What is Buccal Fat Removal (Bichectomy)?

Today, both men and women turn to various cosmetic procedures to achieve a youthful and healthy appearance that aligns with their aesthetic ideals. One such popular procedure is buccal fat removal, also known as bichectomy.

Bichectomy, commonly referred to as cheek reduction surgery, enhances the overall facial contour. By removing excess buccal fat from the cheeks, the procedure helps create more defined cheekbones and a slimmer, more sculpted facial appearance.

Who Is a Suitable Candidate for Buccal Fat Removal?

Buccal fat removal (bichectomy) is generally recommended for men and women over the age of 18 who are of normal weight and have a naturally round facial structure. However, it is typically not advised for individuals who are significantly overweight, obese, or over the age of 45.

Over time, the buccal fat pads (also known as Bichat’s fat pads) naturally decrease in volume. Removing them at an older age can accelerate facial aging. Therefore, each case must be individually assessed, and a thorough evaluation by a qualified surgeon is essential.

To determine whether you are a suitable candidate for bichectomy, your doctor may ask you several health-related questions and request specific tests prior to the procedure.

Bichectomy helps achieve a longer and slimmer facial appearance by reducing excessive fullness in the cheeks. Since it is typically performed as an outpatient procedure, most patients are discharged on the same day.

How Is Buccal Fat Removal Performed?

Buccal fat removal, also known as cheek reduction surgery, is an outpatient procedure typically performed under local anesthesia. Before the surgery, it is crucial to maintain good oral hygiene, as this reduces the risk of post-operative infections.

During the procedure, the surgeon makes a small incision inside the cheek, near the buccal fat pads. After administering local anesthesia, the surgeon carefully accesses the fat pads (known as Bichat fat pads) using forceps and removes an appropriate amount to create a more sculpted and natural appearance. Once the fat is removed, the incision is closed with sutures.

This process is repeated on both sides of the face. At the end of the surgery, a compression bandage is applied to help support the healing process. The entire procedure takes approximately 30 to 45 minutes, and patients are typically discharged on the same day.

Before Buccal Fat Removal Surgery

To ensure a smoother and faster recovery after buccal fat removal, patients are advised to stop consuming alcohol and discontinue smoking at least one week prior to the procedure. Additionally, any use of aspirin or blood-thinning medications should be ceased, as they may increase the risk of bleeding during surgery.

Patients who are on regular medications due to existing health conditions must inform their surgeon about all the drugs they are taking before the procedure. Pregnant women or individuals with serious medical issues should consult with a doctor before deciding to undergo buccal fat removal surgery.

After Buccal Fat Removal Surgery

Recovery following buccal fat removal may vary from patient to patient. However, most individuals begin to see signs of healing within approximately 14 days after the procedure. During the first three days post-surgery, it is recommended to consume soft foods and cold beverages to minimize the risk of bleeding. Patients should also avoid direct sun exposure during this period.

Following the removal of the buccal fat pads, any inflammation that occurs — usually around the lower jaw area — typically resolves within 3 to 6 months.

The surgery enhances the definition of the cheekbones and creates a more elongated, contoured appearance of the face.

Results of Buccal Fat Removal

Since buccal fat removal is an outpatient procedure, patients can typically return to their daily routines shortly after surgery.

In the event of infection, it is crucial to follow your doctor’s instructions regarding prescribed antibiotics and oral care products to ensure proper healing and prevent complications.

Patients are usually required to wear a compression bandage for at least 2 hours post-operation to minimize swelling and bruising. Some swelling in the facial area is normal and expected.

To further reduce swelling, a cold compress can be applied directly to the cheeks for 15 minutes every 4 hours during the first three days. Because the procedure is performed inside the mouth, it is essential to rinse with salt water every 12 hours and take the prescribed medications as instructed for the first 7 days.

Patients should also avoid intense physical activity for the first 5 days. After this period, they can typically resume their normal daily activities. For those who undergo the procedure during the summer months, regular use of sunscreen is highly recommended.

One of the advantages of buccal fat removal is that it does not leave any visible scars. Since the incisions are made inside the mouth, there are no external marks.

While patients often expect a dramatically new facial appearance after surgery, it's important to note that the procedure primarily enhances the contour of the lower face and jawline. Final results may take time to fully settle and will vary depending on the individual’s healing process.

Is the Hollywood Cheek Aesthetic the Same as Buccal Fat Removal?

Hollywood cheek aesthetics and buccal fat removal (bichectomy) are often confused, but they are not the same procedure. While buccal fat removal targets only the fat pads in the cheeks, resulting in a more subtle facial contouring, Hollywood cheek aesthetics involve a more dramatic transformation of the face.

The Hollywood cheek procedure is more complex and includes the removal of a greater amount and different types of fat compared to a standard bichectomy. In addition, it often involves enhancements to the cheekbones and jawline to create a more sculpted, high-definition appearance.

Potential Risk Factors After Buccal Fat Removal Surgery

As with nearly all surgical procedures, unexpected complications or risk factors may arise following buccal fat removal (also known as facial slimming surgery). Since this procedure involves the removal of fat from the cheek area, there are specific risks that patients should be aware of. Therefore, it is crucial to thoroughly research the surgeon beforehand and review their experience and previous procedures.

Although buccal fat removal is generally considered a minor surgery, there is still a risk of damage to facial nerves, which could lead to facial paralysis or permanent nerve injury. Due to the proximity of the buccal fat pads to the salivary glands, there is also a potential risk of injury to these glands. For this reason, choosing a highly experienced and specialized surgeon is extremely important.

Some of the potential risks and complications that may occur after buccal fat removal include:

• Bleeding
• Infection
• Delayed wound healing
• Hematoma (accumulation of blood)
• Adverse reactions to anesthesia
• Fluid accumulation (seroma)
• Numbness or altered sensation
• Swelling
• Facial nerve injury
• Tongue trauma
• Facial asymmetry
• Unsatisfactory aesthetic results
• Need for revision surgery
• Persistent pain

To ensure a smooth recovery, it is essential for patients to follow their surgeon’s post-operative instructions closely. However, as with any surgical intervention, unforeseen complications may still occur.

Are There Any Harms or Long-Term Side Effects of Buccal Fat Removal?

The most critical factor in the success of buccal fat removal is the surgeon performing the procedure. The techniques used, combined with the surgeon’s expertise and aesthetic approach to facial anatomy, play a key role in the outcome.

Generally, buccal fat removal does not have any widely recognized long-term harms. However, certain risks related to the surgical process may still arise. Because the buccal fat pads are located close to facial nerves, pressure applied during the operation may result in temporary or, in rare cases, lasting pain or discomfort. Among all potential issues, the most common complication associated with the procedure is the risk of infection.