Bichectomy in Londrina: a more defined face with safety
If you feel that your cheeks have too much volume, even when at your ideal weight, you have probably heard of bichectomy.
It is the surgery for reducing the Bichat Balls, those fat structures located at the front of the cheeks which,
when voluminous, give the face a rounded appearance.
I am a plastic surgeon trained at the Ivo Pitanguy Institute, a full member of the Brazilian Society of Plastic Surgery (SBCP) and the
American Society of Plastic Surgeons (ASPS). I have been performing bichectomy for many years and I can affirm: when well indicated and executed with
the appropriate technique, it is a safe, quick procedure with a smooth recovery. The procedure lasts about forty minutes and, in
my experience, patients are impressed by the simplicity of the recovery.
Are you a good candidate for bichectomy?
This is the most important question. Bichectomy is not for everyone, and this honesty is fundamental for a good result. You may
be a good candidate if:
You have a rounded face even with an appropriate body weight;
You feel that the volume of your cheeks harms your facial harmony;
You are over fifteen years old (when the face is fully developed);
You have a good facial bone structure, especially in the malar region (cheekbones).
On the other hand, bichectomy may not be indicated for those who already have a naturally thin face, little volume in the cheekbones, or
a tendency to lose facial fat as the years go by. In these cases, the removal of the Bichat Ball could create a skeletal
or aged appearance in the future. Therefore, an in-person evaluation is irreplaceable.
Contraindications that I take seriously
In addition to aesthetic cases where bichectomy is not indicated, there are clinical contraindications that I need to evaluate rigorously:
active infections in the oral cavity, uncontrolled coagulation disorders, decompensated diabetes, and unrealistic expectations regarding
the outcome. I also do not recommend the procedure for patients with a very high body mass index, as future weight loss
can significantly alter facial contours.
A word about the excessive indication of bichectomy
I need to be frank about something that concerns me as a plastic surgeon: in recent years, bichectomy has become a kind of
"trend", and many professionals have started to recommend it indiscriminately, even for patients who would not benefit from
the procedure. This has led to a wave of unsatisfactory results — faces with a sunken appearance, premature aging, and loss of
naturalness. The Bichat ball has important functions: it protects muscular structures during chewing and contributes to the
youthful volume of the middle third of the face. Removing it without criteria is a mistake. My approach is conservative: I only recommend it when I am
sure that the result will be harmonious in the long term.
Bichectomy as a complement to Deep Plane Facelift
A particularly valuable application I consider is bichectomy associated with deep plane facelift. In some patients undergoing
the facelift, excess Bichat Ball can accentuate the "bulldog" appearance (the famous jowls, that
sagging in the jaw area). In these cases, the removal of Bichat fat during the same procedure significantly enhances
the result of the facelift, creating more defined and elegant facial contours.
This combination requires experience and a comprehensive vision. It is not simply about "doing two surgeries at the same time", but about
understanding how facial structures interact and planning the approach in an integrated manner. The result is a more
complete and harmonious facial rejuvenation.
Your fears are normal. Let me clarify them.
Many patients come to the consultation with fears about bichectomy, usually based on stories they have read online or
heard from acquaintances. I completely understand. That is why I make a point of clarifying each doubt:
Fear of pain: The surgery is performed under general anaesthesia, so you will not feel anything at all during the
procedure. In the postoperative period, discomfort is minimal, much less than that of a wisdom tooth extraction, for example. Most of
my patients are positively surprised by this.
Fear of swelling: Yes, there will be swelling, especially in the first three days. This is natural and expected. The
important thing is to know that it decreases progressively, and within two months you will have about 90% of the visible result. The final result,
with all the subtlety of the contours, appears between six and twelve months.
Fear of having a "sucked in" or aged face: This is the most common concern, and the answer lies in the correct indication.
I carefully assess each patient before recommending the surgery. If I identify that bichectomy could harm facial harmony in the future, I simply do not recommend the procedure. I prefer to lose a surgery than compromise the result for a
patient.
Fear of asymmetry: During the surgery, I meticulously compare the amount of fat removed from each side. In addition,
the technique I use allows for complete visualization of the structure before removal, ensuring symmetry.
What result can you expect?
Bichectomy provides a face with more defined contours, enhancing the cheekbones and creating a more elegant and
harmonious appearance. The result is permanent, natural, and, when well indicated, ages beautifully along with you.
It is important to have realistic expectations: bichectomy slims the front part of the cheeks, but does not completely change the
shape of the face. In some cases, other complementary procedures may be necessary to achieve the desired result, and this
will be discussed openly during the consultation.
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Pre-operative of buccal fat removal
The consultation: the most important moment
The consultation is where everything begins, and I take time to conduct it calmly. There is no successful buccal fat removal without a thorough evaluation. During our meeting, I examine various aspects of your face that directly influence the outcome:
Evaluation of the Buccal Fat Pad
I analyse the amount of fat present, its exact location, and how much it truly contributes to the volume of your cheeks. In some cases, what appears to be excess Buccal Fat Pad may have other causes. I need to ensure that the surgery will deliver what you expect.
Masseter Muscle
Do you grind your teeth? Do you have bruxism? The masseter muscle, responsible for chewing, may be hypertrophied and contribute to the lateral volume of the face. In these cases, botulinum toxin may be an alternative or a complement to buccal fat removal.
Malar Region (cheekbones)
Here is a detail that many professionals overlook: it is pointless to reduce the volume of the lower part of the cheeks if the upper part (cheekbones) does not have adequate projection. The result may appear disproportionate. If necessary, I recommend fillers with hyaluronic acid or calcium hydroxyapatite to create the ideal balance.
Skin Quality and Sagging
In patients over fifty years old, what seems like excessive volume may actually be facial tissue that has descended over time. In these cases, a facelift may be more indicated than isolated buccal fat removal, as it repositions the fallen tissues (including the Buccal Fat Pad itself) without removing them. In selected cases, as I mentioned earlier, the combination of deep plane facelift with buccal fat removal may be the best strategy.
Neck Fat (double chin)
Slimming the cheeks may highlight fat in other areas, such as the submental region. I assess the neck in conjunction with the face to ensure a harmonious result. If necessary, I can combine a double chin liposuction with buccal fat removal.
Nose and Chin
A face may appear rounder when the nose and chin have little projection. Sometimes, a rhinoplasty or mentoplasty may be the ideal complement to achieve the desired facial harmony.
Oral Cavity
I examine the inside of your mouth to identify the anatomical structures that guide the surgery and check for any conditions that may interfere with the safety of the procedure.
Pre-operative Tests
I request the following tests before buccal fat removal:
Complete blood count;
PAT with INR + APTT;
Creatinine;
Urea;
Fasting blood glucose;
Total proteins and fractions;
Urine I;
Electrocardiogram;
Surgical risk (evaluation with a cardiologist).
Why General Anaesthesia?
I perform buccal fat removal under general anaesthesia, and there is an important reason for this: comfort and safety. The procedure lasts about thirty minutes, and general anaesthesia allows me to work with absolute precision while you rest peacefully. Many professionals perform it with local anaesthesia, but I believe that the patient experience and the technical quality of the procedure are superior with general anaesthesia.
How I perform buccal fat removal surgery
The technique I use has been refined over years of experience. I start with precise marking between the parotid duct (Stensen's duct) and the bite line, on the inside of the mouth. Then, I infiltrate a solution with adrenaline that minimises any bleeding during and after the procedure.
I then make an incision, approximately one centimetre, in the buccal mucosa, and carefully dissect the buccinator muscle to expose the capsule surrounding the Buccal Fat Pad. It is essential to respect the anatomical limits — the buccal nerve of the facial and the branches of the facial artery pass close to the area. With delicate movements, I traction the adipose body and remove it totally or partially, depending on the planning done in the consultation. The remaining stump is cauterised to ensure perfect haemostasis, and the suture is made with absorbable threads.
I repeat the procedure on the other side, always comparing the amount of fat removed to ensure symmetry. This meticulous care is what differentiates a natural result from an artificial one.
About Complications
The medical literature describes possible complications of buccal fat removal, such as nerve injury, bleeding, or infection. However, in all my experience performing this procedure, I have never had a single case of complication. I attribute this to three factors: careful indication, refined technique, and meticulous attention to every step of the surgery.
This does not mean that complications are impossible in any context, but it demonstrates that, in the hands of an experienced and careful surgeon, buccal fat removal is a safe procedure.
Scars
The incisions are made inside the mouth, which means there are no visible external scars. The oral mucosa heals very well, and in a few weeks you will not even be able to identify where the incision was made.
Same-day Discharge
In the vast majority of cases, the patient is discharged on the same day, as soon as they fully recover from anaesthesia. You will go home with all the care instructions and my direct contact for any questions that may arise.
Post-operative: what to expect
The recovery from buccal fat removal is one of the most tranquil among facial surgeries. I will be honest about what you will experience:
Swelling: It is most evident in the first three days and decreases progressively. Using cold compresses and keeping your head elevated helps a lot. By two weeks, the swelling is already quite discreet.
Pain: Surprisingly low. Most of my patients report only mild discomfort, easily controlled with common painkillers. Many say they expected much worse.
Diet: Liquid and soft diet for five days. This protects the stitches and facilitates healing.
Important Care
Liquid/soft diet for five days;
Sleep on your back for a month;
Rest from work or school for five to seven days;
Avoid physical exercise for thirty days;
Strict oral hygiene with antiseptic mouthwash (chlorhexidine) as directed;
Do not smoke and avoid medications with aspirin or arnica for fifteen days before and after the surgery.
When will I see the result?
This is the question every patient asks, and the answer requires patience. Right after the surgery, you will be swollen, and that is normal. The first follow-up photos are taken at two months, when about 90% of the swelling has subsided. The final result, with all the definition of the contours, appears between six and twelve months.
My advice: do not keep comparing yourself in the mirror every day in the first weeks. Trust the process.
Correction of unsuccessful buccal fat removal
Unfortunately, I have been receiving patients who have undergone buccal fat removal with other professionals and are not satisfied with the result. The most common problems are:
Asymmetry: one side is different from the other;
Excessive removal: the face looks "hollowed out" or skeletal.
How I treat these cases
For asymmetry: I assess whether it is possible to remove more fat from one or both sides to balance the result. Depending on the case, there may be a small residual difference due to internal scars or natural asymmetries of other facial tissues, but the goal is always to improve as much as possible.
For excessive removal: The treatment involves fat grafting to fill the depression caused by excessive removal. As with all fat grafts, there is a natural absorption that varies from person to person, and more than one session may be necessary to achieve the ideal result.
If you have undergone buccal fat removal and are not satisfied with the result, book a consultation. I will conduct a complete evaluation and present options to improve your situation.
Frequently Asked Questions about Bichectomy
Does bichectomy hurt?
I perform bichectomy under general anaesthesia, so you feel absolutely nothing during the surgery. In the postoperative period, discomfort is minimal — in my experience, the vast majority of patients report that it is much less than the pain of a wisdom tooth extraction. I prescribe common painkillers and that is usually sufficient.
Does bichectomy age the face?
This is the most common question I receive in consultation. When well indicated, bichectomy does not age the face. The risk only exists when the procedure is performed on patients who are not good candidates — naturally thin faces or those with little malar volume. Therefore, I am quite selective in my recommendations: if I identify that the surgery could harm facial harmony in the future, I simply do not recommend it.
How long does recovery from bichectomy take?
I recommend that my patients plan for 5 to 7 days of rest. Swelling is most evident in the first three days and decreases progressively. After two weeks, it is already quite discreet. I usually take the first follow-up photos at two months, when about 90% of the result is already visible. The final result appears between 6 and 12 months.
Does bichectomy leave a scar?
There are no visible external scars. I make the incisions inside the mouth, in the buccal mucosa. The oral mucosa heals very well, and within a few weeks my patients can hardly identify where the incision was made.
Who can have bichectomy?
In my assessment, good candidates are people with a rounded face even when at an appropriate weight, with good facial bone structure (especially in the malar region) and over 15 years old. I do not recommend it for those with naturally thin faces or a tendency to lose facial fat with aging, as the result could create a sunken appearance in the long term.
Can bichectomy be combined with other procedures?
Yes, and in my practice, this is quite common. A combination that I consider particularly valuable is bichectomy associated with deep plane facial lifting. In patients with sagging in the jaw area, the removal of the Bichat fat pad significantly enhances the result of the lifting. I can also combine it with chin liposuction, rhinoplasty, or mentoplasty, depending on the case.
How long does the bichectomy surgery take?
The procedure itself lasts about 30 to 40 minutes. In my experience, patients are impressed by the speed. Hospital discharge occurs on the same day, as soon as you fully recover from the anaesthesia.
What happens if I don't like the result?
I have received patients who had bichectomy with other professionals and were not satisfied. For cases of asymmetry, I assess whether it is possible to balance by removing more fat. For excessive removal, the treatment involves fat grafting to fill the depression. Therefore, I emphasise: careful indication before surgery is the most important step to avoid regrets.
Do I need to follow a special diet after bichectomy?
I recommend a liquid and soft diet for five days after the surgery. This protects the internal stitches and facilitates healing. I also advise strict oral hygiene with antiseptic mouthwash (chlorhexidine) as per my prescription. After this period, the diet gradually returns to normal.
Why does Dr. Zamarian perform bichectomy with general anaesthesia?
I perform it with general anaesthesia for two reasons: comfort and precision. With the patient completely relaxed, I can work with the refined technique that the procedure requires, meticulously comparing the amount of fat removed from each side to ensure symmetry. Many professionals perform it with local anaesthesia, but I believe that the patient experience and the quality of the result are superior with general anaesthesia.
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If you wish to know more about bichectomy and find out if you are a good candidate for the procedure, contact Clínica Zamarian and book your first consultation. I will be pleased to evaluate your case personally and indicate the best path to achieve the facial harmony you seek.
