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Removal of the buccal fat pad can be considered safe as long as there is a detailed analysis of anatomical landmarks. The objective of this study was to estimate the prevalence of intra- and postoperative complications resulting from buccal fat pad removal through a systematic review. The search strategy involved observational and/or interventional studies in humans that included at least one case of buccal fat pad removal with a description of the surgery, postoperative progress, and complications. Methodological quality assessment was performed using the JBI checklist. Study heterogeneity was assessed using the I2 test. In total, 12 studies were included. Out of 308 patients who underwent buccal fat pad removal, 81 experienced some form of complication, with an overall prevalence of 25% (95% CI = 0.04-0.46). Complications found in the data collection included edema (38.40%), trismus (30.09%), pain (19.41%), asymmetry (11.65%), facial nerve paralysis (0.97%), infection (0.48%), hematoma (0.48%), and unilateral emphysema (0.48%). All complications occurred in the postoperative period. There was high heterogeneity among the studies. One in four patients undergoing buccal fat pad removal experiences some form of postoperative complication. Consequently, the procedure should be recommended with caution because there is evidence for safety concerns and a lack of predictability in the evaluated studies., Competing Interests: Conflicts of interest statement The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this manuscript., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)