Buccal fat removal (bichectomy)

Buccal fat removal (bichectomy) is an operation intended to reduce fullness in the middle of the cheeks. It is also popularly known as Hollywood cheek surgery. We make a small incision inside the mouth and remove excess cheek fat through it.

You can point out the part of your cheeks you would like to slim. We examine the volume in the middle of the cheeks in relation to your cheekbones and jawline.

The source of cheek fullness

Inside the cheek lies Bichat’s fat pad, also called the buccal fat pad, the fatty tissue within the cheek. Bichectomy removes a portion of this fat. The volume of the fat pad varies from person to person and may also differ between the right and left cheeks of the same person.

The cheekbones, lower jawbone, chewing muscles, and fat all contribute to facial width. Roundness in the middle of the cheeks may relate to fat, while an angular lower face may relate to bone or chewing muscles. Buccal fat removal reaches the fat inside the cheek and reduces its volume. The bone and muscle structures retain their shape.

Cheek fat can be resistant to weight loss. Even if you lose weight overall, fullness in the middle of your cheeks may remain. In this situation, we look at cheek volume in relation to the other parts of the face.

Bichat’s fat pad lies among the deep tissues of the cheek, separate from the superficial fat layer directly beneath the skin. Extending between muscles involved in chewing, this fat also serves as a gliding layer during movement of neighboring structures. Buccal fat removal targets the portion of this deep fat structure that contributes to cheek fullness.

Fullness over the cheekbone and cheek volume beside the corner of the mouth belong to different anatomical areas. The prominence of the cheekbone, superficial fat compartments, and Bichat’s fat pad shape different parts of the face. Not every area that appears full is therefore within the scope of buccal fat removal.

Facial fat occupies different compartments. The middle of the cheek may be full while there is little volume over the cheekbone or around the mouth. Fullness in neighboring areas is also considered when deciding which compartment to remove fat from. A photograph focused only on the middle of the cheek may not show the full distribution.

Who may be considered?

Buccal fat removal may be considered for people with pronounced fullness in the middle of the cheeks who would like this area to be slimmer. In a thin, narrow face where cheek volume is already low, fat removal may not be appropriate. The location and amount of existing fullness guide the decision.

If weight is still changing, current cheek fullness is interpreted in that context. A stable weight helps show which facial areas remain full. During the consultation, you can describe how your cheeks, temples, and the area beneath your chin have changed with weight changes.

If there is hollowing beneath the cheekbone or little volume in the middle of the cheek, removing fat may not fit that appearance. With skin laxity, tissue position matters more than tissue amount. Since buccal fat removal does not remove skin, a request for cheek slimming and a request to address excess skin are considered separately during the examination.

A wide facial appearance may result from the structure of the lower jaw angles or the volume of the chewing muscle called the masseter. In this situation, a plan targeting fat inside the cheek may not address the source of the width. If a front view shows that width is concentrated at the jaw angles, the examination focuses on the bone and muscle structure of that area.

General health suitable for surgery and the absence of active infection inside the mouth are part of the suitability assessment. If there is an uncontrolled illness, the decision about cosmetic surgery is made after that condition has been clarified. The condition of the teeth, gums, and inner cheek surface is also considered before a procedure through the mouth.

What is assessed during a buccal fat removal consultation?

The examination identifies whether fullness is concentrated beneath the cheekbone, beside the corners of the mouth, or along the jawline. A front view shows facial width, and an oblique view shows the transition between the cheek and cheekbone area. A side view can show how cheek volume relates to the nose and chin.

The cheeks may look different at rest and during facial movements. When the teeth are clenched, prominence of the muscle at the jaw angle helps clarify the relationship between width and muscle. Examining cheek tissue thickness and muscle movement helps identify which tissue accounts for the fullness seen in a photograph.

Previous filler, fat injections, or surgery in the cheek area may affect how current volume is interpreted. You may also be asked which parts of your face changed with weight changes. The aim is to distinguish fullness caused by the buccal fat pad from the appearance created by other tissues.

Keeping the head upright and the cheeks uncovered by hair in photographs helps show where cheek fullness is located. A pose with the cheeks sucked inward or lips pursed can make resting volume look different. Front and oblique photographs can be used to explain the desired change. Tissue thickness and its relationship with muscle are understood through examination by hand.

If one cheek looks fuller than the other, the difference may not come entirely from the fat pad. Cheekbone placement, the direction of the lower jaw, and chewing muscle volume may differ within the same face. In a plan addressing asymmetry, the tissue to be removed from each side is therefore determined according to its own anatomy. Equalizing fat amounts and changing all right-to-left facial differences are separate goals.

Facial proportions and the surgical plan

The fat pads in the two cheeks may differ in volume. The examination also explores how this difference relates to bone structure, muscle volume, and soft tissue distribution. Removing the same amount of fat from both sides is not a necessary condition for a plan suited to facial proportions.

We listen to the slimming you have in mind for the middle of your cheeks and relate your wishes to the shape of your cheekbones and jawline. If you would also like to change an area of your nose or chin, you can share this during the same consultation. We can add buccal fat removal to other facial operations, including performing it within the same surgical plan as rhinoplasty.

Reducing fullness inside the cheek does not change cheekbone height or lower jaw width. The examination can explain how bone structure and fat distribution create a face shape you like. A prominent cheekbone or jaw angle in a photograph lies outside the area changed by removing cheek fat. When sharing a photograph, you can point out the particular transition you like.

When describing cheek slimming, making the whole face smaller and reducing fullness beneath the cheekbone are different requests. Facial width relates to bony boundaries, while the contour through the middle of the cheek is influenced by soft tissue. Pointing out the area you would like to change during the examination helps determine whether your wishes match the fat tissue accessible through the mouth.

The procedure through the mouth

We can perform buccal fat removal under local anesthesia, numbing only the cheek area. We make a small incision inside the cheek near the upper teeth. Through it, we reach the fat and remove the excess in a controlled manner. We then close the incision inside the mouth with dissolvable sutures.

The incision inside the mouth lies in the inner lining of the cheek, called the mucosa. This route reaches buccal fat, which is separate from superficial subcutaneous fat. Its relationship with the upper teeth and the position of the salivary gland duct opening into the cheek are considered when choosing the incision location.

The procedure is planned according to the fat pad’s contribution to cheek appearance and the volume of surrounding tissues. The portion to be removed relates to existing fullness and the extent of the buccal fat pad. The surgical plan targets part of this structure. Reaching the fat inside the cheek and shaping the cheekbone are different surgical procedures.

The terms cheek reduction and cheek slimming may be used for different procedures. Bichectomy specifically refers to removing tissue from the buccal fat pad. When explaining the method, incision location, the targeted fat compartment, and whether there is an additional procedure for bone or muscle are therefore discussed separately.

Differences between cheek slimming methods

Liposuction removes subcutaneous fat using a thin instrument called a cannula. Buccal fat removal takes tissue from Bichat’s fat pad through the mouth. Because fat compartments in the cheek, beneath the chin, and in the neck require different access routes, the plan follows the location of fullness.

Fillers or fat injections add volume to a particular facial area. Facelift procedures address soft tissue position and excess skin. Buccal fat removal reduces fat volume inside the cheek. During the examination, the need to reduce volume, add volume, or reposition tissue is distinguished according to these tissues.

Fullness in the lower cheek and downward-shifted tissue beside the corner of the mouth may create a similar impression of heaviness in the mirror. Skin elasticity and the tissue’s position relative to the jawline help clarify the distinction during the examination. Buccal fat removal reduces fat, while surgery addressing the position of sagging tissue requires a different anatomical plan. You can begin the consultation by showing which area your wish for cheek slimming concerns.

Planning with nose and chin procedures

A recessed chin affects the shape of the lower face, while fullness in the middle of the cheeks affects the sides of the face. If chin surgery and buccal fat removal are considered together, separate goals are set for chin projection and cheek volume. Reducing cheek volume does not change the position or forward projection of the chin bone.

Fullness beneath the chin and Bichat’s fat pad inside the cheek occupy different locations. A procedure for the neck and area beneath the chin does not target the same anatomical region as buccal fat removal. When describing fullness in the lower face, pointing separately to the corner of the mouth, jawline, and area beneath the chin clarifies the scope of the procedure.