Buccal fat removal is just the tip of the iceberg

Chrissy Tiegen admitted to going through the procedure in 2021  (GC Images)
Chrissy Tiegen admitted to going through the procedure in 2021 (GC Images)

Buccal fat removal. The three words you’ve seen everywhere during the Christmas break, but what the hell do they mean?

Buccal fat removal (pronounced “buckle” not “boo-cal” like I’ve been saying it for the past two weeks, apparently), popularised by celebrities like Chrissy Tiegen, is a relatively simple procedure that slims down the face by removing the little pockets of fat from within your cheeks. “It’s essentially a surgical procedure that involves getting the fat removed from the cheek to achieve a contoured chiselled face,” says Dr Ross Perry, medical director of Cosmedics.

Perry says the procedure became one of the most talked about procedures of 2022, with interest piquing especially amongst younger clients. “Buccal fat is something everyone has, it’s the fleshy part between the cheekbones and jawline,” he explains. “[Buccal fat removal] is a surgical operation that requires going into the patient’s mouth and removing the fat from inside of the cheeks.” Kind of like asking a squirrel to spit out all of its acorns, really. It is also, crucially, different to liposuction, because it involves cutting out the fat, not suction.

So where does this sudden opposition to chipmunk cheeks come from? Regan Ellis, a 22-year-old content creator from Milton Keynes, says she underwent the procedure because she couldn’t do anything to shift her “excess” cheek fat, even when she dropped a couple of stone in body weight. “I was getting blood blisters and ulcers on the inside of my mouth where I was biting down because I had so much excess cheek fat,” she told the Standard. This is because buccal fat is a structural fat, unrelated to weight loss. So, for a mix of aesthetic concerns and medical reasons, she says, Regan went under the knife, and never looked back. “I would definitely recommend it to others,” she says, “just make sure you’re educated and knowledgeable about what you’re getting done [...] Just don’t go in blindly.”

TikToker Regan Ellis has had her buccal fat removed and loves her new look (Regan Ellis/Instagram)
TikToker Regan Ellis has had her buccal fat removed and loves her new look (Regan Ellis/Instagram)

One unwelcome side effect has been going viral over the past month: the “Handsome Squidward”. The Handsome Squidward look is where a lack of buccal fat can bite back later in life as your face loses its natural bounce thanks to ageing, and leaves you with hollow, gaunt-looking cheeks, a la the good looking iteration of Spongebob Squarepants character Squidward, who has very over pronounced cheekbones and jawline.

Tunk Tiryaki, a consultant plastic surgeon at the Cadogan Clinic, says that this side effect is so widespread that he’s recently been inundated with requests to “reverse” buccal fat removals by re-adding the fat that was once removed. “Buccal fat removal cannot be strictly reversed,” he told the Standard, “but dermal fillers or a fat grafting procedure can be performed to replace the fat which was removed – this is a procedure I am doing more and more of.

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“I’ve seen many people who have had buccal fat removal and while they may be happy with their appearance initially, this often changes further down the line as they age. Removing buccal fat doesn’t create definition, it only creates emptiness. We naturally lose fat and collagen in our faces as we age and so if buccal fat is removed it only accelerates the ageing process, leaving you with a hollow appearance.”

But this hollowed out, handsome Squidward look comes with time. Most people, like Regan, who get buccal fat removal young, have a good few years before any issues with gauntness or empty cheeks. And yet, the Handsome Squidward comparisons have been all over the internet this past month. This, cosmetic surgeon Dr Angelica Kavouni explains, is because there’s likely more than buccal fat removal going on under the surface.

“It’s difficult to say [with these celebrities] whether some of the aesthetic result has to do with an actual operation or just extreme contouring of the face,” she explains. “Makeup artists have always tried to create that contour line below the cheekbone - but I think in most cases you can assume some of the buccal fat has been removed as well. And it could be a combination with liposuction, where you remove the superficial fatty tissue to help the skin to tighten and accentuate the line under the cheekbones.” And there’s usually jaw filler at play too. “It’s often combined with augmentation of the jawline, which can be achieved with implants.”

Model Chrissy Tiegen has admitted to going through the procedure (Invision/AP)
Model Chrissy Tiegen has admitted to going through the procedure (Invision/AP)

All of this can lead to a pretty Squidward-esque look if you’re not too careful, but Dr Kavouni explains that it doesn’t have to be a detrimental procedure. “You have to make sure to remove approximately 60-70% of the buccal fat amount and leave some of it behind to avoid a gaunt look later on in life.”

So it is possible to undergo the procedure and maintain some of the bounce in your cheeks, you just have to do it right. Or, if you want to emulate some your favourite stars with high cheekbones and slim cheeks, just remember that there’s a bunch of smoke and mirrors between you, them, and that picture where they look like they have zero buccal fat. As Dr Perry explains, they’re likely just airbrushed.

“Quite often photo filters and airbrushing have been done and that’s likened to someone having buccal fat removal,” he says. “In my opinion it’s worth just getting better at contouring with make-up rather than going down this route.” So take it from the surgeon himself and sharpen your contour kit, not your scalpel.