Bichectomy (Buccal fat removal)

A guide to understanding bichectomy

Bichectomy, commonly known as buccal fat removal, has become one of the most requested aesthetic procedures in recent years, largely due to the influence of social media and the spread of a beauty standard based on a slim facial contour and very prominent cheekbones.

It is a minimally invasive procedure with high safety standards. However, particular care must be taken when selecting suitable candidates, as it is usually requested by very young patients and performed for purely aesthetic reasons. In addition, the changes achieved are subtle, a factor that does not always match patients’ expectations.

What bichectomy involves

Bichectomy is a minimally invasive surgical procedure that consists of making a small incision on the inside of the cheeks to remove the buccal fat pads (Bichat’s fat pads), two small deposits of fatty tissue located just beneath the cheekbones. These fat pads usually weigh no more than 10 grams and are positioned between two powerful muscles: the masseter, a short and strong muscle involved in chewing; the buccinator, which enables actions such as blowing, whistling, sucking and facial gestures involving lip pursing.

The buccal fat pads do not have a specific functional role other than contributing to facial roundness. Therefore, the objective of buccal fat removal is to refine the lower face and enhance cheekbone definition by subtly hollowing the cheeks.

The procedure is performed in the operating theatre without the need for general anaesthesia. Only local anaesthesia is required and, if the patient wishes, sedation can be administered. Bichectomy, also known as buccal lipectomy, takes approximately 30 minutes and does not require hospital admission.

Indications for bichectomy

The growing demand for this procedure is largely related to a beauty ideal characterised by elongated facial features and projected cheekbones. In reality, bichectomy is performed exclusively for aesthetic reasons, as there is no medical indication for removing this fatty tissue and it has no impact on physical health.

Suitable candidates include men and women with excessively rounded faces or with a degree of disproportion in relation to the rest of the facial oval. Bichectomy may also be considered by patients who wish to slim their cheeks and enhance their cheekbones in order to achieve a more harmonious facial appearance.

“In general, the best results are achieved by combining different therapeutic options and acting at an early stage”

Recovery after bichectomy

Bichectomy is performed through two very small incisions inside the mouth, leaving no visible scars. This makes it a minimally painful procedure with an easy recovery.

In the days following the intervention, it is normal for the face to be swollen and for bruising to appear on the cheeks. These are mild effects that usually resolve spontaneously over the following days with standard painkillers and anti-inflammatory medication.

Most patients can return to their normal daily activities after three to four days, with the only additional precaution being to avoid intense physical exercise for two to three weeks, depending on the specialist’s advice and individual recovery.

In some cases, patients may experience trismus, an involuntary contraction of the chewing muscles that makes it difficult to open the mouth, speak, eat or gesture normally. This effect is not serious and usually resolves within a few days by performing oral opening exercises.

In rare cases, and usually as a result of poor technique, bichectomy can cause injury to Stensen’s duct, a structure associated with the parotid glands and salivary drainage. Damage or obstruction of this duct may lead to facial swelling, intraoral inflammation or oral infections. For this reason, despite being a quick and apparently simple procedure, it is essential that bichectomy is performed by experienced surgeons to ensure maximum safety.

Considerations regarding bichectomy

From a technical point of view, bichectomy can be performed on men and women of any age. However, younger patients are those who benefit most, as they still retain sufficient volume in the facial fat compartments and have not yet experienced the bone loss associated with the natural ageing process. In these cases, if a slimmer face is desired, reducing cheek volume by partially or completely removing the buccal fat pads can be an appropriate solution.

By contrast, mature patients usually do not have sufficient fat to remove, as ageing is associated with progressive loss of facial fat and bone density, which naturally refines the face. In such cases, other techniques such as fillers or facial implants are more suitable, which is why bichectomy is generally not recommended in mature patients.

Careful patient selection is also essential even in young individuals, as excessive fat removal at an early age may lead to a prematurely hollow or gaunt appearance. This could require early use of fillers or tightening treatments later on.

More information

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