Written and medically reviewed by Prof Dr Srinjoy Saha, MS, MCh (Plastic Surgery), FACS, FRCS (Glasgow) · Last reviewed: 4 August 2026
Harvard Fellowship • Apollo Professor • PSF Achauer Award • Gold Medal • In Practice since 1998
The question most people arrive with is not whether buccal fat removal works. It does.
The question is what the face looks like in fifteen years, because the internet is full of people who had it done at twenty-four and regret it at forty.
Faces hollow with age whatever anyone does to them. Bone recedes, the ligaments loosen, and every fat pad in the face shrinks — the buccal pad included. What removal does is start that process early, in one specific place, and make it permanent there.
So the decision that matters is not whether to take fat out. It is what happens to it afterwards. Discarded, it is gone. Re-grafted to the cheekbone and the chin, the same tissue goes back into the two places a face needs projection as it ages.
One pad. Taken from where it blunts the face, put back where it defines it.
Rhinoplasty in Kolkata costs approximately ₹60,000 to ₹3,50,000. What determines your costs ↓
Examples of Face Contouring Cases After Buccal Fat Removal
What Facial Contouring Corrects
The shape being aimed at.
What reads as an attractive face now has sharper features, a smooth ogee curve running from the temple over the cheekbone to the jaw, and proportions closer to an inverted triangle — wide at the cheekbones, narrow at the chin.
That triangle needs work at three points, not one.
The three points.
The lower cheek is too full. The buccal fat pad sits below and behind the cheekbone. When it is prominent the face reads round and the cheekbone disappears into it.
The cheekbone is not projecting enough.
Removing fat does not create a cheekbone. It only stops hiding the absence of one. This is where most buccal fat removal goes wrong — the patient wanted a cheekbone and got a narrower round face.
The jaw is too wide.
In many South Asian faces the masseter is heavy, which squares the lower face and works against the triangle regardless of what is done above it.
What Facial Contouring Cannot Do
Six patterns account for most revision presentations. Find yours.
It cannot be undone.
The buccal fat pad does not grow back. Grafting can be repeated if the projection is less than planned; removal cannot be reversed if too much came out. Everything else on this page follows from that asymmetry.
It cannot give you the proportions in the reference photograph
Especially if that photograph is a phone camera held at arm's length, or an app. Those are not real proportions. A photograph taken at a metre with a standard lens is the comparison that matters.
It cannot lift.
If the complaint is sagging rather than fullness, this operation makes it worse — it removes the volume holding the skin out. The right conversation is a lift, and you will be told so.
It is not a one-off purchase.
The reduction is permanent. The projection is not — about two years on its own. Holding it longer means maintenance, and maintenance has a cost. It is a modest cost done the way it is done here, but it is not nothing, and you should know that before you book rather than after.
It cannot create bone.
Grafted fat sits on the cheekbone and follows its shape. Where the underlying bone is flat, the graft softens the transition. It does not build a projection the skeleton will not support.
It cannot stop the face ageing.
It changes what the face has to age with.
Where Is Your Roundness Coming From?
This decides the operation, and it is settled by examination rather than by photograph.
Fat is soft and moves when you press it. Buccal fat sits deep, in a discrete pocket below the cheekbone, and it does not shrink much with weight loss — which is why people who have lost fifteen kilos still have round cheeks.
Muscle is firm and it bulges when you clench. If your jaw widens when you bite down, the masseter is part of the problem and no amount of fat removal will fix it.
Bone does not move. A wide mandibular angle is skeletal, and neither fat nor botulinum toxin changes it.
Most people are a mixture, with each of these three weighted differently.
A plan that names only one of the three is treating whichever one the surgeon happens to operate on.
What the Nose Can Be Rebuilt With
Cartilage is the gold standard. Your own cartilage becomes part of you, it has decades of published outcome data behind it, and there is no foreign material left in the nose afterwards. Every alternative is measured against it.
There are four realistic materials. Each is good at something. Each costs you something. Which one your nose needs is settled by examination, not by preference — including the surgeon's.
Septal cartilage
Straight, firm, thin, and already inside the nose. The first choice whenever any remains, and no incision anywhere else on your body.
The problem is availability.
In most revisions it was harvested at the first operation, and what is left is the L-strut holding your nose up, which nobody should be taking. Where a workable amount survives, it is used before anything else is considered.
Rib cartilage — costal
The strongest option, and the one that can do every structural job on the list. It is the answer for a badly damaged nose, a saddle deformity, total dorsal reconstruction, and any case needing more volume than the head can supply.
Its real advantages are worth stating plainly:
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It is your own tissue. Nothing foreign stays in the nose. No implant to become infected or to extrude.
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Volume is effectively unlimited. Where the reconstruction is large, no other material competes.
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The outcome data is the deepest of the four. Costal grafting has decades of published follow-up behind it.
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Nothing has to be bought. In a cost-constrained situation this matters, and it is why the operation is done this way at government and low-cost institutes.
What it costs you:
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A chest incision and a second wound. In practice this is the most painful part of the recovery — more than the nose. It affects sleeping, breathing deeply and coughing for the first week or two, and it adds a chest scar to the nasal work.
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Substantially longer surgery, with the anaesthetic time that goes with it.
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Warping. Rib cartilage keeps a tendency to bend after carving. Careful carving reduces it and it does not happen to everyone — but when it happens it happens late, months or years afterwards, in a nose that had looked correct.
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Calcification in older patients, which makes the rib harder to carve accurately.
Additional morbidity of taking a rib is not a marketing claim. It is the stated problem in the literature: harvesting costal cartilage is described as increasing operative time and carrying secondary-site complications including contour irregularity, poor scarring and pneumothorax.
Ear cartilage — conchal
Taken through a small incision behind the ear. The donor site heals well, the scar is hidden, the harvest is quick, and it adds very little to the operation.
Conchal cartilage is curved and springy. That makes it genuinely good for battens, for lining, for alar support and for some tip work — where those are the job, it is the right material and there is no reason to look further.
It is not straight enough or rigid enough to hold a columellar strut, lengthen a short nose, or rebuild a dorsum. Used for a structural job it was not designed for, the structure is not really being rebuilt and the nose moves again later.
Bioresorbable Scaffold
A three-dimensional lattice - an open, interconnected mesh, is shaped to do the structural job a cartilage graft would do. The material is polycaprolactone, in surgical use for around thirty years and in the same polymer family as one of the standard absorbable sutures.
Two properties matter. It is open, so your own tissue grows into it — fibrovascular tissue grows through the pores from the time it is placed, and what develops is a composite of scaffold plus your own living tissue. It resorbs over years rather than months, so by the time the polymer has gone the tissue that grew through it is mature and carrying the load. There is no window in which support has been lost and nothing has replaced it.
What it is good for:
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No donor site at all. No chest incision, no ear incision, no second wound, no second scar, none of the first-week chest pain.
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It cannot warp, because it is not cartilage. Late deviation from a carved graft is not a failure mode available to a polymer lattice.
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Volume is not the constraint. It is shaped to the plan rather than to whatever a donor site yielded.
What it costs you:
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It is an implant, and implants carry implant risks. Until your own tissue has grown through and replaced it, it is a foreign material sitting in a nose whose skin envelope is already scarred and less well perfused than an unoperated one. Infection and extrusion are possible in a way they are not with your own cartilage. This is the trade-off, and it is the reason the material is not right for every nose.
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The outcome data is thinner. Cartilage grafting has decades of published follow-up. Polycaprolactone scaffolds in the nose have far less. That is a real difference and it should count in your decision.
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It has to be paid for.
Why the Ageing Question Is the Right Question
The buccal fat pad shrinks on its own with age.
Everyone's does. Removing it accelerates a process already under way in that one place, and the result some people arrive with is a face that looked sculpted at thirty and gaunt at forty-five — hollow below the cheekbone, with the shadow that used to read as definition now reading as loss.
This is why the amount taken matters more.
The amount taken out matters more than the technique used to take it, and why the operation suits a forty-year-old better than a twenty-two-year-old.
Re-grafting the high-quality fat changes the arithmetic.
The volume does not leave the face; it moves up. How long it stays there is a fair question. The answer is a number — about two to three years for the graft on its own. It has lasted more than five years when it was maintained afterwards with simultaneous injections of platelet-derived growth factors and dermal fillers in small proportions. Those are the figures from an internal review of 55 patients treated here.
Comparison of the 4 Graft Options
# | Septal Cartilage | Ear - Conchal | Rib - Costal | Scaffold |
|---|---|---|---|---|
Where Preferable | Wherever any remains | Battens, lining, alar support, limited tip work | Large reconstruction, saddle nose, total dorsal rebuild, cost-constrained settings | Where a donor site must be avoided and nose reconstruction is within its range |
Something to buy | No | No | No | Yes |
Long-term outcome data | Decades | Decades | Decades | 8 years |
Added operating time | Minimal | Short | Substantially long | None |
Can warp later | Rarely | Not used for load bearing | Yes - months to years afterwards | Negligible |
Your own tissue | Yes | Yes | Yes | Not initially, until your tissues replace it |
Main source of first-week pain | Nose | Nose | Chest, not the nose | Nose |
Second wound on your body | No | Small, behind the ear | Yes - large, chest | No |
Volume available | Small | Small | Large | Shaped to the plan |
Straight and rigid enough for structural work | Yes | No — curved and springy | Yes | Yes |
Usually available at revision | No — used at the first operation | Yes | Yes | Yes |
What the comparison table cannot show
Every row assumes the surgeon is competent with the material.
A scaffold placed badly is worse than a rib graft placed well, and the reverse is equally true. Material narrows the range of things that can go wrong. It does not remove them.
No column is the winner.
Cartilage is the reference standard and the scaffold is a useful alternative for specific situations. If you are offered rib elsewhere and the surgeon can explain why it suits your nose, that is a reasonable conversation and you should have it. If you do not want the additional risks of chest wounds, chest scars, and rib cartilage resorption or warping, but your surgeon insists on using rib cartilage, you may want to think about taking a second opinion.
The right question is not "which is best" but "which is right for your nose".
Those have different answers, and only one of them can be settled after your examination and consultation.
Who Facial Contouring Suits
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A full, round lower face with cheekbones that are present but obscured.
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A heavy or square jawline from masseter bulk rather than bone width.
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Someone at a stable weight, not mid-way through losing or gaining.
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Skin that will redrape over a smaller volume rather than hang.
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Someone who would rather their own tissue did the work, with synthetic filler kept to occasional top-ups.
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Someone describing the goal as shape rather than youth.
Who Facial Contouring Doesn't Suit — Yet
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A naturally narrow or already thin face.
Removing buccal fat from a face that is not full produces permanent hollowing. This is the commonest reason to decline the operation and it is not negotiable by asking twice.
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Weight still changing.
Significant loss after removal compounds the hollowing. Wait until weight has been stable for six months.
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Age under about twenty-five.
The pad shrinks naturally with age. A face that is round at twenty may sharpen on its own by thirty, and fat removed at twenty cannot be recovered. This is a wait, not a refusal.
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Loose skin is the real problem.
Then this operation makes it worse. Come back after the conversation about a lift.
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The reference image came from a filter.
Not a moral judgement — the proportions in it are not achievable because they are not proportions.
Realistic Expectations
It sharpens proportion, not identity.
The face stays recognisably yours.
Some of the fat graft will resorb.
What remains holds for about two to three years on its own. A second subsequent fat grafting session may be necessary, harvesting your abdominal, thigh, or arm fat.
Bone sets the ceiling.
Grafted fat follows the shape underneath it.
The maintenance is real, and it is planned rather than sold.
Platelet-rich plasma at intervals, a small filler top-up only when the volume looks low. If you would rather do nothing afterwards, say so and expect the two-to-three year figure.
The result arrives over three months.
Results take longer to understand if procedures are combined. Swelling is substantial for the first fortnight and the graft is deliberately over-placed. Where several procedures are done in one sitting the swelling is heavier and takes noticeably longer to settle — that is the thing patients here are most often unprepared for.
Symmetry improves; matched symmetry is not the goal.
No face is symmetrical to begin with.
What to expect during revision nose surgery
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Revision swells for longer than primary surgery.
Scarred tissue holds fluid. Judging a revision at three months is judging it early.
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The target is unremarkable, not striking.
A revised nose that draws attention has failed, whatever it measures.
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The limiting factor is usually the skin, not the surgeon.
How much definition a thickened, contracted envelope will show is the ceiling on the result, and it is set before the operation starts.
What Happens at Your Consultation
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Examination of the skin envelope and what remains of the framework.
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Internal examination of the airway.
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Review of your previous operation note where you have it.
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Standardised photography.
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A direct answer on what is correctable and what is not, the graft plan and the reasoning behind it, the risks specific to you, and the cost with what it includes.
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Subsequent consultations may be necessary to finalise the treatment.
You will not be asked to decide on the day. 1-2 weeks of cooling off period is recommended and followed here.
Facial Contouring: Stepwise Overview
Anaesthesia
Buccal fat transfer is done under general anaesthesia as a one-day case. You come in, have the operation, and go home the same day. If you do not have people to support you at home, or have post-anaesthesia problems,
With neck liposuction — same anaesthetic, and depending on volume an overnight stay.
Botulinum toxin, platelet-rich plasma and filler top-ups — local anaesthetic only, in the clinic room, separate from the main operation.
A consultant anaesthetist reviews you before the day of surgery and is present throughout. This is at Apollo Multispeciality Hospital, which is JCI-accredited with intensive care and a blood bank on site.
Surgery is at Apollo Multispeciality Hospital, which is JCI-accredited with intensive care and a blood bank on site.
Preparing for Revision Nose Surgery
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Stop all nicotine four weeks before surgery — cigarettes, vapes, patches, gum, pouches. Longer is better. The skin over a revised nose is already working with a reduced blood supply because of the first operation, and nicotine narrows what is left. Skin loss over the nose is the one complication on this page with no good correction, and it happens disproportionately in smokers. If you cannot stop, say so and the operation is deferred rather than done at that risk.
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Stop two weeks before surgery: aspirin, ibuprofen and other anti-inflammatories, fish oil and omega-3, vitamin E, garlic, ginger, ginkgo, ginseng, turmeric and St John's wort. Paracetamol is fine for pain in the meantime.
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Tell us about everything you take, including anything sold as natural. Like, green tea, herbal remedies, etc. Several ordinary supplements thin the blood about as effectively as aspirin does, and they are the commonest reason an operation is postponed on the day.
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Bring the operation note, discharge summary and any photographs from the first surgery. If you do not have them, request them — you are entitled to them and they change the plan.
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Arrange for someone to take you home.
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Plan around two weeks before you want to be seen socially.
Risks & Complications
Common
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Prolonged swelling, particularly of the tip
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Bruising
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Temporary numbness of the tip
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Temporary reduction in the sense of smell
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A blocked nose for several weeks
Less common
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Residual asymmetry
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Under- or over-correction
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A visible or palpable irregularity
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A graft shifting
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Bleeding needing attention
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Infection
Uncommon but serious
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Skin loss over the nose — more likely in revision than in primary surgery, and much more likely in smokers
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Septal perforation
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Significant airway obstruction
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Extrusion of a graft or implant. Where a scaffold is used this is the risk specific to it — a foreign material in a scarred, thin envelope can become exposed. It is uncommon, and it is the main reason a scaffold is not the right answer for every nose
Anaesthetic risk is assessed separately by the anaesthetist and is not covered here.
And the one specific to this operation: a further revision may be needed.
Rates after revision are higher than after primary surgery. That is true of every surgeon, including this one.
Recovery & Swelling Timeline
Glasses, specifically.
For the first week the splint carries the weight and glasses can rest on it. Once the splint is off, nothing rests on the bridge for six weeks where bone was cut — the nasal bones take six to eight weeks to become stable, and steady pressure during that window can leave a lasting indentation or move the bones.
Use contact lenses, bridgeless frames, or tape the frames to your forehead. Where only the tip was worked on and no bone was cut, four weeks is enough.
Scarring
The columellar scar sits in a natural shadow between the nostrils. In most people it settles to a fine line that is not noticed in conversation. It does not disappear.
If you have had a previous open rhinoplasty the same scar is re-used, so no new external scar is created.
A chest scar comes with a rib harvest and a small scar behind the ear comes with a conchal harvest. Neither comes with a scaffold. For some patients that decides the material, and it is a legitimate reason to choose it — provided the reconstruction is one a scaffold can carry.
Where you scar badly elsewhere on your body, say so at consultation. It changes the closure and the aftercare.
Duration of Results
A structurally rebuilt nose is stable once healing is complete. What changes it afterwards is time, weight change and injury — the same things that change any nose.
Each material fails differently, and knowing how is more useful than knowing which is strongest. A carved cartilage graft can warp, late, in a nose that had looked correct for a year or more.
A scaffold cannot warp, but it is a foreign material until your own tissue has replaced it, and foreign materials can become infected or exposed. Neither of those is common.
Both are real, and both should be part of the conversation before you consent.
Before You Book a Nose Revision Anywhere
Ask any surgeon, including this one.
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"What are you going to rebuild it with, and why that one for my nose?"
The reason should be about your anatomy. If it is about the surgeon's usual practice, keep asking.
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"What are the disadvantages of the material you are proposing?"
Every one of them has some. A surgeon who names none has either not thought about it or is not telling you.
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"If you are proposing rib — what happens if it warps in year two, and who pays?"
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"If you are proposing an implant or scaffold — what happens if it gets infected or extrudes?"
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"How many revisions do you do a year, as against primary rhinoplasty?"
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"Who gives the anaesthetic, and are they a consultant? Which hospital, and is it accredited?"
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"What does a further procedure cost, and within what period?"
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"Will you show me my own before-and-after photographs at each review?"
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"Are you telling me this is fully correctable?"
If so, ask what the limiting factor is. Every revision has one, and a surgeon who names it is telling you the truth.
Cost of Revision Nose Surgery in Kolkata
Revision rhinoplasty in Kolkata costs approximately between ₹1,50,000 to ₹3,50,000.
The lower end is a limited correction — a tip, a small structural repair, your own cartilage, nothing bought in. The upper end is a full structural rebuild with the operating time and materials that go with it.
That floor sits higher than primary rhinoplasty, which starts at ₹60,000 on the costs page. It is not a premium for the word "revision". A revision takes longer, most of the extra time goes on releasing scar tissue before any rebuilding starts, and the septal cartilage a primary would have used is usually gone.
Beyond that there is no menu price, and a figure quoted before examination is a figure for an operation nobody has planned.
Cartilage is generally the cheaper route, especially in government hospitals. A scaffold is the more expensive one, because it has to be purchased, while cartilage only costs increased operating time and increased morbidity. If cost is a deciding factor for you, say so at consultation — it is a legitimate part of the decision and it changes what is recommended.
Where surgery is done for a documented breathing obstruction, some insurers will consider the functional component. Cosmetic components are generally excluded, and the decision is the insurer's.
What to gather, and when to raise it, is set out on the costs page.
What the quoted figure includes
Surgeon's fee · anaesthetist's fee · surgery and anaesthesia assistance · operating theatre and equipment · implants, grafts or scaffold · consumables and disposables · medicines during admission · hospital bed and stay · splint and dressings
What it does not include
Pre-operative investigations · medication after discharge · post-operative consultations · further revision surgery · applicable tax · travel and accommodation
Consultation fees, GST, applicable taxes, deposits, quotation validity, revision charges and what to ask before comparing any quotation: What a quotation includes, consultation fees, insurance and revisions
If Any Further Procedure Is Needed
Small refinements may sometimes become necessary 12-18 months later. They are usually done under local anaesthetic.
Three conditions have to be met before planning any further procedure, and all of them, not just one:
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You are unhappy with a specific, identifiable aspect of the result.
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That concern can be identified on examination — not only in a photograph.
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There is something that can actually be done about it.
The surgeon's fee is reduced when operating a second time in the same nose. Facility, anaesthesia and any graft materials remain payable, because those are not the surgeon's to waive.
This is set out in writing and signed before your first operation, not discussed afterwards when you are unhappy.
Coming from outside Kolkata
Plan to stay at least ten days in Kolkata.
Day 1: Consultation, examination, photography, investigations.
Day 2–3: Revision Nose Surgery.
Day 5–7: Splint removal.
Day 10: Review, then travel.
Do not book your flight or train before day 10. The splint comes off between days five and seven, and the nose needs to be seen after that before you leave.
Schedule an online second opinion before travelling:
We meed the following photographs - frontal, both profiles, both three-quarter views, and one basal view taken with the head tipped back. Include your previous operation note. A preliminary opinion can be given remotely; the plan is confirmed only after examination.
Frequently Asked Questions (FAQs)
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How long do I have to wait after my first surgery?
Six months at the earliest, and a year is better. The tissues need to settle and the shape needs to stop changing before anyone operates again. The exception is significant breathing obstruction, which is addressed sooner.
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Which graft is best for revision rhinoplasty?
There is no single best one. Cartilage is the reference standard and your own septal cartilage is the first choice wherever any survives. Beyond that it depends on how much structure is missing: ear cartilage for battens and lining, rib for large reconstructions, a bioresorbable scaffold where a donor site has to be avoided and the rebuild is within its range. The material is chosen after examination, not before.
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Can it be done without taking cartilage from my chest?
Often, yes. Ear cartilage covers some structural jobs and a bioresorbable scaffold covers others without any donor site at all. Where a large volume of structure is missing, rib remains the strongest option and avoiding it may cost you result. That trade is discussed openly rather than decided for you.
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Is a bioresorbable scaffold safe if it dissolves?
That is how it is designed to work. It is an open lattice rather than a solid block, so your own tissue grows through it from the time it is placed, and it resorbs over years — by the time the polymer has gone the tissue that grew through it is carrying the load. The trade-off is that until then it is an implant, and implants carry a risk of infection and exposure that your own cartilage does not.
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Does rib cartilage really warp?
It can, and patients are often not told. Carved costal cartilage keeps a tendency to bend, and when it happens it happens late — months or years afterwards, in a nose that had looked correct. Careful carving reduces it and most rib grafts do not warp. Against that, rib is your own tissue, there is nothing foreign left in the nose, and the long-term data behind it is the deepest of any option.
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Will my breathing get better?
Where the obstruction is structural — septum, turbinates, valve collapse — usually yes. Where allergy or mucosal disease is contributing, that is treated separately and surgery alone will not fix it.
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I don't have my operation note from the first surgery. What now?
Request it from the hospital; you are entitled to it. If it cannot be obtained the assessment proceeds on examination, but the note is genuinely useful — knowing what was taken changes what has to be replaced.
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Can this be done in one operation?
Most revisions, yes. Severely contracted or near-destroyed noses are sometimes staged, and you would be told that at consultation rather than afterwards.
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Will it look obviously operated?
The aim is the opposite. A revised nose that draws attention has failed, whatever it measures.
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How much worse is the recovery than my first surgery?
The nose itself is similar. The difference is swelling, which lasts longer in scarred tissue. Where a rib is taken the chest is the sore part for the first week or two; where it is not, the recovery is confined to the nose.
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What does revision rhinoplasty cost in Kolkata?
₹1,50,000 to ₹3,50,000, depending on how much has to be rebuilt, which material is used and whether the airway is being corrected at the same time. The floor is higher than primary rhinoplasty because a revision takes longer, much of it spent releasing scar tissue before any rebuilding begins.
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I had my surgery abroad. Can you still take it on?
Yes. Bring whatever documentation you have.
Photographs in This Page
Every photograph in this section is of an actual patient of Prof. Dr Srinjoy Saha, published with that patient's specific written consent for publication. Images are unretouched apart from standardised cropping and lighting, and are taken under consistent conditions before and after surgery. Any image illustrating a concept rather than a patient is that of a Model.
Surgical outcomes depend on individual anatomy, skin thickness, tissue quality and healing. Individual results vary. No image here is a promise or prediction of your result.
Consult Prof. Srinjoy Saha
Prof. Srinjoy Saha is a Harvard-trained surgeon-scientist and a Member of the Regenerative Medicine Committee of the American Society of Plastic Surgeons. He is the only Adjunct Professor of Plastic Surgery in Apollo AHERF among their 245 India-wide faculty list. He is a Fellow of the Royal College of Physicians and Surgeons of Glasgow and the American College of Surgeons.
He is an experienced rhinoplasty surgeon who has seen enough complications to be careful, and enough good outcomes to be calm. He analyses every nose surgery case individually, and operates accordingly. He works to a regenerative-first protocol he calls the Jyoticision™ System
Frequently, he receives complex and revision rhinoplasty cases referred from across India.
YOUR NEXT STEPS
Rhinoplasty assessment covers nasal analysis in relation to facial proportions, skin thickness by examination, cartilage strength, septal position, internal examination of the airway, chin projection — a weak chin makes any nose look larger, and assessing it is part of a rhinoplasty consultation — and standardised photography.
Afterward, a discussion of what is achievable in your case and what is not, graft or implant planning where relevant, review of medical history and medication, and the risks specific to you.
A personal consultation will clarify what is achievable for your anatomy and goals. Consultations are chargeable.
