A bichectomy, also known as buccal fat removal, is a cosmetic surgical procedure designed to slim and contour the lower face. It involves the targeted removal of specific fat pads within the cheeks to create a more sculpted appearance. This surgery is increasingly popular among individuals seeking to achieve a more defined facial structure.
Defining Buccal Fat Removal and the Aesthetic Goal
The procedure targets the buccal fat pad, a mass of fat located deep within the cheek, distinct from the subcutaneous fat layer just beneath the skin. This fat pad, sometimes referred to as the Bichat’s fat pad, is situated between the buccinator and masseter muscles. It extends from the temple down toward the jawline.
In some individuals, this fat pad is disproportionately large, giving the face a round or “chubby” appearance despite being at a healthy weight. The primary aesthetic goal of a bichectomy is to reduce the volume in this mid-to-lower cheek area.
Removing a portion of this fat creates a hollow beneath the cheekbone, enhancing the prominence of the cheekbones and defining the jawline. This facial contouring is often sought to achieve a more V-shaped or angular facial profile, typically associated with a more mature look. The removal of the buccal fat pad is permanent, as the fat tissue does not regenerate once excised.
Steps of the Bichectomy Procedure
A bichectomy is generally performed as an outpatient procedure, often taking less than an hour to complete.
The surgery is typically conducted under local anesthesia, often combined with light sedation, though general anesthesia may be an option for some patients. The surgeon then makes a small incision, usually around one centimeter in length, on the inside of the cheek near the back molar teeth.
This intra-oral incision allows the surgeon to gently access the buccal fat pad without creating any visible external scars. The fat pad is then eased out through the incision, and the surgeon carefully removes a predetermined amount of the fat tissue.
Once the desired volume reduction is achieved, the small incisions are closed with dissolvable sutures, which eliminate the need for a follow-up visit to have stitches removed.
Recovery, Expected Results, and Potential Complications
Recovery from a bichectomy allows most patients to return to daily activities within a few days. Swelling and mild discomfort in the cheeks are expected, typically peaking within the first two to three days after the procedure.
Initial swelling can temporarily make the cheeks appear fuller than before the surgery, and it takes several weeks for the majority of this inflammation to subside. Patients are advised to maintain meticulous oral hygiene, often using antiseptic mouth rinses, and to follow a liquid or soft diet for the first few days to protect the internal stitches.
While some initial slimming may be noticeable after the first few weeks, the final, sculpted results take significantly longer to appear as the deeper tissues settle. True final results are typically visible only after three to six months, once all residual swelling has completely resolved. Since the buccal fat pad is permanently removed, the resulting contour is permanent, though the long-term appearance will still be affected by the natural aging process and weight fluctuations.
Infection is a risk, especially given the intra-oral incision. Rare but serious risks include temporary or permanent damage to the facial nerve branches, which run close to the buccal fat pad and control facial expressions. There is also a risk of damage to the parotid duct, which carries saliva from the parotid gland.
Removing too much fat, or having the procedure too early, can lead to an overly hollowed or gaunt appearance later in life, especially since natural facial fat volume tends to decrease with age. This potential for an aged look years down the line makes careful patient selection and precise fat removal by the surgeon paramount.