Buccal Fat Removal with Tear Trough Fat Grafting

Patient Overview

• Patient: Aida

• Age: 26 years old

• Gender: Female

• Procedures: Buccal fat removal (cheek reduction), fat grafting to tear troughs (under-eye hollows)

• After photos taken at: 2 months post-surgery

• Location: Istanbul, Turkey

Volume Redistribution: Taking from One Place, Adding to Another

The most elegant solutions in facial contouring are not purely additive or purely subtractive — they are redistributive. The face that appears unbalanced often has the right total volume in the wrong locations. Fullness where it is unwanted. Hollowness where volume is needed. The surgical answer is not simply to remove or to add, but to move — reducing excess in one zone while restoring deficit in another, bringing the entire facial contour into harmony through a single strategic intervention.

Aida, a twenty-six-year-old patient of Dr. Cem Berkay Sinaci, presented with exactly this imbalance. Her lower cheeks carried buccal fat fullness that rounded her mid-face and obscured her bone structure. Simultaneously, the area beneath her eyes — the tear trough — showed the hollow, shadowed appearance that creates a perpetually tired look regardless of how much sleep one gets. Dr. Sinaci, a European board-certified plastic surgeon (FEBOPRAS) and member of ISAPS and ASPS, addressed both concerns in a single session: buccal fat removal to slim the cheeks, and subtle fat grafting beneath the eyes to fill the tear trough hollows.

What Causes Tear Trough Hollows at a Young Age

Under-eye hollowness is widely associated with ageing, but a significant number of patients develop visible tear troughs in their early twenties or even younger. The tear trough is the groove that runs from the inner corner of the eye downward and laterally along the junction between the lower eyelid and the cheek. When this groove is deep, it creates a shadow that the eye reads as a dark circle — the tired, drawn appearance that no concealer fully corrects.

In young patients like Aida, tear trough hollows are primarily an anatomical variant rather than an age-related change. The volume of soft tissue between the thin lower eyelid skin and the underlying orbital rim bone is genetically determined. Some individuals have generous fat padding in this zone, producing a smooth, seamless transition from eyelid to cheek. Others have minimal padding, leaving the bony rim visible as a depression that casts a shadow in any lighting condition.

This is why Aida could sleep eight hours, drink adequate water, avoid every lifestyle factor blamed for dark circles, and still see hollow shadows beneath her eyes every morning. The cause was structural — a tissue deficit over bone — and the solution was equally structural: placing a small amount of fat precisely over the orbital rim to fill the depression and eliminate the shadow.

Why Fat Grafting Outperforms Filler in the Tear Trough

The tear trough is one of the most commonly treated areas with hyaluronic acid filler, and for mild cases, filler can provide acceptable temporary improvement. But the tear trough is also one of the highest-risk areas for filler complications. The skin beneath the eye is the thinnest on the entire body — sometimes less than half a millimetre — and filler placed beneath this translucent tissue can produce visible bluish discolouration called the Tyndall effect. Filler can also migrate from its injection point, creating lumps or ridges that are visible through the delicate lower eyelid skin.

Fat grafting avoids these risks through biological compatibility. The patient's own fat, harvested and purified, integrates with the surrounding tissue as a living structure. It does not produce the Tyndall effect because it is not a synthetic gel — it is the same adipose tissue that naturally belongs in the area. It does not migrate because the fat cells establish a blood supply and anchor into position. And it does not dissolve after six to twelve months — the fat that survives the initial revascularisation period remains permanently, eliminating the cycle of repeat injections that filler demands.

For Aida's subtle tear trough deficit, only a small volume of fat was needed — a few tenths of a millilitre per side. This conservative grafting fills the depression without overfilling, preserving the natural contour of the lower eyelid while eliminating the hollow shadow that created her tired appearance.

The Two Procedures Working in Opposite Directions

What makes Aida's combination particularly logical is how the two procedures complement each other aesthetically. Buccal fat removal reduces volume in the lower mid-face, creating a slimmer, more sculpted cheek contour. Tear trough fat grafting adds volume beneath the eyes, creating a smoother, more rested upper mid-face appearance. One subtracts. The other adds. Together, they reshape the mid-face from two directions simultaneously.

The visual effect is greater than either procedure alone could produce. Buccal fat removal without tear trough correction would slim the cheeks but leave the hollow under-eye shadows, creating a face that looks thinner but not necessarily healthier. Tear trough correction without buccal fat removal would refresh the eye area but leave the lower cheek fullness unchanged. The combination addresses the complete mid-facial balance — reduced where full, filled where hollow — producing a face that reads as both more defined and more rested.

Reading the Two-Month Result

Aida's two-month photographs capture both procedures at a meaningful stage of maturation. The buccal fat removal result is well-established at this point — the initial post-operative swelling that temporarily masks the slimming effect during the first three to four weeks has resolved, and the reduced cheek volume is clearly visible. The cheek contour will continue to refine subtly over the next several months, but the fundamental slimming is evident.

The tear trough fat grafting has passed through its critical biological phase. The transferred fat cells have either established their vascular connections and survived, or failed to revascularise and been reabsorbed. At two months, the volume beneath Aida's eyes represents close to the final correction. The under-eye shadows that were present preoperatively have been replaced by a smooth, gently convex transition from lower eyelid to cheek — the natural fullness that her anatomy previously lacked.

The combination effect is visible in how the entire mid-face reads differently. The cheeks are slimmer, the cheekbones are more defined, and the under-eye area is smoother and brighter. The face looks simultaneously more sculpted and more rested — a combination that is difficult to achieve through any single intervention.

The Subtlety Factor

Both procedures in Aida's plan share a critical characteristic: subtlety. The buccal fat removal was calibrated to produce a refined slimming effect, not a dramatic hollowing. The tear trough grafting was conservative — just enough fat to fill the depression, not enough to create puffiness or overcorrection beneath the eyes.

This restraint is intentional. At twenty-six, Aida's face will continue to lose volume naturally over the coming decades. Aggressive buccal fat removal now could produce an attractive result today but a gaunt appearance at forty-five. Excessive tear trough filling could create smooth under-eyes today but an unnatural fullness as the surrounding mid-face thins with age.

Dr. Sinaci's conservative approach preserves volume reserves for the future while correcting the specific concerns that brought Aida to consultation. The goal is a face that looks naturally balanced at every age — not one that looks maximally sculpted at twenty-six and hollow at fifty.

Buccal Fat Removal and Tear Trough Treatment in Istanbul

Aida's two-month before and after result demonstrates the concept of facial volume redistribution — reducing where there is excess, restoring where there is deficit, and producing a balanced result through two complementary procedures performed in a single session. For patients searching for buccal fat removal or tear trough correction in Istanbul, her case illustrates that the most harmonious facial contouring results often come from addressing multiple areas together, treating the face as an interconnected landscape where a change in one zone enhances the change in another.