What is Buccal Fat Removal?
What is bichectomy (buccal fat removal), what does it correct and what does it not correct?
Bichectomy is the partial removal of the buccal (Bichat) fat pad located between the masseter muscle and the cheek skin via an intraoral approach; it is also called buccal fat removal or cheek slimming. This fat pad can be noticeably large in some people and may leave a rounded fullness in the lower cheek toward the mouth corner even with weight loss. The procedure reduces this fullness and makes the transition between the cheekbone and the jawline more defined.
Knowing what bichectomy does not correct is important to set realistic expectations. The buccal fat pad constitutes only a small portion of facial fat; subcutaneous fat at the jawline and under the chin, prominence of the masseter muscle, and bony anatomy each separately contribute to facial width. Bichectomy does not change these, does not correct skin laxity, and does not transform one face shape into another. The sharp look often called “Hollywood cheeks” on social media is not a medical term; much of that appearance depends on bone structure, thin skin, lighting and angle.
Is the fullness due to buccal fat? Differentiation before bichectomy
Whether bichectomy will be effective depends on whether the facial fullness is truly caused by buccal fat. A simple mirror observation can give an idea: the area that hardens and becomes prominent when you clench your teeth is the masseter muscle; soft tissue that can be grasped under the chin with fingers is subcutaneous fat; the soft fullness beneath the cheekbone extending toward the mouth corner that becomes more evident when smiling may indicate buccal fat. This observation does not replace clinical examination. The table below summarizes the general relationship between examination findings and commonly considered approaches; the individual plan is determined at the consultation.
| Finding | Commonly considered approach | Note |
|---|---|---|
| Soft fullness under the cheekbone extending toward the mouth corner | Bichectomy | Balanced and measured reduction on both sides |
| Broad lower face that becomes prominent when teeth are clenched | Botulinum toxin to the masseter muscle | For muscle‑related width; effect is temporary |
| Graspable fat at the jawline and under the chin | Facial and submental liposuction | Does not affect buccal fat |
| Thin face with volume loss at the temples and cheeks | Do not remove fat; add volume if needed | Bichectomy can increase hollowing |
| Sagging at the cheeks and jawline | Facelift | The issue is tissue descent, not volume |
| Ongoing weight loss | Delay until weight is stable | The face will already thin or fill with weight changes |
How much of the fat pad is removed in bichectomy?
In bichectomy the entire fat pad is not removed; usually the portion that extends toward the cheek is reduced. The buccal fat pad has a body and deep extensions that extend behind the cheekbone toward the temple; these deep parts contribute to mid‑ and upper‑face fullness and are left in place. Values in grams or cc seen online are not targets: the size of the fat pad varies between individuals and even between the right and left sides of the same person. The amount to be removed is determined by the clinical assessment and the amount of fat observed during the procedure, taking into account symmetry between the two sides.
How do aging and weight changes affect the result of bichectomy?
Because the face loses volume with age and buccal fat also decreases naturally with time, the long‑term appearance years after bichectomy should be considered as well as the current look. A measured reduction may look balanced on a young, full face; the same reduction on a face already showing volume loss can lead to hollow cheeks and a more tired appearance. Weight change also affects the outcome: performing a bichectomy during an active weight loss process or while on weight‑loss injections may result in a thinner‑than‑expected face once weight stabilizes. Therefore weight stability for several months is preferred; if in doubt, waiting or choosing a more conservative reduction is advised.
What can be done in the same session as bichectomy?
Bichectomy can be planned together with procedures that address the lower face contour as a whole, such as submental liposuction, facelift, neck lift or rhinoplasty. If masseter muscle contributes to facial width, botulinum toxin may be considered separately; if cheek volume is deficient, dermal fillers may be an option. When multiple procedures are performed, general anesthesia is usually used and recovery may be longer; each additional procedure’s indication and necessity are discussed individually at consultation.
What is different in men and in patients who previously had bichectomy?
Bichectomy in men is performed using the same technique, but the reduction is planned more conservatively because a fuller, more angular lower face is often considered natural in men. Contribution of the masseter muscle to facial width is also common in men; thus the relative roles of fat and muscle are evaluated during examination. In patients who previously underwent bichectomy, the remaining fat amount and any scar tissue are assessed; a second reduction is considered only if a significant excess remains. If hollowness developed after the previous procedure, the solution is volume addition rather than more fat removal; in that case fat grafting or fillers may be discussed, though they do not fully reverse the initial procedure.
Where is the incision made in bichectomy?
The incision in bichectomy is made intraorally on the inner cheek at the level of the upper molars and is approximately 1–2 cm long; therefore there is no visible external scar. The incision is planned to avoid the opening of the salivary duct into the mouth and is closed with absorbable sutures. The intraoral wound usually closes within a few days; during this period using a soft toothbrush and avoiding picking at the suture area supports healing.
How to compare bichectomy offers?
When comparing bichectomy offers, look at who performs the procedure, how and where it will be done before considering the total price. The brevity of the procedure does not make appropriate patient selection and sterile conditions less important. Ask the following questions when requesting an offer:
- How was it assessed that the fullness in my face is due to buccal fat?
- To what extent is reduction planned and why?
- Who will perform the procedure; will it be in an office or an operating room?
- What type of anesthesia is planned; are medications, mouthwash and follow‑up included?
- Is another procedure proposed in the same session and is it charged separately?
- How will asymmetry, bleeding or an unexpected complication be managed?
Bichectomy for purely aesthetic purposes is not covered by social health insurance.
If you are coming from another city or from abroad
Patients coming from outside the city or from abroad are advised to stay in Istanbul for at least 2–3 days after bichectomy; during this time the first follow‑up is performed and intraoral healing is assessed. Sutures are absorbable, so it is not necessary to stay for suture removal. Op. Dr. Hasan Büyükdoğan's clinic is on Bağdat Caddesi in Kadıköy on the Asian side of Istanbul. For pre‑assessment, unfiltered photos taken from the front, profile and with teeth clenched can be shared through a secure channel; however photos do not replace clinical examination and the definitive plan is made in a face‑to‑face consultation. Consultation can be conducted in Turkish, English or German.
What the procedure can address
Not every patient receives the same treatment; the points below may be considered together or separately, depending on the person:
- 01Noticeable fullness in the lower cheek toward the mouth corner
- 02Rounded cheek appearance that persists despite weight loss
- 03Swelling that becomes pronounced under the cheekbone when smiling
- 04A more defined transition between the cheekbone and the jawline
- 05Refinement of the lower face contour together with facelift or other facial procedures
Who may be a candidate?
Who may be a candidate?
Buccal fat removal (bichectomy) is considered for adults whose cheek fullness is clearly due to the buccal fat pad, whose facial growth is complete and whose weight has been stable for at least a few months. The procedure is considered for persons aged 18 and over; the decision is based more on facial structure than on age. Because buccal fat decreases naturally with age, greater caution is exercised in already thin faces, in those with volume loss at the temples or cheeks, and in older patients. Candidates who can stop smoking, have appropriate oral and dental health, and realistic expectations are better suited.
Who may not be suitable?
- An already thin face or begun volume loss in the cheeks and temples
- Facial width primarily due to masseter muscle, subcutaneous fat, or bony anatomy
- Recent large weight changes, ongoing weight‑loss treatment, or planned significant weight loss
- Untreated intraoral infection, periodontal or dental problem
- Pregnancy or breastfeeding
- Unmanaged smoking or nicotine use that cannot be stopped before surgery
- Anticoagulant therapy that cannot be safely stopped as advised by the physician
Bichectomy does not change bone anatomy or transform one face into another. Because removed fat does not return, the decision should not be rushed; not having the procedure is also a valid option.
The doctor's examination approach
The examination looks beyond appearance to the person's overall anatomy and expectations. Key points assessed:
- Facial width and proportions
- Its contribution to cheek fullness
- Prominence of the masseter (chewing) muscle
- Fat at the jawline and under the chin
- Existing volume at the temples and cheeks
- Right and left cheek differences
- Teeth, gums and intraoral condition
- Appearance now and years later
The process
In planning bichectomy the face is evaluated from the front, side, while smiling and with teeth clenched; standard photographs are taken for planning. It is clearly discussed how much of the fullness is due to buccal fat, masseter muscle or subcutaneous fat, differences between the two cheeks, the extent of reduction, anesthesia type and whether another procedure is needed. Weight history and any weight‑loss treatments are asked about; written instructions on oral care and nutrition are provided before the procedure.
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1
Examination and photography
Facial shape, volume and the source of fullness are evaluated; expectations, weight history and prior procedures are discussed.
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2
Personalized plan
Suitability for bichectomy, the degree of reduction and anesthesia type are determined.
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3
Preparation
If needed, tests are completed; instructions are given regarding smoking, medications, supplements and oral care.
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4
Procedure
Usually lasts 30–60 minutes; through an approximately 1–2 cm incision on the inner cheek the portion of the buccal fat pad extending into the cheek is reduced and the incision is closed with absorbable sutures.
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5
Same‑day discharge
After a short observation the patient goes home with a companion; cold application, mouthwash and dietary instructions are provided.
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6
Follow‑ups
Intraoral healing and swelling are followed at scheduled visits; results are assessed as swelling subsides.
Technique and medical approach
The method depends on the patient; no single technique suits everyone. Main points considered:
| Approach | Description |
|---|---|
| Intraoral bichectomy | Through an approximately 1–2 cm incision on the inner cheek at the level of the upper molars, the buccal fat pad is reached between the fibers of the cheek muscle and gently removed. There is no external incision. |
| Limited (partial) reduction | Instead of removing the entire fat pad, the portion extending into the cheek is reduced; deep extensions toward the temple and behind the cheekbone are left in place. A balanced, measured reduction on both sides is aimed for, considering potential future facial volume loss. |
| Combined with other facial procedures | Bichectomy can be planned in the same session with facelift, submental liposuction or rhinoplasty to address the lower face contour comprehensively. In such cases general anesthesia is usually used. |
Preparing for the procedure
The points below are general information and do not replace personal medical instructions. Your own preparation is set at the examination.
Recovery
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0–1 day
First day
You will go home the same day; keep the head elevated, apply intermittent cold packs to the cheeks for the first 2–3 days. For the first 1–2 days consume warm or cold liquids and pureed foods.
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2–7 days
First week
Swelling is usually most pronounced on days 2–3 and the cheeks may appear fuller than before surgery; this is expected and does not reflect the final result. Eat soft foods and rinse the mouth with mouthwash after each meal. Most people return to desk work on days 3–5.
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1–2 weeks
First two weeks
Noticeable swelling decreases and normal diet is resumed per physician advice; intraoral sutures dissolve spontaneously.
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2–4 weeks
First weeks
Mild swelling may persist; after 2–3 weeks heavy exercise may be resumed with physician approval. Changes in the cheeks are mostly noticeable from the 3rd–4th week onward.
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3–6 months
Months
Residual mild swelling resolves; the cheek contour settles and the final appearance becomes clear.
In the first days after bichectomy patients feel swelling, tightness and mild restriction when opening the mouth more than pain; pain is usually controlled with simple analgesics. Avoid probing the suture area with the tongue or fingers. Seek the surgical team before the scheduled follow‑up if you have increasing swelling or pain, pronounced unilateral swelling, fever, discharge from inside the mouth, or new facial weakness; seek emergency care for shortness of breath.
Results and realistic expectations
The result of bichectomy becomes clear over 3–6 months as swelling subsides; changes are mostly noticeable from the 3rd–4th week onward. Fullness in the lower cheek decreases and the transition between the cheekbone and jawline appears more defined. The change is generally modest; it does not alter the overall face shape or bone structure. Removed fat does not return, but subcutaneous facial fat can increase with weight gain and facial volume continues to change with aging; therefore the long‑term appearance as well as the current look are considered in planning.
Risks and limitations
The risks of buccal fat removal (bichectomy) are explained before the procedure according to the individual's health status and facial anatomy. The most important long‑term, procedure‑specific risk is a hollowed appearance due to excessive fat removal or application in an already thin face. Therefore appropriate patient selection and measured reduction are key to reducing risks.
- Progressive hollowing or an aged appearance of the cheeks over time
- Bleeding, collection of blood or fluid inside the cheek (hematoma, seroma)
- Intraoral infection or delayed wound healing
- Injury to the salivary duct
- Temporary or rarely permanent facial nerve branch weakness
- Asymmetry, less‑than‑expected change and need for revision
- Prolonged swelling or pain, sensory changes and temporary limitation in mouth opening
- Anesthesia‑related risks
Alternative and complementary options
In some cases other methods may be considered. Each has its own limits and is not right for everyone:
| Method | Description |
|---|---|
| 1Botulinum toxin to the masseter muscle | If facial width is due to an enlarged masseter (chewing) muscle, treating it can slim the lower face; it does not affect intraoral fat. Its effect lasts months. |
| 2Facial and submental liposuction | Considered when fullness is due to subcutaneous fat at the jawline and under the chin; it does not affect the buccal fat pad. |
| 3Cheekbone fillers | Adding volume to the cheekbones changes light–shadow balance and can make the lower cheek appear relatively slimmer; it does not remove fat. |
| 4Weight control and observation | Cheek fullness in young people can decrease over time; if weight is not stable, weight control is recommended first. |
| 5About fat‑dissolving injections and devices | The buccal fat pad lies in a deep layer of the cheek, anterior to the masseter muscle. Non‑surgical methods such as fat‑dissolving injections, radiofrequency or massage do not remove this fat pad. |
