Buccal fat removal in Costa Rica: who it suits, and who it doesn't

Buccal fat removal takes out part of the buccal fat pads — two pads of fat inside the cheeks — from inside the mouth, under local anesthesia and with no scar on the skin. But it doesn't suit every face: in a slim face, or one that's already losing volume, it can make you look tired over the years. So I measure first and tell you honestly whether you're a candidate. I'm an oral and maxillofacial surgeon (UNAM, 2013), certified by the Mexican Board of Oral and Maxillofacial Surgery, and I see patients in Tower 1 of Hospital CIMA.

Anesthesia

Local, from inside the mouth

Scar

Inside the cheek; none on the skin

Result

1 to 3 months, in a small study

Consultation

60,000 colones · by video, 20,000

When it's indicated

• Full cheeks in the middle and lower face, from buccal fat confirmed at the exam.
• A face with enough volume to lose a little without looking hollow.
• A stable weight: if you're losing weight, your face is still going to change.
• Realistic expectations: slimming the cheek, not changing the shape of your face or bones.
• You bite the inside of your cheek repeatedly, and the cause isn't a tooth or your bite.

Before surgery

• If you have them, bring photos from a few years ago: they show how your face has changed.
• Bring a list of your medications. If you take blood thinners, don't stop them on your own: I coordinate with your doctor.
• If you're losing weight, it's better to wait until it stabilizes.
• If you smoke, stop before surgery and while you heal: tobacco slows healing.

How I plan it

How I do it

1. 01ConsultationAn exam, photos and a frank conversation about what you want, the risks and what isn't known long term. If it's not right for you, I'll tell you.
2. 02Local anesthesiaI numb the area inside each cheek. You feel pressure, but it should not hurt; if you feel anything, I add more anesthetic.
3. 03A small incision insideI locate where the parotid gland's saliva duct opens on the inner cheek and cut away from it. I separate the tissues gently, never cutting blindly.
4. 04Controlled removalI remove only the fat that comes out without forcing: pulling too hard puts nearby structures at risk and can leave the face hollow. I compare what comes out of each side.
5. 05Closing and instructionsDissolving stitches that fall out on their own. I give you written instructions, and you can message me while you recover.

Recovery

• Your cheeks swell, and at first your face may look fuller: that's swelling, not the result.
• In a small study (21 patients), painkiller use peaked in the first 24 hours and dropped clearly after 72 hours.
• Opening your mouth is harder at first; in that study, it was back to normal by one month.
• Cold packs on the outside for the first few hours, soft food, gentle rinses and medication on schedule.
• In that study, facial measurements changed between 1 and 3 months: the contour is judged once all the swelling is gone.
• At follow-up we compare with your before photos. If one cheek swells much more than the other, or the pain rises instead of easing, call the office.

Risks and how I prevent them

Swelling, pain and limited mouth opening

The most frequent, and they usually pass; I manage them with cold packs, painkillers and soft food. Counting them as complications, one review found a complication in about 25 out of 100 people; another, counting differently, in 4.2% of procedures, mostly minor.

Hematoma or seroma

Collected blood or fluid: 1.99% in one center using a standardized protocol. I control bleeding before closing; if one cheek swells more than the other, I see you promptly.

Asymmetry

It's reported. No face is perfectly symmetrical: I show you your differences in the photos before surgery and compare what I remove from each side.

Facial nerve or infection

Much less often, facial nerve paralysis or infection is reported. I separate the tissues without cutting blindly or pulling on the fat. If one side of your face doesn't move the same, call the office right away.

Parotid duct injury

Under-reported but possible; the authors who describe it consider it preventable. I prevent it by locating the duct opening and cutting away from it.

A gaunt look over the years

An important risk, and a poorly studied one: there's almost no long-term follow-up; one study reported a gaunt appearance in 1.6% of cases. I prevent it by choosing carefully whom to operate on and removing conservatively.

Other options

Not operating

A valid option and often the most prudent: with the years the face loses volume on its own, and a slim face doesn't need to lose more.

Treating what causes the fullness

If the cheek looks full because of the masseter muscle — from clenching your teeth, for example — your weight or your bones, buccal fat removal won't change it. We evaluate that separately.

If you bite your cheek

I check whether the cause is a sharp tooth, a filling or your bite: fixing that may be enough.

Frequently asked questions