Hollow victory: Why doctors are worried about the latest facelift trend

More young people are asking about cosmetic procedures that can give them Bella Hadid's cheekbones, says plastic surgeon Dr Ashwin Soni. Picture / Getty Images

We have many things to thank TikTok for – a myriad of ways to cook cauliflower, for one – but its influence on aesthetic treatment trends is one of the more questionable ones. The latest surgery fad taking over Gen Z’s favourite social media platform is #buccalfatremoval, which has amassed more than 125 million views and counting.

Though technically not a new procedure, interest in the obscure cheek sculpting surgery has spiked dramatically since December, according to Google Trends.

Could the inspiration be Glee actress Lea Michele, who posted a selfie with her noticeably hollowed cheekbones that sent the Twitterverse into a frenzy? While the shadows beneath her rounded cheeks are natural, it certainly ties into an obsession with an overall angular face shape, which is apparently considered desirable amongst the TikTok generation.

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One celebrity who has admitted to having a procedure specifically to attain this look – which involved buccal fat being removed from her cheeks – is Chrissy Teigan, who posted about this treatment on social media when she debuted her new jawline.

But before we dive into the dos and don’ts of why bony facial architecture has become ubiquitous, let’s explain what buccal fat removal is. Buccal (pronounced ‘buckle’) fat itself refers to the pads of fat between the cheekbone and jaw that is often referred to as ‘baby fat’ – or in less flattering terms, ‘chipmunk cheeks’ if you have an excess of it.

Removing it involves relatively straightforward surgery that takes no more than 15 minutes each side under local anaesthetic, and costs between £4000 and £8000 (about NZ$7630 - $15,260), depending on the surgeon.

“The surgery involves a small incision inside the cheek in order to push a small amount of fat out of the ‘pocket’. The fat is then cauterised and the incision is closed with dissolvable stitches. The procedure and healing process is relatively quick and seamless,” explains GMC registered plastic and reconstructive surgeon Dr Ashwin Soni, who has performed the procedure multiple times in medically reconstructive cases.

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The risks

The danger, says Soni, is when the procedure is done on young patients who are chasing the ‘sucking-on-a-straw-look’ that’s Instagram-famous. “I’m noticing that young people are enquiring about buccal fat removal to achieve the chiselled cheeks that Bella Hadid and others have, but once the fat is removed you can’t put it back, which will potentially lead to botched filler jobs and fat grafts later down the line.”

Biologically, says Soni, buccal fat growth accelerates between the ages of 10-20, which explains why adolescents, despite being a healthy weight, are often described as having a baby face or puppy fat.

What’s being forgotten, however, is that once we hit our 40s and 50s, facial structure changes and the cheeks can appear sunken, at which point buccal fat is an asset, not a foe. “When collagen and elastin diminish, the face naturally appears thinner and more contoured – top plastic surgeons I speak with believe that having this procedure too young will be a major contributor to facial ageing in the future,” warns Soni.

BAAPS President Marc Pacifico says, “in some people, buccal fat removal can overly hollow their face, and as they age they have a gaunter appearance. What might look good in the short term might not be the right thing in the long term.”

Aesthetic practitioner Dr Wassim Taktouk agrees that caution is needed. “We haven’t yet seen a case study of how someone who’s had buccal fat removal in their twenties looks 20 years down the line, when bone resorption occurs and facial fat naturally depletes – plus, although rare, there’s all sorts of things that can go wrong, from asymmetry to nerve damage.”

Can it be done safely?

There is a case for buccal fat removal for aesthetic means if the surgeon is highly skilled and the patient is assessed properly, says Tatkouk. “In patients with protruding jowls, the procedure is sometimes performed in conjunction with a facelift, but it should be a very subtle extraction of fat performed by a surgeon who is experienced, and not before other means have been ruled out.

“An excess of buccal fat can first and foremost be the result of weight gain. I’m honest with my patients – dialling in nutrition and exercise to achieve a healthy body weight is the first port of call, then we can discuss if cosmetic intervention is needed.”

What’s more, buccal fat can be confused with exaggerated masseter muscles, which rest just below the ears where the jawline finishes, says Dr Soni. “It’s not always easy to differentiate between the two. Masseter muscles are accessory muscles responsible for chewing and, in patients who grind their teeth, they can become bulky, which is easily corrected with Botox,” he says.

Certainly buccal fat removal has its place, particularly for those who have a disproportionate amount of it. But the catchy-sounding procedure has become a scapegoat for a combination of procedures designed to contour. “When I look closely at those who are rumoured to have had buccal fat removal, it’s evident that they’ve also had filler to enhance their cheekbones and chin to exaggerate the contours,” Soni says.

“Buccal fat removal when done well is actually a very subtle way to give definition, but it’s being portrayed as a one-stop-fix for the angular, contoured look that is all over social media, and that’s just not the case.”

Impermanent options

Perhaps one of the perks of getting older is a chiselled bone structure, but, says Taktouk, “no one should have cheekbones so high you can rest a martini glass on them – it doesn’t look natural”. For those who are contemplating having their buccal fat removed, there are impermanent ways to contour a round face without giving up the padding that you may rely on later in life.

“It sounds counterintuitive, but I always start from the top – often it is fat loss in the upper part of the face that causes a lack of anchoring, which contributes to the lower cheeks appearing more pronounced. Filler in the temples and upper cheeks can be all one needs,” says Tatkouk.

Taktouk adds: “It’s important to work specifically with each patient’s natural anatomy – there’s a worrying trend for aesthetic procedure packages that overfill patients in a way that isn’t harmonious with their natural anatomy, in order to look like the Kardashians or some similarly glamorous celebrity – and this is where surgery trends can be dangerous.”

There’s no doubt that social media has a virulent effect on surgical trends, but there’s no actual evidence that celebrities on TikTok have actually had the buccal fat procedure. “I’m very cautious about temporal trends,” Pacifico says. “Just because a procedure seems to be popular doesn’t mean it’s appropriate for you.”