The buccal fat pad (Bichat's fat pad) is a deep, encapsulated lobe of fat in the cheek that sits between the buccinator and masseter muscles, with a main body and several extensions — buccal, pterygoid, pterygopalatine and temporal. In adults it measures roughly 9–10 mL and about 9–10 g per side. Its buccal extension is the part that contributes to lower-cheek fullness, and the part removed in "buccal fat removal".
Two facts frame everything else. First, most of what you see as cheek fullness is superficial fat, skin and bone, not this pad — which is why a photograph cannot tell you how large yours is. Second, the pad descends and changes with age, and no study has followed operated patients long enough to say what removal does to a face decades later.
Part of the SoftMaxx facial anatomy glossary — every term, one definition each.
1. What and where it is
The classic anatomical description comes from fresh-cadaver dissection: the pad's relationship to the masticatory space, the facial nerve and the parotid duct was mapped, and the authors noted that "in properly selected individuals, judicious harvesting of buccal fat can produce dramatic changes in facial appearance by reducing the fullness of the cheek and highlighting the malar eminences" (Stuzin and colleagues, 1990, Plastic and Reconstructive Surgery). A later dissection of 22 sides described three lobes — anterior, intermediate and posterior — fixed by six ligaments, functioning as a gliding pad during chewing (Zhang and colleagues, 2002, PRS).
It is deep. The facial nerve's buccal branches and the parotid duct run over or through its territory, which is why its removal is a surgical procedure with a defined complication profile and not a cosmetic tweak.
2. How big it is
The best-verified size data come from 80 adult cadavers plus 20 imaged by CT and MRI: "The mean volume in males was 10.2 ml and ranged 7.8–11.2 ml, while in females the mean volume was 8.9 ml and ranged 7.2–10.8 ml. Additionally, the mean thickness was 6 mm, with a mean weight of 9.7 g" (Loukas and colleagues, 2006, Surgical and Radiologic Anatomy). The 1990 study is usually quoted for an average weight of 9.3 g; that figure reaches us second-hand, and a commonly repeated 9.6 mL volume attributed to the same paper could not be verified, so we cite Loukas for size.
For scale: the entire pad is about two teaspoons. The surgery removes a fraction of it.
3. How it changes with age
The pad does not simply shrink. A CT study of cadaver heads aged 54–75 versus 75–104 found "inferior migration of the midfacial fat compartments and an inferior volume shift within the compartments", with volume loss specifically in the deep medial cheek fat and the buccal extension of the buccal fat pad — and established that extension as an independent compartment (Gierloff and colleagues, 2012, PRS).
A 2026 scoping review summarises the lifespan picture: the pad "is likely to increase between childhood and adulthood and may not begin to decrease until after the age of 60 or 70", and "vertical descent of the BFP and pseudo-herniation of the buccal extension is the natural progression of aging" (Bellity, Pechevy and Carloni, 2026, Aesthetic Plastic Surgery). In plain terms: with age the pad sags downward and its lower extension bulges, which is why some older faces develop lower-cheek fullness even as the midface hollows.
4. What removal actually does — the measured numbers
Two systematic reviews and one prospective series put numbers on the operation. Across four studies and 134 procedures, the pooled volume reduction was 3.10 mL (95% CI 2.38–3.80), the mean excised tissue was 2.74 ± 0.69 mL, and 84.6% of patients said their contour was "much better" (Traboulsi-Garet and colleagues, 2021, Medicina Oral, Patología Oral y Cirugía Bucal). In 30 patients measured by 3D imaging, the excised pad weighed 1.74 ± 0.72 g on the right and 1.59 ± 0.71 g on the left, and lower-face volume fell from 209.4 to 205.0 mL — about a 2% change (Kubo, 2022, Aesthetic Surgery Journal Open Forum).
Complications: one review of 71 patients found 8.45% minor complications with no parotid-duct or facial-nerve injuries (Moura and colleagues, 2018); a 2025 meta-analysis of 12 studies and 308 patients found an overall complication prevalence of 25% (95% CI 4–46%), mostly transient — oedema 38% of complications, trismus 30%, pain 19%, asymmetry 12%, facial nerve paralysis 0.97% (Albuquerque and colleagues, 2025, Journal of Cranio-Maxillofacial Surgery). The wide confidence interval is the honest summary: the rate depends heavily on which studies you pool.
We describe the procedure; we do not recommend for or against it. That decision belongs with a qualified surgeon who can examine the actual pad.
5. The premature-ageing question
The concern that removing buccal fat makes a face look older sooner comes from the anatomy above — the pad's extension loses volume and descends with age, so removing it early may pre-empt a hollowing that would have arrived anyway. The most-cited statement of the worry is an editorial by senior plastic surgeons: "Although this procedure is great for social media and seemingly beneficial for jawline aesthetics, the evidence remains limited as to whether or not this is an effective long-term solution", and "the possibility of causing premature aging and midface distortion in the long run is disconcerting" (Rohrich, Stuzin and colleagues, 2021, PRS).
It is important to be precise about what that is: expert opinion built on anatomical reasoning, not a measured outcome. The reason it cannot be more than opinion is the state of the evidence. A 2018 review found that of 121 citations on the topic, only two case series of more than five patients addressed aesthetic excision, and that "follow-up regarding loss of subcutaneous fat with aging and late secondary deformities have not been published" (Benjamin and Reish, 2018, PRS Global Open). The 2021 systematic review "was unable to identify a single observational study with long-term patient follow-up data". Nobody has measured the 20-year result. Both the reassurance and the alarm you will read online are running ahead of the data.
6. What cheek fullness does not tell you
- How large your buccal fat pad is. The pad is ~9–10 mL, deep to the masseter and buccinator; surgeons remove ~2–3 mL for a ~2% change in lower-face volume. Most visible fullness is superficial fat, skin and bone, and no photograph — including our scan — can separate them.
- What removal will do to your face in 20 years. Every systematic review reports zero long-term follow-up. The premature-ageing warning is anatomical reasoning, not measured outcome.
- A single "normal" size. Verified adult volumes span 7.2–11.2 mL, the pad grows into adulthood and may not shrink until the 60s or 70s, and complication estimates range from 8% to 25% depending on the studies pooled.
Related: gonial angle and jawline, facial thirds and fifths, facial width-to-height ratio. What SoftMaxx can and cannot measure from a photo is on the methodology page.
7. Sources
- Stuzin JM et al. (1990). The anatomy and clinical applications of the buccal fat pad. Plast Reconstr Surg 85(1):29–37. doi:10.1097/00006534-199001000-00006
- Zhang HM et al. (2002). Anatomical structure of the buccal fat pad and its clinical adaptations. Plast Reconstr Surg 109(7):2509–18. doi:10.1097/00006534-200206000-00052
- Loukas M et al. (2006). Gross anatomical, CT and MRI analyses of the buccal fat pad with special emphasis on volumetric variations. Surg Radiol Anat 28:254–60. doi:10.1007/s00276-006-0092-1
- Gierloff M et al. (2012). Aging changes of the midfacial fat compartments: a computed tomographic study. Plast Reconstr Surg 129(1):263–73. doi:10.1097/PRS.0b013e3182362b96
- Bellity P, Pechevy L, Carloni R (2026). How does the buccal fat pad age and how can it be managed in facelift surgery? A scoping review. Aesthetic Plast Surg. doi:10.1007/s00266-025-05300-1
- Rohrich RJ, Stuzin JM et al. (2021). The role of the buccal fat pad in facial aesthetic surgery. Plast Reconstr Surg 148(2):334–8. doi:10.1097/PRS.0000000000008230
- Benjamin M, Reish RG (2018). Buccal fat pad excision: proceed with caution. Plast Reconstr Surg Glob Open 6(10):e1970. doi:10.1097/GOX.0000000000001970
- Moura LB et al. (2018). Buccal fat pad removal to improve facial aesthetics: an established technique? Med Oral Patol Oral Cir Bucal. doi:10.4317/medoral.22449
- Traboulsi-Garet B et al. (2021). Buccal fat pad excision for cheek refinement: a systematic review. Med Oral Patol Oral Cir Bucal. doi:10.4317/medoral.24335
- Albuquerque MC et al. (2025). Prevalence of complications of buccal fat removal: a systematic review and meta-analysis. J Craniomaxillofac Surg. doi:10.1016/j.jcms.2024.12.014
- Kubo T (2022). Aesthetic values of the buccal fat pad excision in middle-aged patients. Aesthet Surg J Open Forum 4:ojac015. doi:10.1093/asjof/ojac015
8. Common questions
What is the buccal fat pad?
A deep, encapsulated lobe of fat in the cheek between the buccinator and masseter muscles, with a main body and buccal, pterygoid, pterygopalatine and temporal extensions. About 9–10 mL and 9–10 g per side in adults.
Does buccal fat go away with age?
Not simply. It grows into adulthood, may not start shrinking until the 60s or 70s, and with age it descends and its lower extension bulges, while the deep medial cheek fat loses volume.
How much fat is removed in buccal fat removal?
About 2–3 mL, or roughly 1.5–2 g per side, out of a pad of 9–10 mL — a measured change of about 2% in lower-face volume in one 3D-imaging series.
Does buccal fat removal cause premature aging?
Unknown. The concern is a reasoned expert opinion based on how the pad descends with age; no study has followed operated patients long term, so neither the alarm nor the reassurance is backed by measurement.
Can a face scan measure buccal fat?
No. The pad sits deep to muscle; photographs — and photo-based apps, including ours — see surface fullness, which is mostly superficial fat, skin and bone.