Before and after the procedure. Photo / Getty

Critics label it “paying for ageing”, advocates argue it’s a godsend for those in search of chiselled cheeks.

Either way, excitement over buccal fat removal, a procedure where the fat pads below the cheekbones are excised through the mouth, has well and truly hit Aotearoa’s shores.

Popularised by the likes of former supermodel and social media tycoon Chrissy Teigan, the surgery’s title (pronounced like a belt’s buckle) has already racked up more than 109 million views on TikTok, with the term buccal fat alone sitting on 267 million views. But Kiwi doctors spoken to by the Herald, who are fielding an increase in inquiries, fear the surgery could be doing more harm than good.

Despite not offering it, and overall being cautious when it comes to providing plastic surgery procedures descending from TikTok or Instagram fads, Auckland plastic surgeon Katarzyna Mackenzie told the Herald last month at least once a week she gets someone inquiring about buccal fat removal.

“Our bodies have become playgrounds for experimenting with ever-changing beauty trends. However, unlike the trends that populate social media feeds, cosmetic procedures can have long-term ramifications not only on body image but also health.

“I think it is due to celebrities having a dominant role in dictating societal beauty standards.”

As we get older, Mackenzie said the facial muscle and bone become thinner. When this inevitably occurs, and there is no buccal fat support, she said the face appears loose and gaunt.

While it may look flattering at first, she warned over time removing the fat can give the patient an older appearance.

Sarah Hart, an Auckland-based cosmetic medicine doctor, has also seen a spike in patients asking about the procedure.

Up until last year Hart said she hadn’t received any requests for the procedure, but now not only are inquiries coming in, she’s treated a patient in her mid-twenties who had buccal fat removal in her early twenties but wanted the area refilled as it was “looking too gaunt”.

“Colleagues have described it as paying for aging.

“You’re paying for a procedure that in the long run is going to age your face.”

Buccal fat can be “quite prominent” for young people, meaning the cheekbones may not look as sculpted, but by the time patients are in their 30s she said they will often see their cheekbones appear as they lose that “baby face”.

Early in the aging process she said this can look quite nice, as the cheekbones “come out” and the face leans up, but when someone reaches their 40s and 50s, a person with the same body weight, it “tips over” and the face starts to look older due to the lack of fat.

Like Mackenzie, she too holds concerns over how procedures popularised on social media will not necessarily be a wise option.

“It’s interesting what captures Instagram, because it’s a little bit like the lip flip with Botox. We’ve been doing it for, oh my god, 20 years, and it’s a small simple procedure that doesn’t last very long and suits some people but not others and really lip fillers do a lot more. But the lip flip with botox for some reason had this traction with Instagram.”

Hart told the Herald reputable, ethical plastic surgeons in New Zealand are likely to be reluctant to undertake the treatment because of concerns of future impact.

“The big thing with the buccal fat is it’s essentially irreversible, and even though we can refill the area with filler, it’s not the same as having your own fat in there, so you’re doing something irreversible which is different from the little lip flip with the Botox which is six weeks and it’s gone.

“Anyone who asks me about it, I will be saying to them, that procedure in the long run is probably not in your best interest.”