Buccal fat removal is one of those procedures patients arrive already knowing about, usually from a feed full of newly sculpted celebrity cheekbones.
What the feed does not show is the sorting that happens before Dr. Frank Agullo agrees to do it. “The mistake is doing it on somebody who does not really have the fullness,” he says. “If you are thin there already, taking it out will only hollow you as you age. So I look first, and I am honest about whether it will help you.”
At Southwest Plastic Surgery, the procedure lives inside a bigger system: surgical slimming in front, med spa tools behind, and aftercare that protects the result. Here is how the pieces fit.
The Face That Benefits
The right candidate has a genuinely round face with real fullness in the lower cheeks. Removing a portion of the buccal fat pad brings out the cheekbones and turns roundness into a triangular, sculpted shape.
The wrong candidate is already lean in the cheek. For that face, Dr. Agullo declines the procedure, because the roundness the internet wants to remove is the reserve that keeps a face looking young later.
On the aging question patients always raise: the buccal pad is not structural fat. Even in older patients, filler goes high on the cheekbone, never down in the buccal area. Removing lower-cheek fullness does not remove support.
A Procedure Measured in Minutes
Everything happens inside the mouth through two centimeter-long incisions, so there is no visible scar. The procedure takes under thirty minutes, under local anesthesia or light sedation, and patients go home the same day.
| Recovery Milestone | Timing |
|---|---|
| Swelling like wisdom-tooth removal | Day 1 |
| Peak swelling | Day 3 |
| Looks normal to others | Day 6 to 7 |
| Back to normal | About 2 weeks |
| Incisions healed | About 5 days |
Soft food at first, ice, sleeping propped up, and no workouts for a week. Patients planning around an event book six weeks ahead so the photos capture the result, not the recovery.
The Med Spa Half of the Triangle
Buccal removal narrows the front of the cheek. The back half of the slimming, at the angle of the jaw, belongs to masseter Botox at the Southwest Plastic Surgery Med Spa.
The masseter is the chewing muscle, and relaxing it lets the jaw narrow over about six weeks, a different timetable than forehead Botox because the effect comes from muscle shrinking rather than lines relaxing. The two treatments together build the triangle patients are actually asking for: buccal in front, slimmer jaw shadow behind. The med spa’s rotating monthly specials are worth checking before booking the pairing.
For patients who want a more dramatic change, Dr. Agullo adds liposuction of the lower face and neck through a tiny incision behind the ear, sharpening the jawline in the same sitting.
The Aftercare That Prevents the Horror Stories
The cord-like lines patients have seen online are fibrosis, and they come from two errors: over-removal and skipped aftercare.
Dr. Agullo’s protocol addresses both. He deliberately leaves fat behind rather than maximizing the removal, and he insists on lymphatic massages afterward, performed in the office. The massages clear fluid so the cheek heals smooth. “Skip them and you invite the very problem people are afraid of,” he says.
Two reassurances that come up in nearly every consultation: dimples stay, and the cheekbone fullness above is never touched.
The Surgeon Behind the Sorting
Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas: double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, a Mayo Clinic plastic surgery fellowship alum, and a Castle Connolly Top Doctor for thirteen consecutive years.
He treats the face as one connected unit, buccal pad, masseter, jawline, and neck together, and he treats candidate selection as the procedure’s most important step. The patients he turns away are as much a part of the results as the ones he operates on.
For his editorial take, read the companion piece on drworldwide.com. For the clinical Q&A, see agulloplasticsurgery.com.
Ready to Talk?
If your lower face has always been rounder than you would like, schedule a consultation at Southwest Plastic Surgery and get an honest answer about whether buccal fat removal is right for your face. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
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