What Is Bichectomy (Buccal Fat Removal)?
Who Is It For, How Is It Performed, Recovery Process, and Pricing
What Is Bichectomy?
Short Answer: Bichectomy is an aesthetic surgical procedure that makes facial contours appear slimmer and more defined through the controlled removal of the Bichat fat pads located in the middle portion of the cheeks. The procedure can be performed under local anesthesia in most patients and leaves no externally visible scar.
In facial aesthetics, the goal is not merely to look more attractive, but to achieve a more balanced and harmonious appearance while preserving the natural proportions of the face. Some individuals have genetically full cheeks despite being at their ideal body weight. This can cause the face to be perceived as rounder, wider, or more baby-faced than it actually is. Bichectomy is a surgical procedure that comes into play at precisely this point to refine and define facial contours.
Commonly known as “cheek thinning surgery” or buccal fat removal, bichectomy is performed by the controlled removal of the fat tissue inside the cheek called the Bichat fat pad (buccal adipose tissue or buccal fat pad). This fat pad is present in every person, but its volume varies from individual to individual. When this structure is prominent in certain individuals, the face may appear fuller regardless of overall body weight.
During a bichectomy, the goal is not to remove the entire fat pad. Removing excessive fat can lead to volume loss and a gaunt, hollowed appearance in the face, particularly in later years. An experienced plastic surgeon plans the exact amount of fat to be removed on a personalized basis by evaluating the patient's age, skin structure, cheekbone prominence, jawline, and future aging process.
In recent years, as the V-shaped facial appearance and defined facial contours have gained prominence on social media, interest in bichectomy has grown. However, this procedure yields successful results when performed on patients with a genuine anatomical need—not simply because it is a trend. Not every round face requires a bichectomy, and not every patient may be a suitable candidate.
Why Is Bichectomy Performed?
Short Answer: Bichectomy is performed to reduce persistent fullness in the cheeks, thereby making the cheekbones and jawline more prominent. The aim of the procedure is not to make the face look emaciated, but to make facial proportions appear more balanced.
Bichectomy is an operation performed for aesthetic refinement. Its primary objective is to create a more balanced profile without disrupting the natural anatomy of the face. Through the controlled reduction of cheek volume, the middle portion of the face appears slimmer while the cheekbones stand out and the lower facial contours become more defined.
Many people notice that even when they lose weight and their overall body fat decreases, the fullness in their face remains unchanged. The reason for this is often a constitutionally large Bichat fat pad. This deep fat compartment does not always respond to diet and exercise at the same rate as subcutaneous body fat. Consequently, losing weight alone may not provide the desired facial contour in some individuals.
Bichectomy is particularly preferred by individuals wishing to achieve the following aesthetic goals:
- Achieving slimmer facial features.
- Making the cheekbones appear more prominent.
- Creating a sharper, more defined jawline.
- Sculpting the lower facial contours.
- Giving the face a more oval or V-shaped appearance.
- Wanting the face to look slimmer in photographs.
However, balance is always paramount in facial aesthetics. Performing an unnecessary bichectomy on faces that are not overly full can result in an aged and volume-depleted appearance over the years. Therefore, surgical planning must take into account not only today's appearance, but also the natural aging process that will occur in the future.
Who Is a Candidate for Bichectomy?
Short Answer: Bichectomy is a suitable aesthetic surgery for adult individuals who have completed their facial development, have noticeable fullness in their cheeks, are in good general health, and hold realistic expectations.
Like every aesthetic operation, bichectomy yields successful results through proper patient selection. The decision for surgery should not be based solely on the individual's request, but rather on a detailed evaluation of facial anatomy.
Suitable candidates for bichectomy are generally individuals whose faces appear wide or round, who feel that their cheeks negatively affect their facial proportions, and who desire more defined facial contours. The procedure can provide particularly effective results in individuals whose cheek fullness persists despite being at their ideal weight.
In individuals with strong facial bone structure that is masked by excess cheek volume, the cheekbones can become much more visible after surgery. Nevertheless, not every full face is caused solely by the Bichat fat pad. Skin thickness, facial muscle volume (such as the masseter muscle), jaw structure, and overall facial proportions must also be evaluated.
The main characteristics looked for in ideal candidates include:
- Completion of facial development.
- Good general health status.
- Ability to control or cease smoking.
- Having realistic aesthetic expectations.
- Cheek fullness originating from structural buccal fat volume.
An experienced plastic surgeon evaluates not only cheek volume, but also the proportions between the forehead, cheekbones, nose, lips, and chin together to decide whether a bichectomy is truly necessary.
Who Should Not Undergo Bichectomy?
Short Answer: Bichectomy may not be suitable for individuals with very thin facial structures, those who have not completed their facial development, older patients with noticeable volume loss, or individuals with unrealistic expectations.
Bichectomy is not a standard procedure that can be applied to every patient. In some cases, alternative aesthetic methods may be recommended instead of surgery.
Particularly in individuals who already have a narrow and thin facial structure, removing the buccal fat pads can cause the face to look gaunt and hollow. Similarly, because natural volume loss develops in the face as age advances, very careful planning must be done in older patients.
Procedures performed before facial development is complete are also not recommended. Since facial fat distribution at a young age can change over time, making an early surgical decision may not be appropriate.
In patients with an active intraoral infection, the infection must be treated first before surgical planning takes place. Detailed preoperative evaluation is also required in individuals with bleeding disorders or uncontrolled systemic diseases.
Bichectomy should not be performed merely to imitate every facial look seen on social media. Every individual's facial structure is unique, and a successful outcome is achieved through planning tailored to the person's own anatomy.
Why Are Preoperative Consultation and Planning So Important Before Bichectomy?
Short Answer: The success of a bichectomy depends not only on the surgery itself, but on the detailed facial analysis performed beforehand. Proper planning forms the foundation for natural results that provide satisfaction for many years.
A successful bichectomy does not begin the moment the patient enters the operating room; it starts with a comprehensive evaluation in the examination room. Every face has a distinct bone structure, fat distribution, skin thickness, and aging trajectory.
During the consultation, the patient's expectations are listened to first. While some patients only want their cheeks to look slightly slimmer, others may aim for more prominent cheekbones or a sharper jawline. The surgeon's role is to assess whether these expectations are harmonious with the patient's facial anatomy.
Next, the face is analyzed from multiple angles. The prominence of the cheekbones, the projection of the lower jaw, the structure of the chin tip, facial symmetry, and cheek volume are examined together. In some patients, the issue is not solely an excess of buccal fat; a recessed chin tip, under-projected cheekbones, or fat accumulation in the submental (double chin) area can also contribute to the face looking rounder. Therefore, bichectomy is never evaluated in isolation from the rest of the face.
Photographic analysis is also an important part of planning. Facial proportions are assessed on photographs taken from frontal, profile, and three-quarter angles. In this way, the appearance targeted after surgery can be planned more realistically.
Skin quality and skin elasticity are also taken into consideration during the examination. While the face adapts more easily to its new contours in individuals with young and elastic skin, skin laxity that develops with advancing age may require evaluating additional treatment options.
Finally, the patient's general health status, current medications, smoking habits, and previous surgeries are reviewed. All of this information ensures both safe surgical planning and a more predictable recovery process.
The secret to a successful bichectomy lies not in removing the same amount of fat from everyone, but in creating a plan tailored to each patient's face that preserves a natural look and maintains aesthetic balance over the long term.
How Is Bichectomy Performed? Local Anesthesia, Bichectomy in Men and Women, and Ideal Age
How Is Bichectomy Performed?
Short Answer: Bichectomy is based on the principle of controlled removal of the Bichat fat pad through a small incision of approximately 1 to 2 centimeters made inside the mouth. The procedure takes an average of 30 to 60 minutes, leaves no scar on the skin, and most patients are discharged the same day.
Bichectomy is one of the most frequently performed minimally invasive surgical procedures in facial aesthetics. One of the greatest advantages of the operation is that because the incision is made entirely inside the mouth, it leaves no externally visible surgical scar. This provides a major advantage both aesthetically and in terms of the patient's return to daily life.
According to the preoperative facial plan, the amount of fat to be removed from each cheek is determined. During surgery, a small incision is made in the oral mucosa near the level of the upper molar teeth. Through this incision, the Bichat fat pad is accessed. The fat tissue is gently teased out in a controlled manner using specialized surgical techniques, and only the necessary portion is excised.
The most crucial point here is not to remove as much fat as possible, but to remove an amount that preserves the natural anatomy of the face. Although removing excessive fat may seem to provide dramatic slimming in the first few months, it can lead to hollow cheeks and an aged facial expression in subsequent years.
Once symmetry is achieved on both cheeks, the intraoral incision is closed with dissolvable sutures. After the procedure is completed, the patient is kept under brief observation and discharged on the same day.
Can Bichectomy Be Performed Under Local Anesthesia?
Short Answer: Yes. Bichectomy can be safely performed under local anesthesia in most patients. No pain is felt during the procedure, and the patient can return home the same day.
The most commonly preferred anesthesia method for bichectomy is local anesthesia. With local anesthesia, only the surgical site is numbed, and the patient feels no pain throughout the procedure. Even though the patient is awake, they experience no discomfort during the surgery.
An important advantage of local anesthesia is the elimination of risks associated with general anesthesia. In addition, recovery time after the procedure is shorter, allowing patients to return to their daily routines more quickly.
In some patients, however, general anesthesia or sedation may be preferred. The main reasons for this include high surgical anxiety or planning the bichectomy in the same session alongside other operations such as rhinoplasty, chin surgery, facelift, or submental liposuction.
The choice of anesthesia should always be determined individually based on the patient's general health status, expectations, and planned procedures.
How Long Does Bichectomy Surgery Take?
Short Answer: When performed alone, bichectomy surgery is generally completed within 30 to 60 minutes.
A short surgical duration does not mean the procedure is simple. Facial anatomy consists of highly complex structures, and important nerves, blood vessels, and salivary gland ducts pass through the cheek region. Therefore, it is of great importance that the operation is performed by an experienced plastic surgeon.
The duration of surgery may vary depending on the patient's anatomical structure, the amount of fat to be removed, and any additional procedures performed in the same session.
At What Age Should Bichectomy Be Performed?
Short Answer: Although there is no strict upper age limit for bichectomy, it is essential that facial development is complete. It is generally planned for suitable patients aged 20 and above.
Facial bones and soft tissues continue their development after adolescence. Therefore, aesthetic interventions performed before facial maturation is complete may lead to unpredictable results in later years.
In young adults, facial fat distribution is more stable and surgical outcomes are more predictable. For this reason, many surgeons recommend conducting an evaluation after facial development has finished.
At more advanced ages, a different assessment is required. Natural volume loss occurs in the face with aging, skin elasticity decreases, and the cheeks gradually thin over time. In such patients, unnecessary fat removal can cause the face to appear older than it is.
Consequently, age alone is not the sole determining factor. What matters is the patient's facial structure, skin quality, and long-term aesthetic planning.
Bichectomy in Men
Short Answer: The goal of bichectomy in men is to create sharper and more masculine facial contours compared to women. A natural appearance must be preserved, and excessive hollowing must be avoided.
There are distinct anatomical differences between the male and female face. In men, the jawline is stronger, the lower face is wider, and facial contours appear more angular. Therefore, when planning a bichectomy in male patients, the goal is not simply to thin the cheeks; it is to make the jawline and cheekbones more defined while preserving masculine facial character.
The most common mistake made in male patients is removing an excessive amount of fat similar to female facial sculpting. This can create over-thinning and an unnatural appearance.
During planning, the beard line, jaw width, masseter muscle volume, and overall facial proportions must be evaluated together. When necessary, combined approaches with chin augmentation or submental contouring procedures can provide more balanced results.
Bichectomy in Women
Short Answer: The primary goal of bichectomy in women is to give the face a more refined appearance, accentuate the cheekbones, and support a soft V-shaped facial contour.
In female facial aesthetics, smooth transitions and balanced contours are at the forefront. When cheek volume is reduced in a controlled manner through bichectomy, the cheekbones become more defined and the lower face can appear slimmer.
However, the exact same result is not targeted in every female patient. While some individuals desire only a subtle refinement, others may request more pronounced facial contours. The surgeon's duty is to evaluate the patient's expectations in harmony with her facial anatomy and create a plan that preserves a natural look.
Because removing an excessive amount of fat can accelerate facial volume loss in later years, a measured and conservative surgical approach is of great importance in female patients as well.
Aesthetic Procedures That Can Be Combined with Bichectomy
Short Answer: Bichectomy can be combined with different aesthetic procedures in the same session to make the face appear more balanced. The combination plan must be determined entirely according to the patient's facial anatomy.
In some patients, reducing cheek volume alone may not be sufficient to achieve the desired outcome. In such cases, complementary procedures targeting different areas of the face can be planned.
Chin augmentation (mentoplasty) can make a recessed lower jaw appear more balanced. Submental (double chin) liposuction can support the effect of bichectomy by sharpening the jawline. In individuals with insufficient cheekbone volume, the mid-face region can be sculpted with fat grafting or appropriate dermal filler applications.
When planned together with rhinoplasty, the overall proportions of the face can become much more harmonious, as the nose, cheeks, and chin are anatomical structures that directly influence one another.
In older patients, bichectomy performed alongside facelift or neck lift surgeries can contribute to achieving younger and more balanced facial contours. However, combined procedures are not necessary for every patient. Surgical planning should be tailored individually following a detailed facial analysis.
Does the Face Look Natural After Bichectomy?
Short Answer: After a bichectomy performed with proper patient selection and experienced surgical planning, a natural facial appearance is preserved. The goal is not an obvious, artificial change, but rather making facial proportions more harmonious.
A successful aesthetic surgery should make a person look more rested, balanced, and attractive rather than making people around them say, “You’ve had surgery.” That is the exact objective in bichectomy.
To achieve a natural result, not only cheek volume, but also the cheekbones, jawline, lips, nose, and forehead must be evaluated together. When facial aesthetics are approached as a whole, it is possible to achieve harmonious and lasting results rather than an overdone look.
Therefore, when deciding on a bichectomy, a person's own facial anatomy should be taken as the basis rather than social media trends or one-size-fits-all facial templates.
Recovery Process After Bichectomy, Swelling, Risks, Prices, and Frequently Asked Questions
What Is the Recovery Process Like After Bichectomy?
Short Answer: The recovery process after bichectomy is generally comfortable. Mild pain, a feeling of fullness in the cheeks, and swelling may be seen during the first few days. Most patients can return to their daily lives within a few days, although complete tissue healing takes several months.
Because bichectomy is performed through a small incision inside the mouth, the recovery process is faster compared to many other aesthetic surgeries. The absence of an external skin incision prevents visible scarring and helps patients return to social life in a shorter time.
A feeling of tightness in the cheeks, mild tenderness, and swelling after surgery are expected, natural findings. The fact that the face looks fuller than before during the first few days can surprise many patients. However, the reason for this is not surgical failure, but the normal healing response of the tissues.
During the first week, the intraoral sutures begin to heal. Because dissolvable stitches are used, they usually do not need to be removed separately. Regular use of medications prescribed by the surgeon and careful attention to oral hygiene positively influence the recovery process.
How Long Does Swelling Last After Bichectomy?
Short Answer: Swelling is most intense during the first 48 hours. It decreases significantly by the end of the first week, and facial contours begin to become defined within about one month. The final result generally emerges within 3 to 6 months.
Because the cheek region has a rich vascular network, the development of edema after surgery is inevitable. Swelling is at its highest level during the first two days. During this period, the face may appear fuller than it did before surgery.
By the end of the first week, a significant portion of the swelling subsides. In the second and third weeks, the face begins to look more natural. However, patience is required as healing in the deeper tissues continues.
It is normal for swelling to be slightly more noticeable in the morning hours than later in the day. As daily movement and circulation increase, edema generally diminishes.
What Should Nutrition Be Like After Bichectomy?
Short Answer: Soft and lukewarm foods should be preferred during the first few days, and hard foods that could strain the intraoral stitches should be avoided. A balanced diet and adequate fluid intake support healing.
Preferring soft-consistency foods such as soup, yogurt, purees, kefir, and similar items during the first 24 to 48 hours helps protect the tissues inside the mouth.
Very hot foods and beverages are not recommended in the first few days. Hard-crusted foods, chips, nuts, and similar items can irritate the suture area.
A protein-rich diet supports wound healing. Eggs, fish, poultry, and dairy products can be beneficial during this period. Fruits and vegetables containing vitamin C, along with sufficient water intake, also contribute to tissue repair.
Can You Smoke or Drink Alcohol After Bichectomy?
Short Answer: Because smoking and alcohol can negatively affect wound healing, it is recommended to avoid them for a period after surgery.
Smoking reduces the amount of oxygen delivered to tissues, which can delay healing and increase the risk of infection. It can also cause the intraoral wound site to close more slowly.
Alcohol, on the other hand, can interact with certain medications and contribute to increased swelling during the first few days. Therefore, abstaining from smoking and alcohol for the duration recommended by the surgeon ensures a safer recovery process.
When Can You Exercise After Bichectomy?
Short Answer: Light walks can be resumed shortly after surgery, but strenuous exercises and intense sports activities should generally be postponed for 2 to 3 weeks.
Intense physical activity increases blood pressure, which can raise the risk of bleeding and swelling. Therefore, resting and avoiding heavy lifting during the first few days is important.
The timing of returning to sports may vary depending on the patient's healing speed. Exercise programs should be resumed gradually in accordance with the surgeon's recommendations at follow-up appointments.
What Should the Sleeping Position Be After Bichectomy?
Short Answer: Keeping the head elevated above heart level during the first few days can help reduce swelling.
Lying on the back and slightly elevating the head with two pillows is recommended throughout the first week. Sleeping face down or on the side should be avoided in the first few days as it can place pressure on the cheek area.
Is Massage Performed After Bichectomy?
Short Answer: The surgical area should not be massaged unless specifically recommended by the surgeon.
Some patients may consider massaging their cheeks to reduce swelling. However, unguided massage applied in the early period can negatively affect tissue healing. Only the operating surgeon should decide whether massage is necessary.
When Are Full Results Seen After Bichectomy?
Short Answer: Initial changes are noticed within about one month. In most patients, it takes 3 to 6 months for the final results to fully emerge.
Due to postoperative swelling, it is not accurate to judge the true result in the early period.
By the end of the first month, facial contours begin to become more defined. Complete healing of deep tissues and adaptation of the skin to the new contours continue for several months.
In individuals with thicker skin, it may take slightly longer for the final outcome to become visible.
Is Bichectomy Permanent?
Short Answer: The removed Bichat fat pad does not regenerate. Therefore, bichectomy is one of the aesthetic surgeries that provides permanent results.
However, the natural aging process and significant weight fluctuations can affect overall facial appearance. Thus, permanence should not be evaluated independently of natural aging.
What Are the Risks of Bichectomy?
Short Answer: When performed on suitable patients by an experienced plastic surgeon, bichectomy is a safe procedure. As with any surgical intervention, certain risks cannot be completely eliminated.
Complications such as infection, bleeding, temporary edema, prolonged swelling, or mild asymmetry may rarely occur.
Because facial nerve branches and salivary gland ducts are located in the cheek region, anatomical knowledge and surgical experience are paramount. Therefore, having the surgery performed by a specialist experienced in plastic surgery is crucial for safety.
How Are Bichectomy Prices Determined?
Short Answer: Bichectomy prices vary depending on the surgeon's experience, the hospital where the surgery takes place, the anesthesia method, and any additional procedures to be performed.
There is no standard flat fee in aesthetic surgeries. Because every patient's facial structure and surgical plan are different, pricing is also determined on a personalized basis.
In accordance with healthcare regulations in Turkey, the fees for aesthetic operations cannot be published online. Exact pricing information can be determined following a detailed examination and facial analysis.
Conclusion
When performed with proper patient selection and personalized planning, bichectomy is an effective aesthetic surgical method that refines facial features, accentuates the cheekbones, and creates more balanced facial contours. The success of the procedure is closely related not only to surgical technique, but also to a comprehensive preoperative facial analysis and accurate evaluation of the patient's anatomical characteristics.
Through planning that preserves a natural look and takes the future aging process of the face into account, results that provide satisfaction for many years can be achieved. Therefore, undergoing a thorough examination by an experienced plastic surgery specialist before deciding on a bichectomy is of great importance for a safe and successful treatment journey.
Frequently Asked Questions
Is bichectomy a painful surgery?
Because it is performed under local or general anesthesia, no pain is felt during the surgery. Any mild discomfort that may occur afterward can usually be controlled with prescribed medications.
Does bichectomy leave a scar?
No. Because the incision is made inside the mouth, no visible surgical scar forms on the external skin.
How many minutes does a bichectomy take?
When performed alone, it is generally completed within 30 to 60 minutes.
When can I return to work after bichectomy?
Many people with desk jobs can return to work within a few days. For those working in physically demanding jobs, this period may be slightly longer.
Is talking harmful after bichectomy?
No. Avoiding excessive facial expressions during the first few days can be helpful, but normal speaking is generally not harmful.
Can I brush my teeth after bichectomy?
Yes. However, care should be taken not to irritate the surgical site, and the surgeon's instructions should be followed.
Can I chew gum after bichectomy?
Chewing gum is not recommended during the first few weeks. Unnecessary straining of the jaw muscles should be avoided.
Can I drink coffee after bichectomy?
It is better to avoid very hot beverages during the first few days. Afterward, a normal diet can be resumed according to the physician's recommendations.
Does bichectomy cause weight loss?
No. Bichectomy is not a weight-loss method. It aims solely to sculpt and refine facial contours.
Is bichectomy reversible?
The removed fat tissue does not grow back. Therefore, the decision to undergo surgery should be evaluated carefully.
Will the face become full again after bichectomy?
The excised buccal fat pad does not return, but significant weight gain can affect other fat compartments of the face.
Is asymmetry normal after bichectomy?
Temporary asymmetry may be seen in the first few weeks due to uneven swelling. Complete tissue healing must be awaited for the final evaluation.
Is bichectomy suitable for every face type?
No. In individuals whose facial anatomy is not suitable, other aesthetic methods may be a more appropriate choice.
Can I travel by plane after bichectomy?
Air travel is generally possible shortly afterward, but the surgeon's advice should be obtained before making travel plans in the first few days after surgery.
When does the face fully settle after bichectomy?
In most patients, the final results emerge within 3 to 6 months.
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