What is buccal fat removal and how can it support facial feminization?

Buccal fat removal is a minimally invasive surgical procedure that consists of partially removing the buccal fat pads (Bichat’s fat pads), which are fat compartments located inside the cheeks, between the chewing muscles.
These pads play a role during infancy, aiding suction in babies. In adulthood, however, they serve no essential function, and their size can influence facial appearance. When prominent, they add volume to the mid and lower face, creating a rounder or heavier look.

The purpose of buccal fat removal surgery is to reduce this volume, refine facial contours, highlight the cheekbones, and create a more slender, angular, and therefore more feminine appearance.

Buccal fat removal is usually performed under local anesthesia with sedation. The surgeon accesses the buccal fat pads through a small incision inside the mouth, leaving no visible scars. The procedure typically lasts between 30 and 45 minutes, and recovery is fast with minimal discomfort.

In the first few days, swelling, tenderness, and slight chewing limitations may appear. A soft diet, strict oral hygiene, and avoiding physical exertion are recommended. Patience is important, as initial swelling can mask the final results, which become noticeable after 3–4 weeks and stabilize between the third and sixth month.

It is important to note that buccal fat removal does not change bone structure, nor does it feminize the face on its own. Its effect is more evident in patients with full cheeks, and more subtle in those with average or already slim facial volume.

The main benefit of this procedure is its ability to complement other facial feminization surgeries, such as jaw contouring, feminizing rhinoplasty, or facelift procedures.

Patients should not expect a radical transformation of the face through buccal fat removal alone. This surgery should not be considered the sole strategy for achieving facial feminization. Additionally, it is not recommended for patients with very thin faces, as natural fat loss over time may accentuate a hollowed or aged appearance.

It is important to understand that these are two different concepts. While aesthetic medicine sometimes aims to refine the face through strategic volume reduction, fillers usually add volume to sculpt key areas – such as the cheekbones, chin, or jawline, often using hyaluronic acid.

Before deciding on buccal fat removal, it is essential to understand your facial needs and which technique can help you achieve a more harmonious and coherent feminization. A precise diagnosis should evaluate:

• • Skin thickness and facial fat distribution
  • Balance between the three facial thirds
  • Medical history and hormonal treatment (if applicable)
  • The trans woman’s wishes, expectations, and transition process

There is no single valid strategy for facial feminization. What matters is building a personalized, safe, and realistic plan.

Buccal fat removal is safe when performed by experienced surgeons. However, as with any procedure, risks exist: bleeding, hematoma, infection, or, in rare cases, injury to the facial nerve. This is why it should not be trivialized or treated as a “minor cosmetic surgery” without proper planning and follow-up.

It is also contraindicated in patients with very thin faces, active eating disorders, or untreated body dysmorphia. Mental and emotional health must also be considered before recommending any facial procedure.

Facial feminization is a set of procedures and surgical interventions that aim to adapt facial traits toward what is aesthetically perceived as feminine. Whether or not buccal fat removal forms part of this process should always be a joint decision between the medical team and the trans woman.

Above all, it should be part of a global and personalized approach, performed by specialized medical professionals with extensive experience in this type of surgery.