The main downsides of buccal fat removal include potential uneven results, nerve damage, and visible scarring. Uneven results may occur if too much or too little fat is removed, leading to an asymmetrical appearance. Nerve damage is a possibility since the buccal fat pads are located near important nerves. This can lead to temporary or permanent numbness in the cheeks. Additionally, visible scarring may be a concern, especially if the incisions are not well-hidden or do not heal properly. It's important to consult with a qualified and experienced surgeon to minimize the risks and achieve the desired outcome. Understanding the potential downsides will help you make an informed decision about whether buccal fat removal is the right choice for you.