What Is Buccal Fat Removal (Bichectomy)?
Buccal fat removal, also known as bichectomy or cheek reduction surgery, is a cosmetic surgical procedure in which a selected portion of the buccal fat pad, also called the Bichat fat pad, is removed through a small incision inside the mouth.
The buccal fat pad is a naturally occurring fat compartment located deep within the cheek. Its size varies between individuals and can contribute to fullness in the mid-to-lower cheek area.
The aim of bichectomy is to reduce selected cheek volume and create a more defined transition between the cheekbones and jawline. However, the procedure does not guarantee an extremely slim or sharply sculpted face in every patient.
Results depend on several factors, including:
- Facial bone structure
- Existing cheek volume
- Skin thickness
- Jawline anatomy
- Age
- Soft-tissue characteristics
- Amount of fat removed
For patients researching buccal fat removal in Turkey, the procedure should be planned according to overall facial proportions rather than using the same amount of fat removal for every patient.
Patients with naturally narrow or low-volume faces require particularly careful assessment because facial fat naturally decreases with age. Excessive removal may contribute to a hollow or prematurely aged appearance later in life.
Who Is a Good Candidate for Bichectomy?
Bichectomy surgery may be considered for adults who have persistent fullness in the cheek area and whose general health is suitable for elective surgery.
Potential candidates may include:
- Individuals with structurally full or rounded cheeks
- People whose cheek fullness remains despite maintaining a stable weight
- Patients seeking greater definition between the cheekbones and lower face
- Healthy adults without medical conditions that significantly increase surgical risk
- Individuals with realistic expectations about facial contouring
Patients considering bichectomy in Istanbul should undergo facial analysis to determine whether their fullness is actually caused by the buccal fat pads.
A rounded face may also be related to:
- Facial bone structure
- Subcutaneous fat
- Jaw anatomy
- Muscle structure
- Overall facial proportions
In these situations, buccal fat removal alone may not create the expected change.
Who May Not Be a Suitable Candidate for Buccal Fat Removal?
Bichectomy is not appropriate for every face type.
The procedure may require additional consideration in individuals who:
- Already have a narrow or naturally lean face
- Have significant facial volume loss
- Have health conditions that increase elective surgical risk
- Have an active oral infection
- Have unrealistic expectations about the result
- Have not yet completed facial development
Age alone should not be used as the only criterion.
The surgeon should evaluate facial maturity, current cheek volume, general health, facial proportions, and the potential effect of future age-related volume loss before recommending surgery.
Preoperative Preparation for Bichectomy
Careful preparation begins with a detailed consultation and facial analysis.
Consultation and Facial Evaluation
The surgeon evaluates the patient’s:
- Cheek volume
- Cheekbone projection
- Jawline
- Facial width
- Skin and soft-tissue characteristics
- Overall facial proportions
- Individual aesthetic goals
It is important to determine whether reducing the buccal fat pad is likely to improve the specific concern.
For patients researching buccal fat removal in Türkiye, personalized facial evaluation is particularly important because not all facial fullness is caused by Bichat fat.
Medical History and Medication Use
Patients should disclose:
- Chronic medical conditions
- Previous surgery
- Current prescription medications
- Vitamins and supplements
- Allergies
- Smoking and nicotine use
- Previous dental or oral procedures when relevant
Medications or supplements that may affect bleeding may need to be reviewed before surgery.
Prescription medications should never be discontinued without medical guidance.
Smoking and Nicotine
Smoking and nicotine can negatively affect circulation and wound healing.
Patients may therefore be advised to stop nicotine use for a period before and after surgery. The appropriate timing should be determined according to medical evaluation rather than applying one fixed period to every patient.
Preoperative Photography
Standardized facial photographs may be taken from the front, side, and angled views.
These photographs can support surgical planning and allow changes in facial contour to be evaluated during follow-up.
How Is Bichectomy Performed?
Buccal fat removal surgery may be performed under local anesthesia when carried out as an isolated procedure.
Sedation or general anesthesia may be considered when bichectomy is combined with other facial surgery or when clinically appropriate.
During the procedure, the surgeon creates a small incision inside the cheek.
The buccal fat pad is carefully identified, and a planned portion of the fat is removed. The intraoral incision is then generally closed with absorbable sutures.
Because the incision is inside the mouth, there is no external skin incision associated with the standard intraoral approach.
How Much Buccal Fat Is Removed?
The entire buccal fat pad does not necessarily need to be removed.
The amount should be determined according to:
- Existing cheek volume
- Facial width
- Bone structure
- Facial symmetry
- Age
- Expected long-term facial volume changes
- Desired degree of contouring
A conservative approach may be preferred in selected patients to preserve facial volume and reduce the risk of excessive hollowing over time.
The objective is not to remove as much fat as possible but to create a balanced change that remains compatible with the patient’s facial anatomy.
How Long Does Bichectomy Take?
The duration of surgery varies depending on:
- Surgical anatomy
- Anesthesia method
- Whether one or both sides require additional correction
- Whether bichectomy is combined with another procedure
Isolated buccal fat removal is generally considered a relatively short surgical procedure, but one fixed operating time should not be applied to every patient.
Does Bichectomy Leave Scars?
The standard surgical incision is placed inside the mouth.
For this reason, bichectomy generally does not create a visible external skin scar.
However, an intraoral surgical incision still undergoes normal wound healing. It is therefore more accurate to describe the procedure as having no visible external incision rather than claiming that it is completely scar-free.
Recovery After Buccal Fat Removal
Bichectomy recovery is usually gradual, and many patients can return home on the same day when the procedure is performed as outpatient surgery.
During the first days, patients may experience:
- Cheek swelling
- Tenderness
- Mild bruising
- Temporary tightness
- Mild discomfort at the intraoral incision
Swelling can initially make the cheeks appear fuller rather than slimmer. The result should therefore not be assessed during the early postoperative period.
Diet After Bichectomy
The surgeon may recommend a liquid or soft diet during the initial healing period.
Patients may temporarily need to avoid:
- Very hot foods and beverages
- Hard foods
- Foods that may irritate the intraoral incision
- Excessively spicy foods when they cause discomfort
Normal eating can usually be resumed gradually according to wound healing and medical advice.
Oral Hygiene
Because the surgical incision is located inside the mouth, appropriate oral hygiene is particularly important.
The surgeon may recommend a specific mouthwash or oral-care routine.
Patients should clean the mouth carefully while avoiding direct trauma to the surgical sites.
Physical Activity
Return to routine activities varies according to swelling, discomfort, and individual recovery.
Some patients may return to light daily activities relatively quickly, while strenuous exercise should be postponed until medically appropriate.
The timing of exercise should be determined during postoperative follow-up.
International patients undergoing bichectomy in Istanbul should allow adequate time for early postoperative assessment before arranging return travel.
When Are Bichectomy Results Visible?
The immediate postoperative appearance does not represent the final result because swelling temporarily affects cheek volume.
As swelling gradually decreases, changes in cheek contour become more noticeable.
Initial improvement may become visible within the first several weeks, while the final result of buccal fat removal may require several months to become fully apparent as the tissues settle.
The final appearance depends on:
- Amount of fat removed
- Facial bone structure
- Initial cheek volume
- Skin and soft-tissue characteristics
- Healing pattern
Are Buccal Fat Removal Results Permanent?
The portion of the buccal fat pad that is surgically removed does not grow back in the same way.
However, the appearance of the face is not permanently fixed.
Long-term facial contour can continue to change because of:
- Aging
- Weight fluctuations
- Changes in skin elasticity
- Natural loss of facial fat
- Changes in other facial soft tissues
For this reason, bichectomy creates a long-term anatomical change, but it does not guarantee that the face will maintain exactly the same appearance throughout life.
What Are the Risks of Buccal Fat Removal?
As with any surgical procedure, buccal fat removal has potential risks and complications.
Possible risks may include:
- Bleeding
- Hematoma
- Infection
- Prolonged swelling
- Facial asymmetry
- Changes in sensation
- Temporary or persistent numbness
- Injury to branches of the facial nerve
- Injury to the salivary duct
- Poor wound healing
- Insufficient contour change
- Excessive facial hollowing
- Unsatisfactory aesthetic result
- Need for additional or revision treatment
Because important facial nerve branches and salivary structures are located in the cheek region, detailed anatomical knowledge is particularly important during surgical planning.
Can Bichectomy Make the Face Look Older?
Bichectomy does not automatically create an aged appearance.
However, excessive buccal fat removal in a naturally lean, narrow, or low-volume face may contribute to a more hollow appearance over time.
This becomes particularly relevant because facial fat naturally decreases with age.
For this reason, long-term facial volume should be considered alongside the patient’s current appearance when determining whether buccal fat removal is appropriate and how much tissue should be removed.
Buccal Fat Removal in Turkey and Istanbul: Personalized Facial Planning
Patients considering buccal fat removal in Turkey, bichectomy in Türkiye, or cheek reduction surgery in Istanbul can have very different facial structures despite similar concerns about cheek fullness.
Not every full or round face is an indication for bichectomy.
Surgical planning should consider:
- Cheekbone anatomy
- Jawline structure
- Facial width
- Buccal fat volume
- Subcutaneous facial fat
- Skin quality
- Overall facial volume
- Age
- Weight stability
- Expected age-related volume changes
- Facial symmetry
- Individual expectations
Dr. Murat Diyarbakırlıoğlu evaluates cheek volume, facial bone structure, lower-face contour, age-related considerations, and individual aesthetic goals when planning buccal fat removal.
The objective is not to remove the maximum amount of buccal fat possible, but to develop an individualized facial contouring plan that preserves natural proportions and long-term facial balance.
Why Choose MD Aesthetics and Dr. Murat Diyarbakırlıoğlu?
At MD Aesthetics, bichectomy planning begins with an individualized evaluation of facial anatomy and treatment expectations.
Cheek volume, bone structure, jawline, facial proportions, and the potential long-term effects of reducing facial fat are considered before surgery.
Dr. Murat Diyarbakırlıoğlu determines the surgical approach and amount of fat removal according to the individual patient rather than using a standardized technique for every face.
The process includes preoperative assessment, personalized surgical planning, and postoperative follow-up.
Before deciding on buccal fat removal in Istanbul, patients should understand the expected degree of change, limitations, alternative options, recovery process, and possible risks. Final candidacy and surgical planning should be determined after a detailed facial examination and medical consultation.