A bichectomy is a straightforward plastic surgery designed to narrow out the mid to lower part of the face.
Sometimes referred to as “the Hollywood cheek”, a bichectomy removes the buccal fat of the cheeks, resulting in prominent cheekbones, a better-defined jaw, and an overall slimmer, more sculpted look.
Like all cosmetic surgeries, a consultation with a specialist surgeon is a must, as they will be able to advise a patient on whether or not a bichectomy is appropriate for their facial structure.
As a general rule, a bichectomy is best suited to people in their mid-20s and early 30s, with thick, square, or round faces. A bichectomy should never be performed on an adolescent, as they are still growing into their adult features.
The surgery may not suit older patients either, as facial fat is lost naturally as we age, and a bichectomy may emphasise the aging process. Those outside of a healthy weight range are also not suitable for the procedure, as weight gain and loss can drastically change facial shape.
What happens during a bichectomy?
An experienced doctor can complete a bichectomy in around 30 minutes under local anaesthesia. A small incision (approximately 1cm) is made on the inside of the cheek. The surgeon will place pressure on the outside of the cheek, exposing the buccal fat pad. The fat is cut away and carefully removed, and the wound is then sealed with absorbable sutures.
It is possible to combine this surgery with other facial procedures, including rhinoplasty, lip augmentation, and Botox injections. Patients undergoing multiple surgeries will likely be put under general anaesthesia and will require someone to take them home post-surgery.
Bichectomy after care
Post-surgery, patients will be provided with a special mouthwash to prevent infection, as well as instructions on how to care for the incisions. Given the locations of the incisions, patients should stick to a liquid diet for the first few days after the bichectomy, then progress gradually from soft foods to a normal diet. The wounds should heal within two weeks.
Bruising and swelling of the face is to be expected, and ice packs can be used to reduce swelling and pain.
Final results are expected within a few weeks of the surgery, but might take longer as the face settles into its new shape.
Potential side effects of a bichectomy
Side effects are rare, but may include:
- Infection or poor wound healing
- Excessive bleeding
- A negative reaction to anaesthesia
- Issues with speaking or chewing, due to role of buccal fat in lubricating mouth muscles
- Fluid accumulation or seroma
- Damage to saliva glands
- Loss of sensation or damage to facial nerves
- Deep vein thrombosis (DVT)
- Facial asymmetry or otherwise poor results
The best way to avoid side effects is to see a professional, licensed plastic surgeon, and carefully follow all aftercare advice.
A bichectomy may also result in an increase in the general aging process of the face. This is due to the buccal fat removal combined with the natural fat and collagen loss we endure as we age. The usual advice to take care of your skin and avoid habits such as smoking and excessive drinking is always recommended, but cheek fillers are also an option if appropriate.
If you experience any serious side effects, including severe pain, shortness of breath, or chest pain, contact a doctor or your nearest emergency apartment immediately.
- Kirsten Nunez, 2020, All About Buccal Fat Removal for Thinner Cheeks, Healthline
- Buccal Fat Removal, American Society of Plastic Surgeons
- Dr. Sheila Nazarian, 2021, What is a Bichectomy? Explaining the Buccal Fat Removal Procedure, Nazarian Plastic Surgery