Buccal fat removal: bichectomy and cheek reduction

Buccal fat removal surgery, or bichectomy, improves the shape of the lower face by removing excess fat from the cheeks. This cosmetic procedure, much loved by celebrities, is becoming increasingly popular and goes further than targeted liposuction of the cheeks by allowing better definition of the cheekbones. Who is it for? How is the procedure performed? What results can you expect? Here is everything you need to know about bichectomy.

What are the buccal fat pads?

The buccal fat pad is a pad of fat located on each cheek between the superficial and the deep muscles, behind the masticatory muscles. They can extend as far as the temples and then become the main cause of a rounded facial appearance, preventing proper definition of the volumes and in particular the much-sought facial oval. These fat pads vary in size from one person to another, giving some a hollow appearance and others a rounded one, regardless of each person’s body shape. It is therefore entirely possible to have a slim physique yet a face considered round, solely because of prominent buccal fat pads.

Everyone has buccal fat pads: it is a normal fatty structure, present from birth, which acts as a cushion between the chewing muscles and helps lubricate this area. So it is not their presence but their excessive volume — sometimes referred to as buccal fat pad hypertrophy — that can give the face a rounded appearance and prevent the cheekbones from standing out. It is precisely this overdevelopment, most often hereditary, that bichectomy corrects.

What is bichectomy?

People with overdeveloped buccal fat pads can undergo a bichectomy to reduce their appearance and harmonise the facial features so they look more defined and prominent. It consists of a surgical procedure performed to reduce the fatty tissue located deep beneath the cheeks, slimming the face. This procedure reduces the convexity of the cheek and makes it possible to define the cheekbones and the jawline more distinctly, in line with contemporary beauty standards.

Over time, however, the fatty mass in this area tends to melt away and sag: the face then naturally hollows out with age. This is why surgeons favour reducing the buccal fat pads rather than removing them, in order to avoid excessive hollowing in the long term and a prematurely aged look, and to maintain a balanced volume throughout life. The buccal fat pads also serve a lubricating function for the masticatory muscles and therefore cannot be removed completely.

Who is it for?

Bichectomy to reduce the buccal fat pads is an increasingly popular option among both men and women who want to reshape their face to make it slimmer. It is suited to anyone with too much fatty tissue at the cheeks preventing the volumes of the lower third of the face from being defined, whatever the patient’s build or body mass index.

While the size of the buccal fat pad varies from one person to another, this difference is most often explained by heredity rather than by diet or level of physical activity.

Buccal fat pad reduction is also not recommended for patients whose face is already too gaunt but who would nonetheless like to bring out their cheekbones; in that case, facial fat transfer to restore volume would be more appropriate. Likewise, people who are significantly overweight and considering weight loss should wait before having a bichectomy, since major weight loss can affect the size of the buccal fat pads and therefore the final aesthetic outcome. For a more stable long-term result, losing weight before the procedure is therefore advised.

What are the goals?

Bichectomy can address various concerns relating to a face considered too round, in particular because of the size of the cheeks. The procedure then aims notably to:

• treat overly voluminous cheeks;
• reduce the volume of the cheeks;
• sculpt the contours of the cheeks and improve their definition;
• slim the appearance of the face, especially its lower third.

Our buccal fat pad reduction procedure in Paris

As with any surgical procedure, bichectomy requires a prior consultation with the surgeon to define its scope.

Before the procedure

Bichectomy requires a preliminary discussion with the surgeon during which the patient sets out their expectations. This conversation allows the practitioner to assess the feasibility and the appropriateness of the procedure, in particular by analysing the patient’s face both from the front and in profile. During this discussion the patient is also informed of the potential consequences of the procedure, in particular the rare but possible injury to the salivary duct, the buccal fat pads being located close to the facial nerve and Stensen’s duct.

If all the conditions are met after this discussion and the patient remains convinced of the merits of the procedure (especially for their self-esteem), an operation date can be chosen while respecting the 15-day reflection period after the consultation.

A few pre-operative precautions must also be taken. To avoid any risk of infection, good oral hygiene is essential before a bichectomy. A visit to the dentist along with a scale and polish should therefore be carried out. Smokers must also stop all tobacco use in the 5 weeks before the procedure. In addition, as before any surgical procedure, anti-inflammatories and aspirin-based medication should be stopped 10 days before the procedure.

During the procedure

The partial removal of the buccal fat pads is a relatively minimally invasive surgical procedure that usually lasts no more than 30 to 45 minutes. It does not require hospital admission and can therefore be performed as a day case. It is most often carried out under local anaesthetic, although local anaesthetic with sedation or general anaesthetic can be considered depending on the patient’s wishes.

During the bichectomy, a micro-incision (1 to 2 cm) is made on the inside of the cheek, above the upper molars, exposing the buccal fat pad. The incision, made in the lining of the mouth, leaves no subsequent trace or visible scar. Once the fatty mass is exposed, the surgeon then proceeds to its partial removal, usually taking out between 3 and 5 square centimetres of fatty tissue, or around 50% of its volume. The result is immediately visible and can be adjusted during the procedure at the practitioner’s discretion. Once the bichectomy is complete on each cheek, the incisions are closed with sutures to avoid any visible trace. The sutures placed on the treated area are absorbable and will disappear naturally between 7 and 15 days after the procedure.

Complementary aesthetic medicine treatments can be carried out alongside the bichectomy to refine the result further. This is the case, for example, with hyaluronic acid injections in the cheeks or with jawline redefinition through jawline contouring to make the jaw squarer. When the chin itself needs to be brought forward or projected, a genioplasty to reshape the chin can harmoniously complete the result. If the concern also extends to the lower face, our article on solutions for treating a double chin details the available options for slimming this area.

After the procedure

Once the surgical procedure is complete, the patient can return home the same day. Mild post-operative pain may be felt but is easily relieved by taking painkillers. Cheek swelling will be noticeable for a few days but will subside relatively quickly. A bandage is also recommended in the first few days to limit swelling. You can also regularly apply iced water to your cheek to reduce the swelling. Drainage massages can also be performed in case of persistent swelling.

Swelling of the cheeks as well as possible bruising may require around 3 to 5 days of social downtime. It is therefore advisable to make arrangements in advance, as the buccal fat pad reduction procedure does not qualify for sick leave. It is also advisable to wait around fifteen days before resuming physical activity.

Here again, the most important point of post-operative follow-up remains oral hygiene, to achieve rapid healing and limit the risk of infection. To this end, it is advisable to favour blended food and to use mouthwash regularly during the first week, avoiding hot, spicy or acidic foods that could irritate the operated area.

A follow-up visit with the surgeon who performed the procedure is strongly advised to prevent infections. The practitioner will then set the rest of the aftercare schedule depending on how recovery progresses.

The results of bichectomy

Although the first results may be observed after 15 days to a month (especially for the slimmest faces), the final result will generally be appreciable after 3 months, once the post-operative swelling has fully subsided. According to the American Society of Plastic Surgeons (ASPS), the definitive facial contour may even continue to refine for three to six months after the procedure, while internal healing is completed. The results of bichectomy are permanent: the removed fat does not come back. After this period, the cheeks will look more defined and reduced in volume, with the jaw and cheekbones appearing more pronounced as a result. The final result looks natural and subtle, easing personal discomfort without the difference being too marked compared with before.

Risks and side effects of bichectomy

Bichectomy is a well-codified procedure regarded as low-risk when performed by an experienced surgeon, the intra-oral incision leaving no visible scar. It is not, however, without risk. The American Society of Plastic Surgeons (ASPS) points out that the main risks of buccal fat pad reduction are: asymmetry of the cheeks, injury to a branch of the facial nerve which can lead to temporary (rarely permanent) muscle weakness, injury to a salivary duct, a haematoma, an infection, prolonged swelling or a result judged insufficient requiring a touch-up.

This is why a measured and symmetrical removal is favoured: a « botched » bichectomy most often results from too much fat being removed, which can accentuate hollowing of the cheeks and give an aged appearance over the years. The permanent nature of the procedure makes this point all the more important, which is why it is best to entrust the work to a practitioner who favours caution and the natural harmony of the face rather than overly aggressive reduction.

Price and insurance coverage of bichectomy

Bichectomy is a purely cosmetic surgical procedure and is therefore not covered by the French national health insurance (Sécurité sociale). The total cost of the procedure is set by the surgeon at the pre-operative consultation and generally ranges between 2,500 and 3,900 euros, a fee relatively similar to other procedures of the same kind (cheekbone surgery, for example). This price may vary depending on whether the bichectomy is combined with other complementary treatments. The cost of the procedure is given to the patient from the first consultation, along with a detailed quote.