If you have seen a slimmer, more defined lower face described as “Hollywood cheeks”, the operation behind it is usually buccal fat pad removal, also called bichectomy. The look is popular on social media, but the studies behind it are small and short. This guide explains how it works, what complications are reported and what to ask before deciding.

Key takeaways

  • 'Hollywood cheeks' is a popular name for buccal fat pad removal, also called bichectomy: fat is removed from the lower cheeks, usually through a small cut inside the mouth.
  • A 2025 meta-analysis of 12 studies and 308 patients found some complication in about one in four, with wide uncertainty, and concluded the operation should be recommended with caution.
  • Cheek fat shifts with age, and leading surgeons warn that removing it may hollow the face over time; long-term evidence is thin.
  • Ask whether your face shape and age suit the operation, and how your surgeon avoids the facial nerve and salivary duct.

What is Hollywood cheek surgery?

The buccal fat pad is a pocket of fat deep in the cheek, between the cheek muscle and the skin. Its size varies from person to person. In buccal fat removal, a surgeon takes out part of that pad to reduce fullness in the lower cheek and make the cheekbones and jawline look more defined. “Hollywood cheek” is a marketing label for the result, not a separate procedure.

A 2021 article in Plastic and Reconstructive Surgery describes it as a small intraoral procedure, meaning the work is done through the mouth, often under local anesthesia, and notes that social media has driven a surge of interest. The same authors say evidence is limited on whether it works as a long-term solution.

How well does buccal fat removal work?

Patient satisfaction is often high in the short term, but the evidence is weak. A 2021 systematic review found only four studies that met its criteria. In one, 84.6% of patients said their facial contour was much better. The authors concluded that early results are favorable but that many procedures are done with poor-quality methods and there is almost no long-term follow-up.

Results also depend on the face. A study of 133 patients separated those with a bottom-heavy face from those with sagging lower cheeks, and concluded the operation is effective when candidates are chosen well and the removal is planned by position. That is why a consultation should look at your face shape, your skin and your age, not only your photos.

What complications are reported?

A 2025 systematic review and meta-analysis pooled 12 studies covering 308 patients. About 25% had some complication, though the confidence interval was very wide (4% to 46%) and the studies varied widely. Reported problems included swelling, limited mouth opening (trismus), pain and facial asymmetry; facial nerve paralysis, infection and hematoma were rare. The authors recommended the procedure with caution.

Serious injuries are documented as well. A case report from two oral and maxillofacial teams describes damage to the salivary (Stensen’s) duct in one patient and heavy bleeding from a deep artery in another, and stresses that anatomical knowledge is essential. These cases are not typical, but they show why the surgeon’s anatomical training matters.

Will cheeks look hollow with age?

This is the question to take seriously. The buccal fat pad changes with age: an MRI study of 63 patients followed over at least four years found the pad lengthened and descended, which can deepen the fold beside the mouth. The Plastic and Reconstructive Surgery authors say how much cheek fat persists or shrinks with age is debated, and warn of a possibility of premature aging and midface distortion in the long run.

Surgeons often describe fat removal as lasting, because the removed tissue is not replaced, but no long-term studies prove that your face will still look good in 20 years. Weight changes and aging will keep reshaping your cheeks anyway. If you are thin, naturally narrow-faced or older, ask whether removal could leave you looking gaunt. Our guide to facial proportion and harmony explains what a surgeon looks at.

Questions to ask your surgeon

  • Is my cheek fullness from fat, from bone or muscle, or from weight? How do you tell?
  • How will my face look at 40 or 50 if I have this done now?
  • How much of the pad will you remove, and how do you protect the facial nerve and salivary duct?
  • What swelling, mouth-opening limits and food restrictions should I plan for, and for how long?
  • How many of these operations do you perform, and can I see unedited, dated results of patients my age?
  • What is the plan if I later feel my cheeks look too hollow? Removed fat is not simply put back.

For help judging whether a trend suits you, read our guides on the influencer trap, chin and lower-face balance and whether aesthetic surgery raises self-confidence.

Sources

All pages were opened and checked on 10 October 2026.

  • Rohrich RJ, Stuzin JM, Savetsky IL, Avashia YJ, Agrawal NA. The Role of the Buccal Fat Pad in Facial Aesthetic Surgery. Plastic and Reconstructive Surgery, 2021;148(2):334-338. PubMed 34398085.
  • Traboulsi-Garet B et al. Buccal fat pad excision for cheek refinement: A systematic review. Medicina Oral, Patologia Oral y Cirugia Bucal, 2021;26(4):e474-e481. PubMed 34023838.
  • Albuquerque MC et al. Prevalence of complications of buccal fat removal: A systematic review and meta-analysis. Journal of Cranio-Maxillo-Facial Surgery, 2025;53(4):363-369. PubMed 39809616.
  • Pimentel T et al. Management of Complications Related to Removal of the Buccal Fat Pad. Journal of Craniofacial Surgery, 2021;32(3):e238-e240. PubMed 32868718.
  • Kubo T. Buccal Fat Pad Excision for Facial Rejuvenation: The Relationship Between the Resected Position and Its Influence on Facial Shape and Volume. Aesthetic Surgery Journal Open Forum, 2023;5:ojad089. PubMed 38828091.
  • Yang CS et al. Aging Process of Lateral Facial Fat Compartments: A Retrospective Study. Aesthetic Surgery Journal, 2021;41(6):NP247-NP254. PubMed 33649752.