Young people risk permanent disfigurement by having fat removed from their cheeks surgically, leading cosmetic surgeons have warned.
The irreversible op is sold as a way to accentuate the cheekbones and jawline, giving a taut, chiseled look. But removing this tissue – called oral fat – can damage nerves and delicate glands under the skin, causing severe, long-term paralysis and swelling.
Experts say that while early results may be pleasing, patients will eventually look older before their time, as the lack of tissue in the face causes the skin to sag and wrinkle – and some have to rely on regular filler injections to restore volume to their cheeks. .
“We’re going to end up with hordes of patients who look a lot older than they are because they had facial surgery for fashion reasons,” says consultant plastic surgeon Dr. Monica Fawzy. in head and neck procedures.
Google search analysis shows demand for oral fat removal has increased 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: Model Bella Hadid, left in 2014 aged 17 and right in 2020 aged 23, who is believed to have had oral fat surgery
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 had the procedure and was happy with the results. Hadid, 26, has never commented, but online beauty forums are awash with speculation that she has also undergone buccal fat removal.
A growing number of cosmetic clinics in the UK are offering the 45 minute buccal fat removal procedure, charging between £2,000 and £4,000. But in a statement to be released tomorrow, the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) will “urge caution”.
The alert will highlight the ‘significant risks’ of the ‘social media craze’, including nerve damage and perforation of the salivary gland in the cheek.
BAPRAS spokesperson Dr Fawzy said: ‘There’s a lot of potential harm and very little benefit, so it’s odd that more women are asking for it.
“Operating too close to the facial nerve can lead to paralysis, so it is essential that it is done by experts in facial anatomy.
“But many have little experience working with the face, so patients end up having complications.”
Dr. Tijion Esho, owner of cosmetics 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 a patchy appearance because too much fat was removed from one side.
Buccal fat is found on both sides of the face between the cheekbone and the cheeks, under a major facial muscle called the buccinator muscle. Most clinics perform minimally invasive surgery under local anesthesia. A small incision is made inside the mouth, through which surgeons access the buccal fat. A portion of tissue, about the size of a marshmallow, is cut and the wound is repaired with dissolvable stitches. Patients can usually go home in less than an hour.
According to UK medical law, any type of doctor can perform cosmetic surgery, regardless of their experience. And even if buccal fat removal is done perfectly, patients can still develop signs of aging prematurely, says Dr. Fawzy. “Buccal fat protects against the first signs of aging, because it keeps the face volume, which looks young.”
Singer Liam Payne, who left in 2019 aged 25, right in March aged 29, is said to have had the op
She explains that as we age, a combination of factors, including a natural reduction in fat and thinning of facial bones and ligaments, all lead to loss of volume and sagging of the face.
“The less fat in the face, the harder it is to hide it, so you end up with a gaunt, droopy look years and years sooner than you naturally would have.” Patients whose treatment has gone wrong have taken to online forums to warn others.
One woman, writing a month after her procedure, said it left her with paralysis on the left side of her face.
“I wake up with a wet pillow, a stiff right jaw and a swollen face,” she wrote on cosmetic surgery review site, RealSelf. “It is almost impossible to [drink through a] straw.’
She added that she sometimes had to open her mouth with a spoon to eat.
Another 22-year-old said the procedure was “the worst mistake of my life”. She said: “Now I have two bumps under my cheekbones. I’m trying to fix it with cheek implants, but I have to travel to another country for that. Please think before you do this – that fat will never come back.
Another wrote: “Six months later I noticed the mid/lower part of my face had sunken. My lower face was sagging. My face is ruined.
Cosmetic surgeons have been performing buccal fat removal procedures since the 1930s, to slim down rounder faces.
“It’s been around for a long time, but its popularity has really exploded in the past year since celebrities and influencers started talking about it on social media,” says Dr Esho.
Traditionally, cosmetic surgery fashions have been mostly popular with women, but oral fat removal seems to be one of the few that bucks this trend. The op’s popularity among men is said to be rooted in an online subculture of men who identify as “incels”, short for “involuntary celibacy”. Discussions on chat rooms often revolve around ideas that men who don’t look classic masculine – with a chiseled jawline – don’t attract women.
In 2020, videos featuring young men performing specific tongue “exercises” believed to accentuate the jawline went viral on social media. The craze, known as ‘mewing’, can improve certain facial muscles, advocates say – but also risks causing jaw misalignment that could ultimately damage teeth.
And in November, a Channel 4 documentary on the subculture revealed that some of these men were hitting themselves in the face with hammers in the mistaken belief that it would stimulate bone growth and change their appearance.
One of the most striking chiseled transformations was seen in former One Direction popstar Liam Payne, who stunned fans in March with his new look. Reports surfaced speculating the 29-year-old had undergone buccal fat removal, although he did not comment.
Photo filters on apps such as Instagram and TikTok are also influential, altering the face to have angular cheekbones.
“Everyone wants the perfect taut look – where the skin is super tight, bringing out the cheekbones and jawline,” 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 that they need some relaxation of the face to be able to move it properly.
London clinics offering the surgery say side effects are limited to ‘sore cheeks for a week’ and ‘temporary swelling’ – and there is no scarring. But Dr Fawzy says it’s far from the complete 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 must be extremely careful not to touch any of the major facial nerves that run through the cheek or a gland that drains saliva from the cheeks into the mouth.
“If this happens, patients could suffer permanent damage to these structures, leading to facial paralysis or extreme swelling due to saliva buildup. If the gland is damaged – which I have seen with this procedure – patients need another operation to fix it.
A review article published last year suggested that complications, including paralysis and infections, occur in up to one in five patients.
Doctors have also sounded the alarm about the growing popularity of another procedure for removing cheek fat – fat-dissolving injections. These jabs contain high concentrations of acid which destroy fat cells.
Clinics selling the treatment – which costs between £200 and £2,000 for a course of three – claim the slimming effect is permanent. But the injections can leave areas of the face asymmetrical and there is a high risk of facial nerve damage, experts say.
“It’s hard to target specific areas because the product spreads, so the fat often ends up lumpy and uneven,” says Dr. Esho. “And if you inject into the wrong area, where the facial nerves are, you can cause potentially life-threatening damage.”
Medical training is not required to perform non-surgical procedures, which is one of the reasons mistakes are common. About two-thirds of botched cosmetic procedures are performed by beauticians, according to a survey by the British College of Aesthetic Medicine.
The BAPRAS warning follows the government’s rejection in February of calls by MPs to impose stricter regulations on non-surgical cosmetic procedures, including fat-dissolving injections.
Ministers failed to respond to requests from the Health and Social Care Committee, which produced a report calling for the introduction of a licensing system by August this year.
In an official response, the government said it had missed the recommended deadline due to the work required, but would soon publish plans for the program’s implementation.
Steve Brine, Tory MP for Winchester and chairman of the committee, said: ‘The delay puts people at risk of exploitation. We urge the government to publish the regulations now.