Arcadia, CA plastic surgeon Arthur Y. Yu, MD has a slew of experience giving people the face and body they want. He’s passionate about providing his patients with specialized treatment plans and is deeply knowledgeable about the human anatomy, which helps him perform meticulous procedures with minimal downtime. One popular procedure Dr. Yu excels at is buccal fat removal. This is a treatment many celebrities have undergone, including Chrissy Teigen and Bella Hadid, to reduce the appearance of baby fat for a sleeker cheekbone. Dr. Yu gave us the inside scoop on the procedure.
What is the goal of buccal fat removal?
“Buccal fat is anatomically designed to facilitate the gliding of the masseter muscle and move the buccal muscle. Before the age of 25, this fat is like half a golf ball size. It’s very stable—it stays there. However, after 30 years of age, the fat actually becomes loose and protrudes forward. So it somehow gets out of the boundary of the anterior border of the masseter muscles, and as a result, the fat does not work anymore as a ball bearing. You can sometimes see people with a little bulge in the center of the lower face where the buccal is.
So as you progress to the age of 40 or 50 [the buccal fat] has become so obvious. In about 30% of the population, this fat becomes visible, even without motion, usually when you smile. It’s almost a full golf ball. Now, whenever I smile, my horizontal dimension is actually bigger than my vertical dimension, and most of this is actually contributed by the prolapse, or sometimes we call that pseudo herniation or herniation. So, as a result, you’d like to remove this fat, because number one, it doesn’t function as a ball bearing anymore, and number two, it can make the face look kind of ugly.”
When do you know it’s time to get buccal fat removal?
“Whenever we think that protrusion of the fat is destroying the proportion of the face is the time for you to have the fat removed.”
What does the procedure and recovery entail?
“I designed a very minimally invasive surgery. Almost every single surgeon in the world uses almost a one-inch incision in the mouth in order to have the fat removed. I only use a six-millimeter size, a small incision to tease the fat ball out. That is tremendously important. Most of the doctors in the world would require patients to be on a liquid or semi-liquid diet for seven to 10 days to facilitate the healing. My patients can chew a steak the same night. It has no recovery time.
I’m very facile with my anatomical knowledge. I don’t need to cut open the whole mouth because I know exactly where the fat is. I take my dissector in a couple of times, and a portion of the fat will actually show up by itself. So then I grab this little clip of the fat ball, and then because it’s malleable, teasing it with light force, you can actually gradually ease it out through that little hole you make. So my patients only need one suture, one stitch, that’s it, and I can close it. Versus my colleagues, usually, we’re talking about seven stitches to 10 stitches.”
Is there any pain or swelling following the procedure?
“Out of 100 patients, maybe one patient will require one Tylenol, and the rest of them don’t require anything. You cannot see any bruising. You cannot even see any swelling. Of course, there is swelling. I always tell my patients after one week your face will become smaller and smaller. The reason is the first seven days, you’re going to have swelling. The swelling is actually offset by the loss of buccal fat volume, so it’s basically balanced out as a result. And there’s no bruising because it’s deep. Even if there’s bleeding, the blood is not going to show up through the skin.”
How much of the buccal fat do you remove during the procedure?
“There are concerns about how much buccal fat you need to remove. So we take into consideration how much body mass the patients have, along with how much body mass their parents have, because when we age we usually follow our parents’ path. If their parents have more body mass, we usually remove more buccal fat, but if their parents are quite thin when they age, we will usually remove 50% or maybe 60% to make sure that when they age they don’t have really sunken cheeks.”
Are there any alternative ways to get rid of buccal fat?
“There’s another way of doing buccal fat removal—it’s actually more for the people who are going for a facelift. So when I do a facelift, I can actually remove the buccal fat through the facelift from outside, but definitely not making a cut on the center of the face, of course. It’s
another very interesting phenomenon. I’ve done hundreds of these procedures. I don’t have a single complication, but I did one paper recently, and there are about 2-3% complications, including hematoma and facial nerve injury, which is bad because that means your patient cannot even smile after. There’s also the potential for injury of the surrounding muscle structures. I think it’s probably a result of people who are not really familiar with the local anatomy.”
Is there an ideal face shape people seek out?
“A lot of patients are actually bringing in celebrity photos saying, ‘this is what I want,’ and I ask them to smile. When I see these two balls sticking out, I tell them, ‘buccal fat removal is what you need.’”
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