Buccal Fat Removal in Londrina: a more defined face safely
If you feel that your cheeks have too much volume, even when at your ideal weight, you have probably heard of buccal fat removal.
It is the surgery for reducing the buccal fat pads, those fat structures located in the front part of the cheeks that,
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 buccal fat removal for many years and can say: 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 with the simplicity of the recovery.
Are you a good candidate for buccal fat removal?
This is the most important question. Buccal fat removal is not for everyone, and this honesty is crucial 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, buccal fat removal 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, removing the buccal fat pad 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 buccal fat removal 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 result. 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 buccal fat removal
I need to be frank about something that concerns me as a plastic surgeon: in recent years, buccal fat removal 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 buccal fat pad 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.
Buccal fat removal as a complement to Deep Plane Facelift
A particularly valuable application I consider is buccal fat removal associated with deep plane facelift. In some patients who
undergo the facelift, excess buccal fat can accentuate the "bulldog" appearance (the famous jowls, that
sagging in the jaw area). In these cases, removing the buccal fat during the same procedure significantly enhances
the facelift result, 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 buccal fat removal, usually based on stories they read online or
heard from acquaintances. I completely understand. That’s why I make a point of clarifying every doubt:
Fear of pain: The surgery is performed under general anesthesia, 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 "sunken" or aged face: This is the most common concern, and the answer lies in the correct indication.
I carefully evaluate each patient before recommending the surgery. If I identify that buccal fat removal 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 complete visualization of the structure before removal, ensuring symmetry.
What result can you expect?
Buccal fat removal 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: buccal fat removal 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 openly discussed during the consultation.
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Pre-operative of Bichectomy
The Consultation: The Most Important Moment
The consultation is where everything begins, and I take the time to do it calmly. There is no successful bichectomy without a thorough evaluation. During our meeting, I examine various aspects of your face that directly influence the outcome:
Evaluation of the Bichat Ball
I analyze the amount of fat present, its exact location, and how much it actually contributes to the volume of your cheeks. In some cases, what appears to be excess Bichat Ball 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 bichectomy.
Malar Region (Cheekbones)
Here is a detail that many professionals ignore: 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 be disproportionate. If necessary, I recommend filling 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 bichectomy, as it repositions the fallen tissues (including the Bichat Ball itself) without removing them. In selected cases, as I mentioned earlier, the combination of deep plane lifting with bichectomy may be the best strategy.
Neck Fat (Double Chin)
Thinning the cheeks may highlight fat in other areas, such as the submental area. I evaluate the neck in conjunction with the face to ensure a harmonious result. If necessary, I can associate a double chin liposuction with the bichectomy.
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 condition that may interfere with the safety of the procedure.
Pre-operative Tests
I request the following tests before the bichectomy:
Complete blood count;
PAT with INR + APTT;
Creatinine;
Urea;
Fasting blood sugar;
Total proteins and fractions;
Urine I;
Electrocardiogram;
Surgical risk (evaluation with a cardiologist).
Why General Anesthesia?
I perform the bichectomy under general anesthesia, and there is an important reason for this: comfort and safety. The procedure lasts about thirty minutes, and general anesthesia allows me to work with absolute precision while you rest peacefully. Many professionals perform it with local anesthesia, but I believe that the patient experience and the technical quality of the procedure are superior with general anesthesia.
How I Perform the Bichectomy Surgery
The technique I use has been refined over years of experience. I start with a 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 minimizes any bleeding during and after the procedure.
I then make an incision, approximately one centimeter, in the buccal mucosa, and carefully dissect the buccinator muscle to expose the capsule surrounding the Bichat Ball. 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 pull the adipose body and remove it totally or partially, depending on the planning done in the consultation. The remaining stump is cauterized to ensure perfect hemostasis, 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 bichectomy, 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, bichectomy 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 won't 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 anesthesia. 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 bichectomy is one of the most peaceful 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 pain relievers. 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 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 Bichectomy
Unfortunately, I have received patients who underwent bichectomy with other professionals and were not satisfied with the result. The most common problems are:
Asymmetry: one side is different from the other;
Excessive Removal: the face looks "sunken" or skeletal.
How I Treat These Cases
For Asymmetry: I evaluate 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 any fat graft, 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 a bichectomy and are not satisfied with the result, schedule 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 anesthesia, so you don't feel anything at all 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 pain relievers, and that is usually sufficient.
Does bichectomy age the face?
This is the most common question I receive during consultations. 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. By 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 scars?
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 undergo 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 Ball 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 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 anesthesia.
What happens if I don't like the result?
I have received patients who underwent 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. That’s why I emphasize: 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 anesthesia?
I perform it with general anesthesia 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 anesthesia, but I believe that the patient experience and the quality of the result are superior with general anesthesia.
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If you want to know more about bichectomy and find out if you are a good candidate for the procedure, contact Clínica Zamarian and schedule your first consultation. I will be happy to evaluate your case personally and indicate the best path to achieve the facial harmony you seek.
