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Introduction: Buccal fat pad (BFP) excision (bichectomy) or lipolysis by injectable deoxycholic acid (brand name, Kybella) is increasingly used procedures for cheek contouring and facial slimming. However, the literature on their effectiveness and safety is inconsistent. The most recent review was published over 5 years ago; however, the study was limited, did not include injectable lipolysis, and available literature has doubled since its publication. Thus, an updated systematic review is needed to provide a comprehensive evaluation of these procedures.Methods: Aligned with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, a literature review with pre-determined search terms was conducted with 5 major medical journal databases from 1975 to March 2023. We were unable to conduct a meta-analysis due to limited reporting.Results: Our initial search yielded 590 results, with 13 studies meeting criteria for inclusion with a total of 883 patients. All studies performed surgical BFP excision with no studies performing injectable lipolysis. Seven (53%, n = 181) studies reported mean excised volume at 4.01 ± 1.19 grams per side. Two (15%, n = 61) studies assessed mouth opening, noting a combined mean decrease of 28.0 ± 1.93 mm 4 days post-operative and mean decrease of 1.36 ± 4.96 mm 1-month post-operative. Three studies (23%, n = 115) reported a combined mean increase in pain of 2.62 ± 1.63 on a 10-point scale at 72 hours post-operative. Eleven (85%, n = 883) studies reported complications following BFP excision showing complications in 6.8% of patients with 75% of those complications being swelling that resolved spontaneously.Discussion: This review suggests initial patient satisfaction with BFP excision, with only a 6.8% complication rate, primarily consisting of edema that spontaneously resolves. However, concerns regarding bias were raised in 2 of the clinical trials included in this review. Although the original aim was to compare surgical excision to a dissolution technique using deoxycholic acid (DCA), no studies on the DCA were identified that met inclusion criteria. Some authors compared alternative techniques to standard excision, such as hydrodissection and laser-assisted techniques, noting benefits including faster procedures, less pain, and reduced inflammation. Patient age and BFP volume are crucial considerations for appropriate candidate selection, with over excision cautioned against due to natural aging effects.Conclusion: As BFP contouring continues to gain popularity, it is important to continue to monitor outcomes of BFP reduction and its associated complications. It is apparent that more studies are needed in both surgical excision and injectable dissolution to accurately assess this novel procedure.