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BACKGROUND Buccal fat pad excision is a procedure in which the fat pad is extracted in order to achieve a more youthful appearance. OBJECTIVES To describe an alternative technique that utilizes hydrodissection as a means to extract the buccal fat pad. METHODS This is a controlled, prospective, randomized clinical study with two groups. Group A (n=27) underwent buccal fat pad excision with hydrodissection, and 15 ml of a vasoconstricting anesthetic solution was injected into the buccal fat pad. Group B (n=27) underwent buccal fat pad excision, and 3 ml of Lidocaine 2% with epinephrine was injected. All procedures were performed by the same surgeon. Variables analyzed were surgical time, intraoperative bleeding, and postoperative pain directly following surgery 2 hours after the procedure, as well as maximum pain within 72 hours of surgery and complications. Postoperative care was standardized, and patient follow-up extended over a 6-month period. RESULTS Pain scores for 54 patients were recorded using the Visual Analogue Scale (0-10). Mean transoperative pain scores for Group A were 0.5 (±0.8) and Group B were 1.3 (±1.3), P=0.01; 2 hours postoperative, A=1.2 (±0.7) and B=2.6 (±1), P<0.0001. Maximum pain was within 72 hours, A=1.6 (±0.6) and B=3.1 (±1), P< 0.0001. Mean operative time in minutes was A=8:18 (±0:47) and B=14:08 (±2:28), P< 0.0001. There was a positive correlation between operative time and pain. 5.5% suffered postoperative complications. CONCLUSIONS Buccal fat pat excision with hydrodissection is an effective alternative that decreases surgical times by facilitating extraction of buccal fat pad with less manipulation, thereby resulting in decreased postoperative pain and a more pleasant recovery.