You know that face you get when you taste something sour, or you suck on a lemon, or you’re Angelina Jolie’s Maleficent and are minutes away from turning into a dragon with incredible cheekbones? That puckered, sharp face is the desired end result from the internet’s current viral plastic surgery procedure: buccal fat pad removal.
While the plastic surgery procedure has been around for at least 45 years, it’s gone viral on Twitter as part of larger speculation about what celebrities can attribute their glow-ups directly to surgeons. Actresses like Chrissy Teigen have been vocal about having the procedure and documenting the results, and on TikTok, hundreds of videos showing people’s trips have blown up, with the comments section inundated with recommendations, healing times, and other procedures that can be done at the same time. In less than a month, the surgery’s fast climb online took the discourse from procedure speculation to buzzword, to full-on meme. But are people obsessed with the procedure because they want to emulate it, or because it represents another ever-changing, unattainable ideal?
So what is buccal (pronounced ‘buckle’) fat? According to Dr. Konstantin Vasyukevich, a double-board certified plastic surgeon, buccal fat is a pouch of, well, fat, in your face that maintains volume in your cheeks and prevents layers of muscle and sinew from grinding on one another. Unlike the name implies, buccal fat removal surgery does not completely remove the fat pad. Dr. Vasyukevich tells Rolling Stone the surgery only involves removing a portion of the pad, leaving the rest to do its job of protecting your face from friction.
“Buccal fat removal can slim the lower part of the cheek, so people going after that look want a fairly high and prominent upper part of the cheek and slightly hollow lower part of the cheek,” Dr. Vasyukevich says. “This sort of look is very prominent if you look through fashion magazines.”
The surgery is 20 to 40 minutes long and is minimally invasive, as it only requires a small incision on the inside of your cheek. Recovery time is brief and patients usually only experience facial swelling after the surgery, which can cost anywhere from $2,000 to $15,000.
Dr. David Shafer, a Mayo clinic trained and board-certified plastic surgeon, says while buccal fat removal is popular for its instant results, a sudden influx of patients who do not seek a highly qualified doctor can make the surgery riskier.
“In the past, there wasn’t as much exposure to patients about what procedures were even available. And now online, people are seeing what’s available,” Dr. Shaffer says. “There are lots of doctors posting dramatic pictures. But there’s still risk. The face has a lot of nerves [that] help you move your smile, make you animated, lift your eyebrows and there’s always a chance of nerve or vessel injury. So you don’t want to choose a surgeon based on price and you don’t want to choose a surgeon based on their Instagram followers because they may not be a well qualified surgeon.”
Much of the online backlash to buccal fat removal comes from how the surgery can age. On a younger rounder face, the surgery gives the cheekbones a defined look and can make jawlines look sharper. But as people get older, fat becomes more of a scarcity, which can make a person with less buccal fat look gaunt, according to Dr. Vasyukevich.
“There are no easy ways to reverse it, so those are immediate consequences,” Dr. Vasyukevich says. “More long term, what looks good on people when they’re younger is not necessarily going to look good on the same person when they are in their forties and fifties. That kind of a lower cheek volume depletion can actually prematurely age the face and this is something that’s a real consideration.”
The memes surrounding buccal fat removal show people’s real concerns about what happens when the next viral item isn’t makeup or a dress, but a body. Just look at the Brazilian Butt Lift: The major and invasive procedure grew popular in 2016 when celebrities began promoting curvaceous bodies with small waists. Even after the BBL hype was criticized for co-opting the real-life figures of Black and brown women, the number of BBLs has continued to rise by 77.6 percent globally, according to a 2020 survey from the International Society of Aesthetic Plastic Surgery. As many social media users have pointed out, it’s easy to imagine the trend changing again soon, and celebrating another procedure that gives you fuller, bigger cheeks or whatever people have decided makes you look conventionally attractive. “Just bought up all the barrels of buccal fat from out the back of the surgeon’s office,” one TikTok user joked. “In 10 years when ‘cherub core’ or ‘cheek chic’ or whatever the fuck they’ll call it is inevitably in vogue, the celebs will want it back and I will be there to sell it to them for triple what I paid for it.”
Right now, buccal fat removal is just one of dozens of plastic-surgery procedures made popular online. Dr. Shafer says social media has changed why people come into his office for procedures, and he can often track an increase in surgeries to online trends. But both Dr. Shafer and Dr. Vasyukevich cautions patients to make changes because they want them, not because they’re viral.
“Part of my job is to say no,” Dr. Shaffer says. “And we do. A lot of times just people are coming in for the wrong reasons. They don’t understand the risks and the benefits. They don’t understand the recovery involved or the permanence. Because once you make an incision, you can’t take that away again.”