Young people are risking permanent disfigurement by having fat surgically removed from their cheeks, leading cosmetic surgeons have warned.
The irreversible op is sold as a way to accentuate the cheekbones and jawline, giving a taut, chiselled look. But removing this tissue – called buccal fat – can damage the delicate nerves and glands under the skin, causing paralysis and severe, long-term swelling.
Experts say that while the initial results may be pleasing, patients will end up looking older before their time as the lack of tissue in the face causes skin to droop and wrinkle – and some have to rely on regular filler injections to restore volume in their cheeks.
‘We’re going to end up with hordes of patients who look much older than they are because they’ve had facial surgery for fashion reasons,’ says Dr Monica Fawzy, a consultant plastic surgeon specialising in head and neck procedures.
Google search analysis show that demand for buccal fat removal has risen at least 30-fold since December, with women seeking to emulate the angular facial appearance of supermodels such as Bella Hadid and Chrissy Teigen.
SCULPTED: Supermodel Bella Hadid, left in 2014 aged 17 and right in 2020 at 23, who is rumoured to have had the buccal fat operation
In late 2021, former Victoria’s Secret ‘angel’ Teigen, 37, who is married to popstar John Legend, told her 42 million Instagram followers that she’d undergone the procedure and was happy with the results. Hadid, 26, has never commented but beauty forums online are awash with speculation that she also had buccal fat removal.
Growing numbers of UK cosmetic treatment clinics offer the 45-minute buccal fat removal procedure, charging between £2,000 and £4,000. But in a statement to be published tomorrow, the British Association For Plastic, Reconstructive And Aesthetic Surgeons (BAPRAS) will ‘urge caution’.
The alert will stress the ‘significant risks’ of the ‘social media craze’, including nerve damage and puncturing of the salivary gland in the cheek.
BAPRAS spokesperson Dr Fawzy says: ‘There are lots of potential harms and very little benefit, so it is bizarre that more women are asking for it.
‘Operating too close to the facial nerve can lead to paralysis, so it is vital that it is done by experts in facial anatomy.
‘But many have little experience of working with the face, so patients end up with complications.’
Dr Tijion Esho, owner of cosmetic treatment franchise The Esho Clinic, adds: ‘Unfortunately many people go to inexperienced clinicians because they are cheap. More often than not they end up with nasty infections or an uneven look because too much fat has been removed from one side.’
Buccal fat sits in both sides of the face between the cheekbone and cheeks, underneath a major facial muscle called the buccinator muscle. Most clinics perform the minimally invasive surgery using local anaesthetic. A small incision is made inside the mouth, through which surgeons access the buccal fat. A portion of tissue, roughly the size of a marshmallow, is cut away and the wound is repaired with dissolvable stitches. Patients can usually go home within an hour.
Any type of doctor is able to perform cosmetic surgery, according to UK medical law, regardless of their experience. And even if buccal fat removal is carried out perfectly, patients can still develop signs of ageing prematurely, says Dr Fawzy. ‘Buccal fat protects against the early signs of ageing, because it keeps volume in the face, which looks youthful.’
Singer Liam Payne, left in 2019 aged 25, right in March aged 29, is rumoured to have had the op
She explains that, as we get older, a combination of factors, including a natural reduction in fat, and thinning of the facial bones and ligaments, all cause the face to lose volume and sag.
‘The less fat there is in the face, the harder it is to disguise this, so you end up with a gaunt, drooping look years and years earlier than you would have done naturally.’ Patients whose treatment has gone wrong have taken to online forums to warn others.
One woman, writing a month after her procedure, said that it had caused paralysis on the left side of her face.
‘I wake up with a drooled wet pillow, stiff right jaw and a swollen face,’ she wrote on the cosmetic surgery review site, RealSelf. ‘It’s nearly impossible to [drink through a] straw.’
She added that she sometimes has to prize her mouth open with a spoon to eat.
Another 22-year-old woman declared the procedure was ‘the worst mistake of my life’. She said: ‘Now I have two dents under my cheekbones. I’m trying to fix it with cheek implants, but I have to travel to another country for this. Please think before doing this surgery – this fat will never come back.’
Another wrote: ‘Six months in I noticed the middle/lower part of my face has sunken in. My lower face is sagging. My face is ruined.’
Cosmetic surgeons have performed buccal fat removal procedures since the 1930s, to slim rounder faces.
‘It’s been around for a long time but the popularity has really exploded over the past year, since celebrities and influencers started posting about it on social media,’ says Dr Esho.
Traditionally, cosmetic surgery fads are mostly popular with women, but buccal fat removal appears to be one of the few to buck this trend. The popularity of the op among men is said to be rooted in an online subculture of males who identify as ‘incels’, short for ‘involuntary celibacy’. Discussions on chat forums often revolve around ideas that men who don’t look classically masculine – with a chiselled jaw – fail to attract women.
In 2020, videos featuring young men performing specific tongue ‘exercises’ said to accentuate the jawline went viral on social media. The craze, known as ‘mewing’, can enhance certain facial muscles, claim advocates – but also risks causing jaw misalignment which could ultimately damage the teeth.
And in November, a Channel 4 documentary about the subculture revealed that some of these men were hitting themselves in the face with hammers in the misguided belief that it would stimulate bone growth and change their looks.
One of the most striking chiselled transformations was seen in former One Direction popstar Liam Payne, who stunned fans in March with his new look. Reports surfaced speculating whether the 29-year-old had undergone buccal fat removal, although he has not commented.
Photo filters on apps such as Instagram and TikTok also have an influence, altering the face to have angular cheekbones.
‘Everyone wants a perfect taut look – where the skin is super tight, making the cheekbones and jawline prominent,’ says Dr Esho. ‘But this aesthetic is only a reality on social media, where you can edit images to remove bits of loose skin or fat from the face. I tell patients they need some laxity in the face to be able to move it properly.’
London clinics offering the surgery say the side effects are limited to ‘sore cheeks for a week’ and ‘temporary swelling’ – and it is scar-free. But Dr Fawzy says this is far from the full picture.
‘A lot of patients who come to me saying they want the procedure are put off as soon as I tell them the facts. Surgeons have to be extremely careful not to touch one of the main facial nerves that runs through the cheek or a gland that drains saliva from the cheeks into the mouth.
‘If this happens, patients could end up with permanent damage to these structures, resulting in paralysis of the face or extreme swelling from a build up of saliva. If the gland is damaged – which I have seen with this procedure – patients need another operation to repair it.’
One review paper published last year suggested that complications, including paralysis and infections, occur in up to one in five patients.
Doctors have also raised the alarm about the increasing popularity of another procedure to remove fat from the cheeks – fat-dissolving injections. These jabs contain high concentrations of acid which destroy fat cells.
Clinics selling the treatment – which costs anywhere from £200 to £2,000 for a course of three – claim that the slimming effect is permanent. But the injections can leave the areas of the face asymmetrical and there is a high risk of damage to facial nerves, experts say.
‘It’s difficult to target specific areas because the product spreads, so the fat often ends up bumpy and uneven,’ says Dr Esho. ‘And if you inject in the wrong area, where the facial nerves are, you can do potentially life-changing damage.’
Medical training is not required to carry out non-surgical procedures, which is one reason why errors are common. Around two thirds of botched cosmetic procedures are done by beauticians, according to a survey by The British College of Aesthetic Medicine.
The BAPRAS warning follows the Government’s rejection in February of MPs’ calls to place tougher regulation on non-surgical cosmetic procedures – including fat dissolving injections.
Ministers failed to meet the demands of the Health and Social Care Committee, which produced a report calling for a licensing scheme to be introduced by August this year.
In an official response, the Government said that it failed to meet the recommended timeframe because of the work required but will soon publish plans for delivering the scheme.
Steve Brine, Conservative MP for Winchester and chairman of the committee, said: ‘The delay leaves people at risk of exploitation. We urge the Government to deliver the regulation now.’