Buccal fat removal

Buccal fat removal (bichectomy) is surgery that partially removes the buccal fat pads: two pockets of fat located in the cheeks, between the facial muscles. Reducing their volume slims the lower third of the face, accentuates the cheekbones and creates a more angular contour.

Anatomy

The buccal fat pad (Bichat’s fat pad) is an encapsulated pad of fat, distinct from the fat beneath the skin. It has a central body and several extensions reaching towards the temple, the masseter muscle and the palate. In babies it is proportionally large and helps with suckling; in adults it helps the muscles glide when chewing. Its size varies widely between people and is often asymmetrical between the two sides.

History

It is named after the French anatomist Xavier Bichat, who described it in the early 19th century. For much of the 20th century it was used mainly in oral and maxillofacial surgery as a flap to reconstruct defects in the mouth. Its removal for aesthetic purposes became popular from the late 20th century onwards.

Indications

It is indicated for people with a round face or full cheeks due to a large buccal fat pad who want a more defined face. It does not replace weight loss, does not treat sagging and is not indicated for thin faces: the face naturally loses volume with age, and excessive removal can lead to a gaunt look in the long term.

Technique

It is performed under local anaesthesia through a small incision inside the mouth, at the level of the upper second molar, so it leaves no visible scar. The capsule is opened and part of the fat is removed in a controlled way, checking symmetry between the two sides. The procedure takes less than an hour.

Risks and complications

The reported complications are mostly minor: swelling, haematoma, temporary difficulty opening the mouth (trismus) and infection. Injury to the parotid duct or branches of the facial nerve, asymmetry and over-resection are rare but possible. Scientific reviews note that the technique has few short-term complications, but that there is a lack of quality studies on its long-term effects and on how the face ages after removal. That is why patient selection is key.

Recovery and results

Swelling lasts a few days and a soft diet is advisable. The result appears gradually between six weeks and six months and is permanent, as the removed fat does not grow back.