Facial fat: The good, the bad and the confusing

There was a time when fat was demonized to the point where everything in the grocery store was labeled "fat-free" on the packaging. Fat turned into public enemy number one. Yet was the rage against fat really warranted?

Over the years, the medical community has helped dispel some of the myths surrounding fat, but some confusion remains. Fat may be responsible for adding a few pounds to your waistline or giving you a cherub face, but it also plays a vital role in keeping our bodies healthy and energized – and, believe it or not, giving our faces a more youthful appearance. It's time to unravel facial fat – the good, the bad and the confusing.

Facial fat: The good

It's time to remove "fat" from our list of dirty words. Reasonable amounts of fat are essential for a healthy body and balanced life. Many types of fat are essential sources of fatty acids that the body cannot make alone. Fat also helps the body absorb fat-soluble vitamins like vitamins A, D and E.

What else can fat do? It can help you maintain a glowing and youthful appearance. And as we age, we naturally lose facial fat.

"Our facial fat pads shrink, and our facial skeleton even shrinks, all of which leads to deflation and ultimately contributes to sagging as that internal support is diminished," said Kristy Hamilton, MD.

The loss of facial fat can give the face a gaunt or even hollow appearance. Need more proof that you need facial fat? Consider the rise of the term "Ozempic face." Ozempic is one of many semaglutide medications that are making the transition from type 2 diabetes drug to weight loss drug. It works, in part, by making a person feel fuller for longer so they consume fewer calories and shed excess weight.

As much as we would love to pick and choose where we lose weight, that isn't reality. When using this new weight loss drug class, an individual can experience rapid weight loss, which may cause dramatic facial changes like less facial fat, a hollowed-out appearance, loose facial skin and increased signs of aging, such as more lines and wrinkles. Hence, the term Ozempic face is not just a social media phenomenon.

"We, as plastic surgeons, are seeing more and more candidates for fat transfer in the "Ozempic era" where rapid and significant weight loss has yielded svelte, skinny bodies – desirable – and gaunt faces – not so desirable," said Dr. Hamilton.

Facial fat is good because it keeps the face "plump" and glowing. For those who have lost natural fat because of weight loss or the natural aging process, adding fat back to the face may be a terrific option to recapture a more youthful appearance.

"Fat transfer is an excellent procedure because the natural tissues also rejuvenate the skin, and the results last longer than filler since it's the patient's own tissue," said Dr. Hamilton. "It is always ideal in plastic surgery to replace 'like with like.' In general, fat available for transfer is also much more abundant than filler – so it can even be more cost-effective for patients seeking total facial rejuvenation."

Facial fat: The bad

Not everyone enjoys the cherub aesthetic and wants to remove facial fat to help give them a more svelte and graceful appearance. The latest ASPS statistics show that 2022 was the first year data for buccal fat removal was reported. An estimated 4,543 patients sought the fat removal procedure from ASPS Member Surgeons.

Buccal fat removal is a surgical procedure that removes fat from an area between the cheekbones and the jawbone, changing the natural shape and contour of the face. Where is the buccal fat pad? Suck in your cheeks; the hollow area you see in the mirror is the area where the fat pad is located.

If facial fat can help people achieve a more youthful complexion, why consider removing fat from the face? Individuals taunted with the monikers "baby face" or "chipmunk cheeks" may consider buccal fat removal to tone down the plump appearance of their facial features, but is that choice today going to be the right choice in 10 to 15 years when the face naturally begins to lose facial fat?

"I ask patients, 'When you look at your mom, your dad, your grandparents, do they still have a very round face?'" said Dr. Hamilton. "If older family members are still round in the face, that patient may be a good candidate for buccal fat reduction to sculpt the cheeks and create a leaner, diamond-shaped face."

Dr. Hamilton specified that she is in the camp of buccal fat reduction, not complete buccal fat removal.

"Excess removal in this area in the wrong candidate can accelerate aging by creating a gaunt appearance," said Dr. Hamilton. "However, for the right candidate, it is a very powerful procedure. The key is to be evaluated by an experienced plastic surgeon with expertise in facial analysis and surgery."

She recommends patients interested in buccal fat removal seek a focused facial analysis to assess and understand their facial anatomy, what surgery can accomplish and what the result may look like years later.

Facial fat: The confusing

Are you still confused about the good and bad features of facial fat? Don't be. A board-certified plastic surgeon who is an ASPS member can help you find the right balance that aligns with your aesthetic goals.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.