Before Buccal Fat Removal: Is It Fat or Sagging?
Fullness beside the mouth can make the face look wider, prompting many people to consider buccal fat removal. But what looks like buccal fat is often a combination of deep fat, fat just beneath the skin, and sagging tissue. Whether to reduce volume or lift it depends on the main cause.
Where exactly is buccal fat?
The buccal fat pad lies deep in the cheek, beneath the cheekbone and within the cheek musculature. Buccal fat removal is surgery that removes part of this fat through an incision inside the mouth.
Subcutaneous fat, directly beneath the skin, sits in a different layer. Anatomical studies show that facial subcutaneous fat is divided into separate compartments rather than forming one continuous mass; jowl fat occupies the lowest of these. The researchers explain that each compartment ages differently. When patients ask, “Should I have buccal fat removed?”, we first need to establish which layer is responsible for their fullness.
How is buccal fat different from jowls?
Jowls are the bulges that hang beside the corners of the mouth, just above the jawline. A dissection study of 49 cadavers located their origin in the subcutaneous layer. The tissues beside the mouth need to move freely so the mouth can open wide. With age, the connective tissue that was once short and elastic stretches, leaving excess skin and subcutaneous tissue that form a jowl. Jowls are one area that often responds well to ONDA because heat can be concentrated in the fat beside the mouth. These three cheek concerns involve different layers and need different approaches.
| Category | Buccal fat | Jowls | Sagging cheeks |
|---|---|---|---|
| Location | Deep in the central cheek, below the cheekbone | Beside the mouth, above the jawline | Throughout the cheeks and lower face |
| Layer involved | Deep fat within the cheek musculature | Subcutaneous fat and stretched connective tissue | Skin, connective tissue, and fascia |
| When it becomes noticeable | Rounded cheeks present from a young age | As connective tissue stretches with age | With aging and weight changes |
| Common approaches | Surgical fat removal | Heating the fat layer and lifting | Lifting and muscle strengthening |
How does buccal fat change with age?
A review of midface aging describes how cheek fat compartments descend and the cheek portion of the buccal fat pad changes in volume, making aging more apparent. Another study reported age-related changes in buccal fat volume and position that contribute to a hollow midface.
For that reason, we do not recommend removing large amounts of deep fat simply because your cheeks look full now. It may leave them looking hollow later. Keep this in mind before deciding on surgery.
Is cheek fullness fat or sagging?
If your cheek shape changes considerably between sitting and lying down, sagging likely plays a larger part. If the central cheek stays rounded in either position, fat is more likely the main factor. Most patients have a mix of both, so we assess skin thickness, fat volume, and where tissue has descended. Treating all cheek fullness as excess fat can miss the real cause: when sagging is involved, improving the contour also means improving firmness.
Can cheek fullness improve without buccal fat surgery?
When subcutaneous fat and sagging are the main causes, nonsurgical treatment can improve the contour. Microwave treatment at 2.45 GHz cools the epidermis while heating the dermis and fat layer to reduce fat cells and encourage new collagen. In a study of 10 women with submental skin laxity, two treatments 30 days apart reduced the mean laxity score from 3.6 to 2.3 at 12 weeks, with no reported adverse effects. In practice, this approach often works well for patients with both sagging cheeks and a double chin, particularly when pain and downtime are concerns.
When weakened supporting muscles contribute to sagging, muscle treatment can help. Combining electrical muscle stimulation with radiofrequency strengthens muscle and encourages collagen production. We generally recommend four sessions 1–2 weeks apart, extending to six when more firmness is needed. One patient who completed four EMFACE sessions told us their whole face felt firmer.
How does Dong-An Joongsim Clinic treat cheek fullness and sagging?
At Dong-An Joongsim Clinic, a doctor personally provides your consultation and treatment. We first identify the tissue layer responsible for your concern, then choose the approach.
ONDA skin tightening is provided under the care of Dr. Soyoun Koo, recognized by El.En and DEKA as Korea's first ONDA LIFTING EXPERT MEMBER. She assesses skin thickness, fat volume, and where sagging occurs before choosing how to use the 3 mm and 7 mm handpieces on the cheeks, jowls, lower face, and double chin. When muscle weakness is involved, we may add EMFACE. A doctor examines your facial shape and muscle anatomy to set the treatment areas and intensity. One patient said they felt reassured that the doctor assessed them and set the device personally, and noticed a lift beneath the cheekbones and along the jawline. BTL Asia presented the clinic with a plaque marking 1,000 EMFACE cases. To compare ONDA with radiofrequency and ultrasound, see our ONDA comparison guide for details.
What should you know before treatment?
Fat reduction and contour changes vary with fat volume, skin thickness, and the degree of sagging. If the deep buccal fat pad itself is large, surgery may be more suitable than nonsurgical lifting, and we will tell you so at your consultation. ONDA is not suitable for people with cardiovascular, liver, or kidney disease, people undergoing tumor treatment, or those who are pregnant or breastfeeding. EMFACE is not suitable for people with pacemakers or metal implants.
Buccal fat and jowls: common questions
What should I look for when booking a buccal fat consultation in Apgujeong, Gangnam, Seoul?
Check whether a doctor personally determines if the fullness comes from deep fat or sagging. At Dong-An Joongsim Clinic, near Exit 5 of Apgujeong Rodeo Station, a doctor handles both your consultation and treatment.
How does buccal fat surgery differ from ONDA?
Buccal fat removal surgically reduces deep fat within the cheek musculature. ONDA delivers heat to the subcutaneous fat and dermis without an incision to reduce fat and improve firmness.
Will reducing cheek fat make my face sag more?
Besides reducing fat, the microwave treatment heats the dermis, which helps stimulate new collagen. If the face needs more support, your doctor may add muscle treatment to the plan.
When will I see results?
With ONDA, you may notice firmer skin right away, followed by a gradual improvement in contour as fat reduces. With EMFACE, changes peak around 3 months after a course of four sessions.
References
- Rohrich RJ et al., “The fat compartments of the face: anatomy and clinical implications for cosmetic surgery”, Plastic and Reconstructive Surgery, 2007. https://doi.org/10.1097/01.prs.0000265403.66886.54
- Minelli L et al., “The Surgical Anatomy of the Jowl and the Mandibular Ligament Reassessed”, Aesthetic Plastic Surgery, 2023. https://doi.org/10.1007/s00266-022-02996-3
- Ugradar S et al., “A Review of Midface Aging”, Ophthalmic Plastic and Reconstructive Surgery, 2023. https://doi.org/10.1097/IOP.0000000000002282
- Zhu C et al., “Buccal Fat Pad Augmentation for Midfacial Rejuvenation: Modified Fat Grafting Technique and Ogee Line Remodeling”, Aesthetic Surgery Journal, 2024. https://doi.org/10.1093/asj/sjad214
- Zappia E et al., “An innovative microwave technology for the treatment of submental skin laxity”, Lasers in Medical Science, 2025. https://doi.org/10.1007/s10103-024-04270-1