Will buccal fat removal make your face look hollow later?
Updated: 10 hours ago
Medical editor: Dr. Semih Yıldız, plastic, reconstructive and aesthetic surgeon (FEBOPRAS) · Last updated: October 2026
It can, if too much fat is removed or if the face was slim to begin with. Every face loses volume with age, and buccal fat taken out today is no longer there to cushion that change. When only part of the fat pad is removed, and only from genuinely full cheeks, the risk of a hollow look later is much lower, although it never falls to zero.
That is why the amount is planned rather than maximised. For bichectomy in Istanbul, Dr. Semih Yıldız adapts the removal to the shape of each face, with the aim of cheeks that still look healthy decades later. The reasoning behind that caution starts with what buccal fat actually does.
What buccal fat does in your face
The buccal fat pad is a deep pocket of fat in the lower cheek. It lies below the cheekbone, partly tucked under the front edge of the main chewing muscle (masseter), and it is separate from the fat directly under the skin. In many people it creates the soft, rounded fullness of the lower face that is often described as a “baby face”.
Two points matter for long-term planning. First, some people keep round lower cheeks even at a healthy, stable weight, and in them the buccal fat pad is often a large part of that fullness. Studies have not settled how closely buccal fat itself follows changes in body weight, so the fullness is judged at a stable weight. Second, the part that is removed does not grow back. Whatever is taken out at 25 is also missing at 55.
How the face changes with age
Facial ageing is not only about lines and wrinkles. Over the decades, several layers change at the same time:
The fat compartments of the face slowly lose volume, and some of them shift downwards.
The bones of the midface and jaw gradually lose some projection, so the soft tissue has less support.
The skin becomes thinner and less elastic.
The buccal fat pad tends to sag lower over the years, which can add fullness near the jawline. There is no clear evidence that it also shrinks: some imaging studies comparing age groups even found it larger in older adults.
The combined result is a flatter cheek with a deeper shadow under the cheekbone. This happens to everyone, with or without surgery. What differs is how much reserve a face has when the process starts.
Why removal can add to hollowing
A bichectomy permanently removes part of the volume that supports the lower cheek, while the other layers of the face go on changing with age. In a face that starts out full, removing part of the buccal fat brings the cheek closer to an average contour, and enough volume remains to age naturally. In a face that is already slim, the same amount can leave a visible dip below the cheekbone.
That dip may look sculpted in photos at 25. Twenty years later, when the other fat compartments have thinned as well, the same face can look tired or drawn. The risk is greatest when a large amount is removed from a face that did not have much to spare. This is why a hollow appearance, either from over-removal or with ageing, is listed among the possible complications of the operation.
Faces that are more at risk
Buccal fat removal is usually not advised, or is kept very limited, when these points apply to you:
Your face is naturally narrow or long, and your cheeks do not look full at rest.
You can already see a shadow beneath your cheekbones, or your temples and under-eye area look hollow.
Your body fat is very low, for example from endurance sport.
You plan to lose a lot of weight, whether through diet, medication or surgery.
Your midface has already started to lose volume with age, so the cheeks look flatter than they used to.
Fullness caused by strong jaw muscles, a broad bone structure or sagging tissue is a different matter: removing buccal fat would not treat it. For that reason, the source of the roundness is identified first during planning.
What conservative removal means in practice
Conservative does not mean ineffective. It means that only a planned portion of the buccal fat is removed, mainly the part that bulges into the lower cheek, rather than as much as can be reached. The goal is a lower face that looks softer and more defined, and still natural from the side and when you smile.
Three things guide how much is enough:
How full your lower cheeks are at rest and when you smile, judged from front and side photos and confirmed at the face-to-face consultation.
Whether your weight is stable, and how your face has looked at different weights in the past.
Your age, and therefore how much natural volume loss still lies ahead.
The two possible errors are also not equal. If the change turns out more modest than you hoped, it can be reassessed once the final result has settled after 3–6 months. Fat that has been removed, on the other hand, cannot be put back in its original form.
If a hollow look appears years later
A hollow look that develops later can usually be improved. Volume can be restored with fat transfer, in which some of your own fat is moved to the cheek, or with hyaluronic acid fillers, which last about 6–12 months and can be repeated. Fat that survives a transfer stays long term, but part of it is always reabsorbed, so the amount that remains is harder to predict. When the main problem is sagging rather than lost volume, lifting the tissue usually helps more than adding volume alone.
Prevention is still simpler than correction. If you are considering buccal fat removal, the most useful starting point is not how much fat can be taken out, but how much your face can spare over the coming decades.
Frequently asked questions
Does buccal fat grow back after a bichectomy?
No. The part of the buccal fat pad that is removed does not grow back, and the remaining part stays in the cheek. Your face can still become fuller if you gain weight, because the fat under the skin and in other areas of the face responds to weight changes. That is why a stable weight before surgery is part of the planning.
Can a bichectomy be reversed?
Not directly. Removed buccal fat cannot be returned in its original form. If the cheeks later look too hollow, volume can be added with fat transfer or hyaluronic acid fillers. These can soften the hollow, but they behave differently from the original fat pad, which is the main reason removal is planned conservatively from the start.
Does conservative removal still make a visible difference?
For a face with genuinely full lower cheeks, it usually does. Removing a planned portion of the buccal fat creates a slimmer, more defined lower face, although the change develops slowly as swelling settles over 3–6 months. The result is subtler than an aggressive removal, but it is more likely to keep looking natural as the face ages.
If you are unsure whether your cheeks have enough fullness for a safe reduction, a free online assessment of your front and side photos can help you decide.
This article provides general information and does not replace a medical consultation. Results vary from person to person.
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