Dr. Esin Özlem Atmış
Buccal Fat Removal (Cheek Slimming)
A conservative approach to cheek slimming through the inside of the mouth, planned with how your face will age in mind.
Facial surgery · Cheeks
Less fullness today, without a hollow face tomorrow.
Buccal fat removal, also called bichectomy or cheek reduction, removes part of the fat pads in the lower cheeks through a small incision inside the mouth. It can make the cheekbones and the area between the cheek and the jawline look more defined.1
Facial fat naturally decreases with age, so removing too much can leave a hollow or sunken look later in life.2 This is why patient selection and a conservative plan matter more here than in many other facial operations.
In short
- Small incisions inside the mouth, no visible scar.1
- Usually done under local anaesthesia; you go home the same day.1
- Liquid then soft diet for a few days; healing takes about three weeks; the final result takes several months.1
- Risks include nerve or salivary duct injury, asymmetry, numbness and over-removal.1,2
- Narrow faces and older patients are often poor candidates.1
Who it suits, and who it does not
Good candidates are usually healthy, have a stable weight and are bothered by fullness in the lower cheeks.1 Poor candidates include people with narrow faces and older patients, because buccal fat diminishes naturally with age.1
Is it really buccal fat? Round cheeks can also come from general facial fat, a strong chewing muscle (masseter) or the shape of the bone. Weight loss cannot target one area of the face, and buccal fat removal does not change muscle or bone.2
Thinking about how your face will age
The fat pads that make a face look full at 25 help to keep it from looking gaunt at 55. Because fat in the face decreases naturally over time, a cheek that looks ideal after aggressive removal can look hollow years later.2 For this reason the plan is conservative, and in some faces the honest advice is not to remove buccal fat at all.
In older faces, a full lower cheek is often descended tissue rather than excess fat; during a deep plane facelift, buccal fat that has bulged forward may be reduced conservatively as part of the lift.3
Before surgery: blood thinners, supplements and smoking
Bring a written list of every medicine, injection and supplement you take, including doses. The table shows what usually happens; it is not an instruction to stop anything yourself. Blood thinners protect against stroke and clots, so any pause is agreed with the doctor who prescribed them.4
| Medicine | What usually happens before planned surgery |
|---|---|
| Warfarin | Usually stopped about five days before surgery; some patients need a temporary heparin injection plan.4 |
| Apixaban, rivaroxaban, edoxaban, dabigatran | Usually paused one to two days before, depending on bleeding risk; dabigatran needs longer when kidney function is reduced.4 |
| Clopidogrel, ticagrelor, prasugrel | If the cardiologist agrees, usually stopped about 5, 3 to 5, and 7 to 10 days before respectively. After a recent coronary stent, planned surgery is often postponed.4 |
| Aspirin | Often continued when it is taken to protect the heart; the decision is individual and made with your prescribing doctor.4 |
| Ibuprofen, naproxen and similar painkillers | Increase bleeding and are usually avoided before surgery; paracetamol is the usual alternative.5 |
| Vitamin E, ginkgo, garlic, ginseng and other supplements | Can increase bleeding; usually stopped at least two weeks before, sometimes three.6,7 |
| Weight-loss or diabetes injections (GLP-1 medicines such as semaglutide or tirzepatide) | Most people can continue them, but the anaesthesia team must know. Surgery may be postponed during dose increases or if you have nausea or vomiting; some patients need a liquid diet for 24 hours before.8 |
Bleeding disorders. Tell us at the first contact if you have a diagnosed bleeding disorder (for example von Willebrand disease or haemophilia), a low platelet count, liver disease, or a history of unusual bleeding after tooth extractions, operations or with periods. Blood tests and a haematology opinion come before any surgical plan. Some people are better served by not having elective cosmetic surgery at all.
Blood pressure and diabetes. Poorly controlled blood pressure or diabetes increases the risk of a collection of blood under the skin (haematoma) and of poor healing; both should be well controlled before surgery.7
Smoking and nicotine. Stop all nicotine, including vapes, patches, gum and snus, at least three to six weeks before surgery and for three to six weeks afterwards. Nicotine narrows small blood vessels and raises the risk of wound problems and skin loss; if you relapse, tell us, because postponing is safer.9
The operation
A small incision is made inside the mouth on each side, the fat pad is gently pressed forward and the planned amount is removed; the incisions are closed, often with dissolving stitches. It is usually done under local anaesthesia; general anaesthesia is used when it is combined with other procedures.1
Recovery and risks
| Time | What is typical |
|---|---|
| First 1–2 days | Liquid diet, then soft food; a mouth rinse may be prescribed1 |
| A few days to a week | Return to normal activities when your surgeon agrees1 |
| About 3 weeks | Incisions healed; swelling, bruising and numbness fading1 |
| Several months | Final result visible1 |
Risks include infection, injury to facial nerve branches or the salivary duct, numbness or altered sensation, asymmetry (the two fat pads are not always the same size), bleeding and, in the longer term, a hollow look if too much fat is removed.1,2 Fat that has been removed cannot simply be put back, which is another reason for a conservative plan.
Travelling to Istanbul for buccal fat removal
Many patients travel from other cities or countries. A clear plan makes the trip calmer and safer:
- Online consultation first: most international patients start with an online consultation. Send your concern, your medical history, your medicines and a few clear photos through the channel the practice arranges, before you book flights.
- Arrive at least one day before surgery: the anaesthesia assessment and the final examination take place before the day of the operation.
- Hospital stay: usually a same-day procedure under local anaesthesia.
- Time in Istanbul: the stay is short; most people resume normal activities within a few days to a week.1 The exact number of days is confirmed after the consultation.
- Follow-up: reviews are planned at 1 month, 3 months, 6 months and 1 year. They can be done online if you live abroad; you will know whom to contact for urgent questions after you return home.
Dr. Atmış and cheek slimming
Op. Dr. Esin Özlem Atmış is an ENT and facial surgeon in Istanbul. She completed her specialist training in otorhinolaryngology at Ankara University Faculty of Medicine in 2014 and is a member of the Turkish Facial Plastic Surgery Association. She is one of the congress presidents of Face Bosphorus 3 (Istanbul, April 2026), a meeting on facial anatomy and medical practice. At Face Bosphorus 2025 she gave an opening talk and chaired sessions on the upper face and periorbital region, biostimulators and whole-face assessment; she was a listed speaker at Face Minima 2025, and at the 4th Congress of European ORL-HNS in Barcelona (2017) she chaired sessions that included facial anatomy. Details are on her scientific activities page.
Because she follows patients over years, she weighs today’s request against how the face is likely to change with age, and she often recommends removing less than first expected, or a different solution.
Her approach starts with understanding the concern before discussing an operation: what has changed, how it affects you, and which structures are actually responsible. The aim is a proportionate plan that keeps your expression and character, which sometimes means a smaller procedure, a different order of treatment, or no surgery. Besides Turkish, she speaks English and Italian.
Frequently asked questions
Will I look gaunt when I am older?
That is the main long-term risk if too much fat is removed, because facial fat decreases naturally with age.2 A conservative plan reduces it.
Will there be a scar?
No visible scar; the incisions are inside the mouth.1
When will I see the result?
Swelling hides the change at first; the final result takes several months.1
Can it be reversed?
Removed fat cannot simply be put back. Volume can be added later in other ways, but it is better to remove conservatively.
What can I eat afterwards?
Liquids for a day or two, then soft food as advised.1
Can it be combined with a facelift?
In older faces, fullness is more often descent than excess fat; during a facelift, bulging buccal fat may be reduced conservatively.3
Clinical references
- Cleveland Clinic. Buccal fat removal.
- Harvard Health Publishing. Buccal fat removal: what to know about cheek reduction surgery.
- Hohman MH, Raggio BS, Patel BC. Deep Plane Facelift. StatPearls, NCBI Bookshelf (updated 2026).
- Perioperative management of antithrombotic medications: guidelines from the American College of Chest Physicians (summary in Am Fam Physician, 2023).
- Mayo Clinic. Blepharoplasty.
- American Society of Anesthesiologists. Herbal and dietary supplements and anesthesia (patient leaflet).
- Mayo Clinic. Face-lift.
- American Society of Anesthesiologists. Multi-society guidance on GLP-1 receptor agonists before elective surgery (2024).
- American Society of Plastic Surgeons. How nicotine sabotages plastic surgery.
This page is general information, not a personal diagnosis or treatment recommendation. Medicines must never be stopped without the advice of the doctor who prescribed them. Seek urgent medical care for heavy bleeding, rapidly increasing swelling, breathing difficulty, chest pain or sudden vision changes after surgery.
Start with a careful, honest consultation.
A consultation is not a commitment to surgery. It is where your concern, your anatomy and your health are looked at together.