Bichectomy

Although beauty trends change every decade, the “V” shaped face form created by sharp facial features, prominent cheekbones, and a thin jawline is accepted as the unchanging peak of aesthetic perception. When we look at the facial structures of icons like Angelina Jolie, Bella Hadid, or Margot Robbie, we see that the common point is the slight hollowness in the cheeks and the resulting strong bone structure.

Many people, even if they are at their ideal weight, complain about the roundness of their face or “chubby” cheeks. Diets are made, hours are spent in gyms, the body gets thinner, but those cheeks just don’t go away. The reason for this is that the structure of the fat tissue in our cheeks is different from other fats in our body. The medical way to get rid of these stubborn fat pads and shape the face like a sculptor is Bichectomy.

Known among the public as “Cheek Thinning” or “Hollywood Cheek,” this procedure is a magic touch that changes the whole air of the face when performed on the right patient with the right technique. However, like every aesthetic procedure, Bichectomy is a surgical procedure that needs to be considered seriously.

In this giant guide; we will answer all your questions in the finest detail, from the anatomical foundations of Bichectomy to who should never have this surgery, from the moment of operation to nutrition tips during the recovery process.

Table of Contents

What is Bichectomy? An Anatomical Look

Bichectomy is the surgical removal of the fat tissue located in the deep part of the cheeks, called the “Bichat Fat Pad” (Buccal Fat Pad).

What is the Bichat Fat Pad? There are two types of fat tissue in our face:

Subcutaneous Fats: Superficial fats whose volume changes when we gain or lose weight.
Deep Fat Pads (Bichat): This is our target. These fats are encapsulated fat packets located deeply between the chewing muscles (masseter and buccinator).

The biological task of these fats is to prevent the cheeks from sticking together and ensure the sliding of muscles during the sucking reflex in infancy. However, in adulthood, these fats have no functional task. Genetically, in some people, these pads are larger than normal or the facial skeleton is small; this gives the person a heavier, “baby face” expression than they are. These fats are independent of metabolism; meaning no matter how much you diet, they do not melt. Bichectomy allows the thinning of the face by removing these resistant fats.

Who is a Suitable Candidate for Bichectomy?

Bichectomy is not a procedure that can be applied to everyone. When done to the wrong patient, it can make the person look old and gaunt. The ideal candidate profile is as follows:

Ideal Candidates:

Round / Square Face Line: People with a wide face and full cheeks.
Those at Ideal Weight: Those whose face looks heavy even though their body mass index is within normal limits.
Those with Indistinct Cheekbones: Those whose cheekbones remain buried due to cheek fullness.
Those with Asymmetry Problems: Those where one cheek looks more swollen than the other.
Those with Realistic Expectations: Those who want their lines to become prominent, not their face to change completely.

Who Should Not Have Bichectomy? (Contraindications):

Those with Very Thin Faces: If your face is already thin and long, removing these fats will give you a “skeletal” and sick appearance.
Advanced Age (Over 45-50): Fats in the face naturally melt and sag with age. Removing this support tissue at an advanced age can accelerate signs of aging and cause the face to collapse.
Overweight Individuals: In patients at the obesity limit, the reason for the chubby appearance of the face is not only Bichat fats but subcutaneous fats. Weight loss is recommended first.

Pre-operative Preparation and Planning

You have decided and met with your doctor. How does the process proceed?

Physical Examination: Your doctor analyzes your cheek thickness, skin quality, and cheekbone structure. They locate the fat pads by asking you to slightly vacuum your face (sucking cheeks in).
Expectation Management: How much thinning will occur is discussed. Remember, Bichectomy is not a weight-loss surgery, it is a contouring surgery.
Medications: Blood thinners (Aspirin etc.), Vitamin E, and herbal teas should be stopped 1 week in advance as they will increase the risk of bleeding.
Oral Hygiene: Since the operation will be performed intraorally, having dental cleaning done before surgery and paying attention to oral hygiene reduces the risk of infection.

How is Bichectomy Surgery Performed? Technical Details

Bichectomy is a delicate procedure that looks technically simple but requires deep anatomical knowledge. Because facial nerves and salivary gland ducts pass right next to the Bichat fats.

1. Anesthesia: Usually performed under Local Anesthesia. Just like at the dentist, only your cheeks are numbed. The patient is awake, can talk, but does not feel pain. If the patient is very excited, Sedation (light sleep) can be added. If combined with other aesthetic surgeries (Nose, Face Lift), general anesthesia is preferred.

2. Incision: The surgeon makes a small incision of approximately 1 cm into the cheek mucosa from inside the mouth, at the level of the upper molars. Since the incision is inside the mouth, there is no visible scar from the outside.

3. Removal of Fat: After the incision is made, the surgeon reaches the Bichat fat pad with special instruments or finger pressure. When the fat capsule is opened, the yellow-colored fat tissue, the size of a hazelnut or walnut, pops out.

Critical Point: Not all fat is removed. Usually, a 40-50% portion is taken. Removing all of it can cause cheek collapse in the future. The amount is balanced for both sides according to the asymmetry of the face.

4. Closure: After the fats are removed and bleeding control is done, the incision site is closed with 1 or 2 self-dissolving stitches. There is no trouble of removing stitches.

5. Duration: The entire procedure takes between approximately 30 and 45 minutes.

Recovery Process: What Awaits You?

The recovery process after bichectomy is quite comfortable, but there is a short edema period affecting “social life.”

First 24 Hours:

The patient can return home immediately after the procedure.
A special bandage compressing the cheeks may be applied (according to doctor’s preference), this bandage is removed after 2-3 hours.
Pain is minimal, slight aching passes with simple painkillers.
Ice Application: Applying ice to the cheek externally every 15 minutes on the first day is vital to reduce swelling (edema).

Nutrition (First 3 Days): This is the most critical period. Since there are stitches inside the mouth:

Liquid and Soft Diet: Foods that do not require chewing should be consumed. Like soup (warm), yogurt, pudding, puree, smoothie.
Hot is Forbidden: Hot foods can increase bleeding and loosen stitches. Everything should be warm or cold.
Grainy Food Forbidden: Small grainy foods like rice, bulgur, or crackers that can escape between stitches should be avoided.

Oral Hygiene: After every meal, the mouth must be rinsed with the antiseptic mouthwash given by the doctor or saltwater gargle. Teeth can be brushed gently without touching the suture area.

Edema (Swelling) Period:

Swelling reaches its maximum level in the cheeks on the 2nd and 3rd day after surgery. You may look like a “Hamster” or as if you had a tooth extracted. This is completely normal.
Swelling subsides rapidly starting from the 1st week.
In the 2nd week, the face returns to normal, but the actual thinning has not started yet.

Seeing Results: Patients usually expect their faces to thin immediately after surgery, but this is a misconception. The face looks more swollen at first due to edema.

Real Result: The hollowness (contour) in the cheeks starts to be felt from the 3rd week.
Final Result: The full effect is seen between the 3rd and 6th month with the complete removal of edema and the skin adapting to its new shape. Patience is the key to this business.

Advantages and Disadvantages

Every procedure has its pros and cons.

Advantages:

Scarless: Since the incision is inside the mouth, no scar remains on the face.
Permanent: Removed fat cells do not come back. Even if you gain weight, your cheeks will not become as full as before.
Fast: Can be done as a lunch break aesthetic.
Effective: Sharpens facial features, gives a more mature and attractive expression.

Disadvantages / Risks:

Difficult to Reverse: Removed fats cannot be put back (but fat injection can be done from elsewhere).
Aging Effect: If taken excessively, it can create a collapse (gaunt look) in the face in advanced ages.
Nerve Damage: Although very rare (in inexperienced hands), branches of facial nerves can be damaged, leading to temporary lip asymmetry.
Salivary Gland Damage: Stensen’s duct (salivary duct) is close to the incision area, if damaged, saliva accumulation may occur.

Procedures That Can Be Combined with Bichectomy

The face is a whole. Sometimes just thinning the cheeks is not enough for the perfect “V” shape. When Bichectomy is combined with the following procedures (Profileplasty), the results become much more striking:

1. Chin Filler (Jawline): While the cheek is emptied with Bichectomy, the face is made more triangular and sharp by filling the jawline and chin tip.

2. Cheekbone Filler: If the cheekbone above is highlighted with filler while the cheek becomes hollow, a “lift” effect is created and the face looks thinner.

3. Double Chin Liposuction: While the cheeks thin, the sagging of the double chin spoils the image. The face-neck connection is sharpened by removing the fats under the chin (liposuction).

4. Masseter Botox: If the reason for the width of your face is not only fat but also the width of the chewing muscles (masseter), Bichectomy alone is not enough. The muscle is reduced with Masseter botox, fat is removed with Bichectomy. This duo is the golden combination of “Face Slimming.”

Bichectomy in Men

Bichectomy is not unique to women. Men who want to have angular and bony facial features like Brad Pitt also frequently prefer this procedure.

Difference: In men, the aim is not to thin the face too much and feminize it. The aim is only to remove cheek fullness and show the jawline more masculine and muscular. Therefore, a more conservative (less amount) removal is done in men.

Frequently Asked Questions

Will my cheeks sag after Bichectomy? No, on the contrary. Since the inside of the cheek empties, the cheekbones emerge and the face looks more “up.” However, in elderly patients with very poor skin elasticity, there may be some loosening since fat support is taken. Therefore, patient selection is important.

Will I have difficulty eating? There may be slight restriction and sensitivity in mouth opening for the first 2-3 days. However, your chewing function is not affected. Staying away from hard foods is recommended for your comfort.

Can I smoke after surgery? Smoking is the biggest enemy that delays the healing of intraoral wounds and increases the risk of infection. It is strongly recommended not to smoke at least until the stitches heal (first 1 week).

Does Bichectomy make you age? This is the biggest urban legend and also the biggest fear. Answer: It depends on who it is done to. If done to someone whose face is already thin and has little fat tissue, yes, it can make them look old in the future. However, when done to the right patient with full cheeks, round face, and excess fat tissue, it does not age, on the contrary, it shapes the face. The keyword is “correct patient selection” and “correct amount of removal.”

Conclusion: Get Rid of Excess on Your Face

Bichectomy is one of the procedures that creates a big difference with a small touch in facial aesthetics. It is a powerful solution for those tired of the constant question “Did you gain weight?”, those trying to hide their cheeks in photos, or those dreaming of a more sophisticated, bony facial line.

However, remember, your face is your signature. To not spoil this signature, setting out with an experienced plastic surgeon or oral and maxillofacial surgeon who knows anatomy very well, and knows not how much to take but “how much to leave,” is the most important step.

Achieving those sharp lines of your dreams can be as close as a 45-minute procedure.