwood, Malibu, Culver City, West Hollywood, Pasadena, the San Fernando Valley — as well as patients who travel to him specifically for his reputation for natural-looking facial surgery results and his candid pre-operative consultations. His RealSelf 100 designation reflects his commitment to transparent patient education alongside excellent surgical outcomes.
Anatomy & Science
Why Buccal Fat Pad Removal is Incredible
The buccal fat pad — also called Bichat's fat pad after the French anatomist who first described it — is a distinct, encapsulated mass of adipose tissue in the deep cheek. It has a main body and three extensions: temporal, pterygoid, and buccal — which together occupy a significant volume in the midface, contributing to the rounded, full appearance of the lower cheek between the cheekbone and jawline.
Unlike subcutaneous facial fat, which is distributed throughout the superficial compartments of the face and changes with weight fluctuation, the buccal fat pad is a structurally independent compartment. It does not reliably reduce with caloric restriction or exercise. Its size is largely determined by genetics, and it varies significantly between individuals — some patients carry large, pronounced buccal fat pads that create genuine fullness regardless of their overall body weight; others have naturally modest pads whose reduction would add little benefit and potentially cause harm.
The Aging Dimension: Why Candidacy Must Account for the Long Term
This is the conversation that many practices in Los Angeles are now having — but that Dr. Karamanoukian has always made central to his consultation process. The buccal fat pad is not merely a cosmetic structure: it provides volumetric support to the midface that becomes increasingly important as the face ages. Natural facial aging involves progressive deflation of fat compartments throughout the face — the temples hollow, the tear troughs deepen, the cheeks lose support — a process that typically accelerates through the forties and fifties.
When buccal fat is removed in a young patient with a naturally slender face or modest buccal fat volume, this aging-related deflation can produce premature, exaggerated hollowing in the midface — the appearance of gauntness that is associated with illness or accelerated aging rather than elegance. Published clinical data and a growing body of patient-reported outcomes make this risk clear: what looks chiseled at 27 can look skeletal at 37 if patient selection is not conservative.
~1 hrTypical procedure duration under local anesthesia
5–7 daysTypical return-to-work timeline post-operatively
3–6 moTimeline to final, fully-settled results
PermanentRemoved buccal fat cells do not regenerate
Patient Selection
Are You a Good Candidate for Buccal Fat Removal?
Rigorous candidacy assessment is the most important step in buccal fat removal. Because the results are permanent and the procedure is irreversible, Dr. Karamanoukian invests significant consultation time in evaluating each patient's facial anatomy, age, skin quality, and long-term facial aging trajectory before recommending the procedure. The criteria below represent the profile of patients who achieve the most natural, lasting, and satisfying results.
β Characteristics of an Ideal Buccal Fat Removal Candidate
- Adults aged 25 or older with a fully matured facial structure — facial fat distribution continues to evolve through the mid-twenties, and earlier intervention risks removing volume that the face would have naturally balanced on its own
- Patients with genuinely prominent, well-defined buccal fat pads confirmed through clinical palpation and visual examination by Dr. Karamanoukian — not simply patients who perceive their face as "too round"
- Individuals who have maintained a stable, healthy weight for at least 6–12 months — and whose cheek fullness persists despite overall leanness, confirming that buccal fat (not generalized adiposity) is the primary source of the fullness
- Patients with strong underlying skeletal structure — a well-defined zygomatic arch, prominent cheekbones, and a defined mandibular angle — that will support and showcase the contoured appearance long-term once the overlying fat is reduced
- Non-smokers with good skin quality and adequate skin elasticity — smokers face elevated infection risk from intraoral incisions and impaired wound healing that can compromise the result
- Patients who approach the consultation with realistic expectations — understanding that results enhance existing structure rather than create entirely new facial architecture, and that the change is subtle rather than transformative
- Those in good overall physical health without contraindications to local anesthesia, sedation, or minor outpatient surgery — a thorough pre-operative medical history review is performed at every consultation
- Patients who desire a refined, sculpted midface that looks natural and proportionate — not a dramatic social-media-inspired transformation that may not age well or suit their overall facial geometry
- Individuals who understand the permanence of the procedure — the removed fat does not grow back, and the long-term commitment to this change is fully appreciated before proceeding
- Patients who are motivated by their own aesthetic goals rather than external pressure, social media trends, or the appearance of a specific celebrity — the best surgical outcomes arise from internally motivated, well-informed patients with clear personal goals.
Surgical Technique
Understanding the Buccal Fat Removal Procedure
Buccal lipectomy is performed as an outpatient procedure at Kare Plastic Surgery's Santa Monica surgical center, typically under local anesthesia with or without oral sedation. General anesthesia is used when buccal fat removal is combined with other surgical procedures. The procedure takes approximately 45–60 minutes.
Consultation & Anatomical Assessment
Dr. Karamanoukian evaluates your facial bone structure, skin quality, fat distribution, and overall facial proportions. He assesses the prominence of your buccal fat pads through palpation and visual analysis, and discusses your goals and aesthetic references. He will tell you frankly whether he believes the procedure will enhance your appearance long-term — and recommend alternatives if the anatomy does not support it.
Pre-Operative Preparation
Pre-operative instructions include stopping blood-thinning medications and supplements (aspirin, ibuprofen, fish oil, vitamin E) at least one week before surgery. Smoking cessation for a minimum of two weeks pre- and post-operatively is required, as smoking significantly impairs intraoral wound healing. An antiseptic mouthwash rinse protocol begins the day before surgery to reduce the oral bacterial load at the incision site.
Anesthesia
Local anesthetic (similar to dental block anesthesia) is injected to numb the buccal mucosa bilaterally. Oral or intravenous sedation is available for patients who prefer a more relaxed surgical experience. The procedure is performed with you awake and comfortable — and because the entire incision is inside the mouth, there is no external injection, marking, or draping of the face.
Intraoral Incision & Fat Pad Exposure
A small incision — approximately 1–2 cm — is made in the buccal mucosa on the inside of each cheek, adjacent to the upper second molar. This incision is positioned along the natural bite line and heals invisibly. The buccinator muscle is gently parted to expose the buccal fat pad, which presents as a lobulated, yellow mass distinct from the surrounding musculature. Dr. Karamanoukian uses careful blunt dissection to preserve the parotid duct (Stensen's duct) and the buccal branches of the facial nerve, which run in close proximity to the fat pad.
Conservative Fat Pad Excision
The buccal fat pad is gently prolapsed into the incision using a combination of internal pressure and careful external digital pressure applied to the cheek surface. Dr. Karamanoukian excises a calibrated amount of fat — intentionally conservative — recognizing that the final visible result will be enhanced by the natural tissue settling and aging trajectory of the face. He avoids complete fat pad excision in most patients, preferring partial reduction that produces a natural rather than skeletal appearance. Hemostasis is confirmed before closure.
Wound Closure
The buccal mucosa incisions are closed with absorbable (dissolvable) sutures that do not require removal. No external sutures or dressings are placed. The closed incisions are imperceptible to the patient and heal rapidly in the moist intraoral environment, typically with minimal discomfort after the first 24–48 hours.
Recovery & Follow-Up
Patients are monitored in the recovery area for 30–60 minutes post-operatively and discharged with a companion. Post-operative instructions include a soft diet for the first 5–7 days, antiseptic mouthwash twice daily, head elevation during sleep, and activity restrictions for two weeks. A follow-up appointment at 1 week and again at 6–8 weeks allows Dr. Karamanoukian to monitor healing, assess symmetry, and review the emerging contour changes.
Aesthetic Outcomes
What Patients Gain from Buccal Fat Removal
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Cheekbone Definition
Reducing buccal volume creates a shadow contrast between the zygomatic prominence and the lower cheek, enhancing the natural appearance of cheekbone structure that was previously obscured by fullness.
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V-Shape Facial Contour
The procedure narrows the lower midface, contributing to the tapered, V-shaped facial silhouette that many patients seek — creating more elegant proportions between the upper and lower thirds of the face.
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No External Scarring
All incisions are made inside the mouth. There are no skin incisions, no external sutures, and no visible scars — a significant advantage over other facial contouring approaches.
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Minimal Downtime
Most patients return to desk work within 5–7 days. The absence of external wounds means recovery is less visible than many other facial procedures, and most patients look presentable at 10–14 days post-operatively.
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Permanent Results
Removed buccal fat cells do not regenerate. Patients who maintain a stable weight enjoy lasting facial contour changes — a genuine long-term investment in their appearance when performed on the right candidate.
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Combinable with Other Procedures
Buccal fat removal pairs well with chin augmentation, rhinoplasty, facelift, submental liposuction, and non-surgical adjuncts like Botox for masseter slimming — allowing comprehensive facial contouring in a single session when appropriate.
Recovery & Results
Recovery Timeline After Buccal Fat Removal in Los Angeles
Buccal fat removal has a relatively forgiving recovery compared to more extensive facial surgeries, but patients should have realistic expectations about the healing timeline — particularly for swelling, which can temporarily make the cheeks appear fuller before the final contoured result emerges.
Days 1–3: Immediate Post-Operative Phase
Swelling and mild discomfort are expected in the first 48–72 hours. The inside of the cheeks may feel sore, tight, or bruised. A soft diet — broths, yogurt, smoothies, mashed foods — is essential to avoid irritating the intraoral incision sites. Ice packs applied to the exterior cheeks can help manage swelling. Patients should sleep with the head elevated above the level of the heart.
Days 4–10: Visible Swelling Phase
Swelling typically peaks between days 3 and 5, and the cheeks may actually appear fuller than before surgery during this period. This is a normal, expected part of healing and should not cause concern. By day 7–10, most patients are comfortable enough to return to desk work and light activities. The intraoral incisions are healing rapidly during this phase.
Weeks 2–6: Progressive Improvement
Swelling diminishes progressively, and the beginning of the new contour becomes visible. Patients may resume moderate exercise at two weeks post-operatively. The cheeks continue to soften and settle, and the defining shadow that characterizes the buccal fat removal result becomes increasingly apparent as tissue edema resolves.
Months 2–6: Final Results
Full, final results are typically visible between 3 and 6 months post-operatively, once all residual swelling has resolved and the soft tissues have completely remodeled to their new three-dimensional configuration. The contour changes are permanent, and most patients find that the subtlety and naturalness of their result improves further as the tissues settle.
Post-Operative Care Instructions at Kare Plastic Surgery
- Soft diet for the first 5–7 days — avoid hard, chewy, crunchy, or acidic foods
- Rinse mouth with antiseptic mouthwash (Peridex/chlorhexidine) twice daily for 2 weeks
- No smoking for a minimum of 4 weeks post-operatively
- Sleep with head elevated for the first 3–5 nights to reduce swelling
- Apply cool compresses to exterior cheeks for the first 48 hours
- Avoid strenuous exercise and contact sports for 2 weeks
- Avoid blood-thinning medications and supplements for 48 hours post-procedure
- Attend scheduled follow-up appointments at 1 week and 6–8 weeks
Combination Procedures
Combining Buccal Fat Removal with Other Facial Procedures
Many patients achieve more comprehensive facial contouring by combining buccal fat removal with complementary procedures in a single surgical session, reducing overall recovery time and anesthesia exposure. Dr. Karamanoukian evaluates each patient's candidacy for combination surgery individually.
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Chin Augmentation (Mentoplasty)
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Masseter Botox (Jaw Slimming)
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Submental / Neck Liposuction
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Mini Facelift / SMAS Lift
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Eyelid Surgery (Blepharoplasty)
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Dermal Fillers & Sculptra
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Morpheus8 Skin Tightening
A particularly popular combination at Kare Plastic Surgery is buccal fat removal paired with masseter Botox — which slims the lower jaw by reducing the bulk of the masseter muscle — and submental liposuction to address under-chin fullness. Together, these three procedures create a comprehensive lower facial contouring result that addresses the midface, jawline, and neck in a single session. Dr. Karamanoukian discusses appropriate combinations at each individual consultation, with patient safety and surgical practicality as the primary guiding factors.
Risks & Considerations
Buccal Fat Removal Risks and Rewards
Buccal fat removal is a safe procedure when performed by a board-certified plastic surgeon with formal training in facial anatomy. However, as with any surgical procedure, it carries risks that patients must understand and weigh against the potential benefits. Dr. Karamanoukian reviews these comprehensively at every consultation and does not proceed without confirmed informed consent.
Surgical Risks
- Asymmetry: No face is perfectly symmetrical before surgery, and minor asymmetry in post-operative results can occur. Dr. Karamanoukian's careful intraoperative assessment of fat volume removed bilaterally minimizes this risk.
- Injury to the parotid duct (Stensen's duct): The parotid salivary duct runs in close proximity to the buccal fat pad. Inadvertent injury can cause a salivary fistula or reduced salivary flow — a rare but serious complication that underscores the importance of surgical training and anatomical knowledge.
- Facial nerve branch injury: The buccal branches of the facial nerve (cranial nerve VII) pass through the deep plane of the midface adjacent to the buccal fat pad. Temporary or permanent weakness of the lower facial musculature is a rare risk that requires precise surgical technique to avoid.
- Infection: Intraoral incisions carry an inherent exposure to oral bacteria. Antiseptic mouthwash protocols and short-course antibiotic prophylaxis are used to minimize this risk.
- Hematoma or seroma: Accumulation of blood or fluid in the surgical pocket is an uncommon risk managed with careful hemostasis at time of surgery.
Long-Term Aesthetic Considerations
- Over-removal and facial hollowing: The most significant long-term risk of buccal fat removal — and the most commonly reported source of patient dissatisfaction. Aggressive removal in patients with naturally slender faces or in patients who were too young at time of surgery can produce a gaunt, prematurely aged appearance that worsens with natural facial fat atrophy over time. Dr. Karamanoukian's conservative excision philosophy and rigorous candidacy assessment are the primary safeguards against this outcome.
- Accelerated midface aging: Because the buccal fat pad contributes structural support to the midface, its permanent removal can in some patients accelerate the hollowing trajectory that naturally occurs with aging. The loss of this volume is not reversible through weight gain — it requires fat grafting or filler to address if it becomes aesthetically problematic.
- Correction with fat grafting: Patients who experience excessive hollowing after buccal fat removal — whether performed at Kare or elsewhere — may benefit from autologous fat transfer to restore midface volume. Dr. Karamanoukian manages these revision cases as part of his comprehensive facial surgery practice.
Common Questions
Frequently Asked Questions About Buccal Fat Removal in Los Angeles
Is buccal fat removal permanent?
Yes — this is one of the most important facts for patients to understand before proceeding. Removed buccal fat cells do not regenerate. The structural change to the midface is permanent, which is precisely why careful patient selection and conservative surgical technique matter enormously. Patients who gain significant weight may see some increased facial fullness from other fat compartments, but the buccal fat pad itself will not return. If a patient later develops excessive hollowing — which can occur with natural aging — correction requires fat grafting or filler to restore lost volume.
How long is recovery after buccal fat removal?
Most patients take 5–7 days away from work. Significant swelling peaks in the first 3–5 days and progressively resolves over 6–8 weeks. During the swelling phase, the cheeks may actually appear fuller than before surgery — a temporary and expected finding. Final results, including the full definition of the midface contour, are typically visible at 3–6 months post-operatively as all residual tissue edema resolves.
Can buccal fat be removed with liposuction or Kybella?
No. The buccal fat pad is anatomically inaccessible to liposuction — it sits deep to the buccinator muscle in a fascial compartment that cannot be reached with a liposuction cannula from external skin entry points. Kybella (deoxycholic acid) is approved for submental fat only and is not appropriate for buccal fat reduction — its use in this area risks serious complications including facial nerve injury. Surgical excision through an intraoral incision is the only safe and effective method of buccal fat reduction.
I am 22 years old. Am I too young for buccal fat removal?
Potentially yes. Most experienced facial plastic surgeons — including Dr. Karamanoukian — are cautious about performing buccal fat removal on patients under 25, for two reasons. First, facial fat distribution continues to change through the mid-twenties, and what seems like excess fullness at 22 may become naturally balanced facial volume by 26 or 27 without any intervention. Second, removing buccal fat in a young patient extends the long-term exposure to the aging-related hollowing risk: the face that looked sculpted at 22 has a longer runway to develop gauntness by the late thirties. Dr. Karamanoukian evaluates each young patient individually and may recommend a period of observation before committing to an irreversible procedure.
Can buccal fat removal make me look older as I age?
In poorly selected candidates, yes — this is the central long-term risk. The face naturally loses volume with aging, and buccal fat contributes midface structural support that becomes more important as surrounding fat compartments deflate. In a patient whose anatomy supports the procedure — with substantial buccal fat, strong bone structure, and adequate overall facial volume — the result ages well. In a patient with a naturally slender face or modest buccal fat pads, removal can accelerate the hollowed, gaunt appearance associated with advanced age. Dr. Karamanoukian's candidacy assessment specifically evaluates the long-term aging trajectory of each patient's face before recommending the procedure.
Will buccal fat removal give me the "model cheekbone" look I see on social media?
The degree of cheekbone definition achievable with buccal fat removal depends entirely on your underlying bone structure. The procedure reduces the fat that may be obscuring your cheekbones — it does not create cheekbones that are not structurally present. Patients with well-defined zygomatic arches and strong facial bone structure see the most striking results, because removal of the overlying fat allows their natural skeletal definition to emerge. Patients with flatter or less prominent bone structure will see more modest improvement in definition. Dr. Karamanoukian provides an honest pre-operative assessment of the result your anatomy can realistically achieve.
How much does buccal fat removal cost in Los Angeles?
The cost of buccal fat removal at Kare Plastic Surgery in Santa Monica varies based on whether the procedure is performed alone or in combination with other facial surgeries, the anesthesia type selected, and any pre- or post-operative care included in the surgical plan. A personalized fee quote is provided at your consultation. Financing options are available through our office for qualified patients. Buccal fat removal is a cosmetic procedure and is not covered by medical insurance.
What if I had buccal fat removal elsewhere and I am unhappy with the result?
Patients who have undergone buccal fat removal at other practices and are experiencing hollowing, asymmetry, or unsatisfactory contour are seen at Kare Plastic Surgery for revision consultation. Depending on the degree and nature of the concern, Dr. Karamanoukian may recommend autologous fat transfer (fat grafting) to restore volume to the over-excised midface, structural filler placement as a non-surgical interim measure, or a combination approach. Revision cases are evaluated individually, and realistic options are presented based on a thorough anatomical assessment.
Consult with Los Angeles's Buccal Fat Removal Expert
If you are considering buccal fat removal, the most important first step is an honest consultation with a board-certified plastic surgeon who will tell you what your anatomy can — and cannot — achieve. Contact Dr. Karamanoukian's Santa Monica office to schedule your private consultation today.
(310) 998-5533 Request a Consultation