An oval face with narrow contours and gently defined cheekbones is considered particularly harmonious. While full cheeks were once equated with youthfulness, the ideal of beauty has visibly shifted today. Many people perceive a very round face as lacking definition. Especially in the lower mid-face, the so-called "Bichat's fat pad" is often the culprit, as it makes this area appear wider, which is often perceived as disproportionate to the rest of the face. The solution can be the targeted removal of this cheek fat through a procedure called bichectomy.
At LIVION, we perform this procedure with great care and precision. The goal is not a mask-like, sunken face, but rather subtle contouring that suits your individual anatomy. In this article, you will learn exactly what happens during a bichectomy, what advantages the procedure offers, and for whom it is suitable.
What exactly is a bichectomy?
A bichectomy is a surgical procedure in which a portion of the so-called Bichat's fat pad is removed. This fat pad lies between the chewing muscles and the skin, relatively deep within the mid-face. Its function in adults is rather limited; medically speaking, this fatty tissue in the cheek area plays no significant role. Its appearance is genetically determined, so some faces naturally appear fuller, regardless of whether the person is slim or not.
The fat pad is removed through a small incision on the inside of the cheek, i.e., from inside the mouth. Therefore, no externally visible scars are left. Unlike liposuction, the tissue is completely removed here, not just reduced. The amount removed is determined individually and depends on the desired result. At LIVION, naturalness is our priority. We remove enough fat to contour the face without creating a mask-like appearance.
Who is a suitable candidate for a bichectomy and what results can be achieved?
Generally, bichectomy is suitable for people with a softer or rounder face, particularly those with prominent cheekbones. It's not about weight or body shape, but rather the structure of the face itself. Even slender individuals can appear very childlike or disproportionate due to pronounced bichat's fat pads in the face. If you desire clearer facial lines, more defined cheekbones, or a slimmer silhouette in the lower face, this procedure could be an option.
After the healing period, the cheek area appears slimmer and better contoured. Patients often report that they perceive their face as more mature, defined, and elegant after the bichectomy.
Typical reasons for choosing a bichectomy include:
- A harmonious face shape
- Reduction of pronounced cheek fullness
- Enhancement of natural facial contours
However, the decision to undergo the procedure should always be made after a personal consultation, during which other options will also be discussed. Together, we will determine whether your facial anatomy is suitable for a bichectomy and what result is realistic.
When is a bichectomy not suitable?
As effective as bichat's fat pad is for certain face shapes, it's not the right choice for everyone. Those who already have a narrow face or who are losing volume in the mid-face with age should have a thorough assessment to determine whether removing the Bichat's fat pad is advisable. This tissue also acts as a buffer between the skin and muscles. Removing it from very slender faces can quickly make them appear sunken and tired.
Even with very elastic skin or existing loss of contour in the lower face (e.g., sagging cheeks), this method is not the first choice. In these cases, a facelift or volume treatment may be more suitable. During the consultation at LIVION, great care is taken to ensure that individual needs and wishes are aligned.
What exactly is the procedure for a bichectomy? How long does the recovery take?
At LIVION, bichectomy is performed on an outpatient basis under local anesthesia. The procedure itself typically takes about 20 to 30 minutes. A small incision is made inside the cheek through which the Bichat's fat pad is carefully exposed and removed. The mucous membrane is then sutured with self-dissolving sutures. In some cases, external tape is used to counteract any potential weaknesses.
Since the procedure is performed through the oral cavity, no external scars remain. Swelling is also usually moderate and subsides within a few days. Cooling the area, a soft diet in the first few days after the surgery, and consistent oral hygiene support healing. Strenuous exercise and sports should be avoided for about a week.
Most of our patients are able to resume their normal social activities within a few days. The final result becomes apparent gradually over the following weeks, once the swelling has completely subsided. LIVION will provide you with close follow-up care during this phase to ensure optimal healing.
Is a bichectomy very painful?
Bichectomy is one of the gentler surgical procedures performed on the face. During the procedure itself, most patients experience no pain due to the local anesthetic. Even after the procedure, most report only a slight feeling of tightness or pressure in the cheeks. Pain medication is usually only required for one to two days. Wound healing is rapid because the mucous membrane is well-supplied with blood and generally heals without complications.
Safety remains a sensitive issue, as every surgical procedure carries a risk of infection. Therefore, it is crucial to entrust yourself only to experienced hands. At LIVION, bichectomies are performed exclusively by specialized physicians with extensive experience in aesthetic facial surgery.
How long do the results last? Is a bichectomy reversible?
The results of a bichectomy are permanent. The removed fatty tissue does not regenerate – even with weight gain. This means that the newly achieved facial contours remain. It is only possible that further changes in the tissue may occur with the natural aging process, affecting the overall appearance.
In practice, reversing the procedure is not possible, as the removed fat cells do not regenerate and the extracted fat cannot simply be reinjected. Therefore, it is crucial to carefully consider the decision and seek comprehensive advice. In this case, only an aesthetic correction using autologous fat or filler injections would be possible to restore volume.
