Bichectomy

What is bichectomy?

Bichectomy — also called buccal fat removal — removes a measured portion of the buccal fat pad through a small incision inside the mouth, with no external scar. Each cheek contains a discrete pocket of fat, the buccal fat pad, that sits below the cheekbone and behind the corner of the mouth. In some faces, particularly genetically full lower faces, this pad gives a rounded or chubby appearance even when the patient is at a healthy weight. It sculpts the lower face for genetically full cheeks, but is not a weight-loss tool. Done well, it produces a refined contour; done poorly or in the wrong patient, it can age a face prematurely.

What it does and doesn't do

Done well, bichectomy sculpts the lower face into a more defined, slimmer shape. It is a contouring tool, not a treatment for general weight loss in the face. Removing buccal fat from a face that doesn't have a surplus produces a hollowed, prematurely aged appearance that is difficult to reverse — so the guiding principle is to remove less than you think. A good bichectomy is one that almost no one notices except you, where the face simply looks more refined, not "operated."

Who is it for?

The ideal candidate is between 20 and 45, at a stable weight, with naturally rounded lower cheeks that diet and exercise haven't been able to change. Patients with naturally narrow faces, very thin patients, and patients over 45 (when natural fat loss is starting) should be cautious, since removing buccal fat from a face without a surplus produces a hollowed, prematurely aged appearance that is difficult to reverse.

Procedure process

Bichectomy is performed under local anaesthesia with mild sedation, typically as a 30-40 minute outpatient procedure. The surgeon makes a small incision inside the mouth (no external scar), removes a precisely measured portion of the fat pad, and closes with dissolving sutures. Patients walk out the same day. Bichectomy is often combined with chin augmentation, jawline fillers, or rhinoplasty for a more comprehensive lower-face refinement; many international patients in Istanbul request it as an add-on to nose surgery, since recovery overlaps.

After the procedure

Swelling is usually moderate for 5-7 days. Patients are told to eat soft foods, rinse with antiseptic mouthwash, and sleep elevated for the first few nights. Most patients return to work within a week. Final results emerge over 8-12 weeks as residual swelling resolves, gradually revealing the sculpted contour underneath.

Risks

Real but rare risks include infection (less than 1%), temporary numbness (resolves within weeks), parotid duct injury (very rare in skilled hands), and asymmetry. The most common "complication" is regret, usually because too much fat was removed, or because the patient wasn't a good candidate to begin with — which is why conservative removal matters, since removed fat does not regenerate and the procedure is not reversible.

Related procedures

Bichectomy is often combined with chin refinement and jawline contouring for a more comprehensive lower-face refinement.

Frequently asked questions