Why everyone is suddenly talking about buccal fat removal

Buccal fat removal, a cosmetic procedure designed to remove fat from the cheeks and create the appearance of sculpted cheekbones, has risen in popularity over the last few years. (Marina Demeshko/Adobe Stock) 9

Buccal fat removal might just be the new Brazilian butt lift -- aka the newest cosmetic surgery procedure to take over social media.

Over the past few weeks, buccal fat removal has become a hot-button topic on social media after several celebrities were rumored to have had the procedure, which sparked both supporters and detractors to share their views and experiences.

Searches for buccal fat removal shot up dramatically starting around December 11, according to data from Google Trends.

Here's everything you need to know about the procedure -- and why it's so controversial.

Buccal fat removal involves excising fat from the cheeks

Buccal fat removal is just what it says on the label: the removal of fat from the buccal fat pad, a mass of tissue located deep within the cheek. The procedure is typically conducted under anesthesia. A surgeon will create small incisions on either side of the inside of the patient's mouth to expose the buccal fat pad, and then remove some or all of the fat.

Darren Smith, a New York-based plastic surgeon, told CNN that "you can accentuate the cheekbones by removing the fat that is in the buccal fat compartment."

Smith said he typically sees three kinds of patients who are interested in buccal fat removal. One is "folks who just have a fuller face, that almost have a cherubic, round face, that might want to slim it out a little bit." Buccal fat removal can result in a slimmer-looking face, according to Smith.

But the reason that buccal fat reduction is currently trending is for another purpose: By removing fat from the cheeks, the procedure can create the appearance of more sculpted, defined cheekbones. A patient interested in this effect "might not have a full face, but they just wanna see a little more definition in the cheekbones," he said. These patients are looking to emphasize the "submalar hollow" below the cheekbone, he added.

When it's "done artfully, not overdone, it can look cool in a lot of cases," said Smith.

The third category of patients that Smith said he sees for buccal fat removal are "older patients that we're seeing for facial rejuvenation."

The "buccal fat pad is subject to gravity, and it can droop over time," he said. "It can actually contribute to this jowly, heavy lower face appearance. So in those folks, you'd often remove it in combination with a procedure like a facelift."

Celebrities and social media have driven increased interest in the buccal fat removal

Smith says that he's seen a definite spike in interest in buccal fat removal over the past few years.

"It's a procedure that is becoming more and more popular," he said.

Last year, model Chrissy Teigen announced on Instagram that she had undergone buccal fat removal. "And since I quit drinking, I'm really seeing the results, and I like it," she said in an Instagram story at the time. "Yeah, I did it, what?"

Other celebrities sporting sculpted cheekbones have been rumored to have the procedure -- although it's unclear if they actually have.

And social media is a major driver of interest, according to Smith.

"I think social media plays a tremendous role," he said. "We're seeing social media setting all kinds of trends, as people are having faster and more frequent access to latest celebrity looks and trends."

Additionally, social media has enabled patients to share their first-hand experiences getting cosmetic surgery. "People are now sharing their experiences more" which results in a "fading of the taboo of plastic surgery," according to Smith.

"People are so much more open to talking about it," he said.

Ellen Gendler, a cosmetic dermatologist based in New York, told CNN that she has observed an increase in patients asking about buccal fat removal in recent weeks.

"Last week, I've had 20 people ask me about buccal fat removal," she said.

Surgeons urge caution about the procedure

Surgeons, cosmeticians, and everyday users have also used social media to urge caution about the procedure. Gendler, for instance, posted a TikTok on Monday in which she warned patients, particularly young women, to avoid buccal fat removal.

"The latest trend of buccal fat removal is probably the dumbest trend I've seen in a long time," she said in the video.

Gendler told CNN that because it removes volume from the face, buccal fat removal can have a prematurely aging effect on patients. While it might look flattering at first, as the patient ages and naturally loses volume in their face, the lack of buccal fat may make them appear gaunt and older.

And once your buccal fat is gone, there's no way to get it back -- although cosmetic fillers and fat injections might be used to replicate the look of buccal fat, Gendler said.

"When you take out an underlying structure in a permanent procedure and you age around it, you don't know how it's going to look," she said.

Gendler urged patients contemplating buccal fat removal to consider the risks and understand how their results might change over time. "I feel that it is not a procedure that you should go into without understanding this very real risk," she said.

Smith emphasized the importance of counseling patients about the pros and cons of each procedure. "One of my main jobs is to help people make sure they're making responsible decisions when they're getting procedures," he said.

A talented surgeon will be careful and precise when removing buccal fat, he said. "The big danger with buccal fat pad excision is prematurely aging the face," he explained. "Something we know from a long time ago is that volume is what, among other things, brings the face a youthful experience."

"Really, buccal fat pad removal has to be done artistically, it's not the kind of thing where you just want to remove all the buccal fat," he said. "You have to be very careful about removing the right amount for the right person."

Why it's 'not something to do just because you saw it on Instagram'

Other social media influencers have pointed out that the high-cheekbone aesthetic that patients hope to achieve with buccal fat removal is just the latest in a series of unattainable beauty standards.

Makeup influencer Rachel Ocool, for instance, created a tutorial for makeup that emphasizes round cheeks -- rather than trying to eliminate them.

"Plastic surgery to remove your fuller cheeks is trending," said Ocool in the TikTok video, which has garnered over 1 million likes on her verified account. "Not on my watch!"

She proceeded to demonstrate "how I accentuate my round cheeks, because they're cute."

At the same time, some influencers have used social media to document the positive effect the procedure has had on their self-esteem.

Jaci Marie Smith, a podcaster and TikTok creator, told CNN that she decided to create a TikTok about her experience receiving buccal fat removal

"There's a lot of of controversy and slander going around right now about buccal fat removal," said Smith in her video. The California-based creator underwent buccal fat removal in January.

Smith said she had long felt her fuller face didn't match her body type. After hearing about the procedure through friends and on social media, she met with a plastic surgeon who told her she was a good candidate.

"I'm really happy with the results because I feel like it fits with my body type more," she told CNN. "I feel very much more myself."

She chose to speak about her experience on social media because of other users saying "that it makes you look old, makes you look sunken and hollow, and that it's a bad look."

"The purpose of me making it was to educate more about what buccal fat removal is, and that you, if you're interested in getting it done, you should go to a doctor that you really trust," she continued.

"I feel like I got this done for me, and for no one else," she added.

Smith, the plastic surgeon and no relation to the TikTok creator, echoed her message about personal motivation.

"My kind of rallying cry in the world of plastic surgery is that nobody needs plastic surgery," the surgeon said. "if you're gonna do it, you should do it for personal joy."

"Buccal fat incision is, like anything else, not something to do just because you saw it on Instagram," he said.