Bichectomy, colloquially known for decades, started by creating a trend and popularizing aesthetic facial surgery. The concept of the surgery goes beyond the de-accentuation of rounded faces and aims to remodel the contour and enhance cheekbones, especially marked in the zygoma (the free part of the malar bone), because it subtracts volume from the lower part of the face. This surgery also influences the vertical contour of youthful faces associated with a good familial background, keeping the upper and middle halves of the facial dividing line in two golden proportions, which are priority areas of aging procedures. Making the facial oval parallel suggests a more oval effect, creating a small, young, and healthier face just by the illuminated light effect in the facial proportions.
The demand for surgery has grown exponentially, and with very positive feedback from satisfied patients, it is recommended as the indicated solution to optimize the results in other surgeries through its respective power. It has also grown among men who wish to reshape their faces and dislike the recording lines. To commit to offering the best possible treatment to those who really need and are suitable for the surgery, doctors and surgeons need to study the indications, understand the emotional motivation, and theatrical expectations of the patient, in addition to looking at case collections. A bichectomy, from the anatomical and functional point of view, is a surgical procedure whose objective is to reduce buccal fat pad hypertrophy. The procedure is characterized by removing the central compartment of the buccal fat pad that does not cause aesthetic or functional problems. Anatomically, buccal fat superficially lies between the ligament of Treitz and the masseter muscle; medially, it lies between the depressor anguli oris and the buccinators, and laterally, it lies between the masseter and the buccinator muscles. Since buccal fat has rapid growth, during the initial surgery, the safest fat to remove is the central fat. It is possible to have fat proliferation after the first surgery, and a resection of the lateral fat on a second opportunity is recommended. A bichectomy shows a special kind of patient who seeks a sculptured shape and not an extremely thin and haggard aspect. It can be done from puberty. The action of the masticatory muscles is not negatively affected, and functional problems are rare. Proper information should be provided to the patient about how they will feel different after achieving the facial modification; at least in the first phase of adaptation. Cheekbones are modifiable by artificial filling with fillers and alloplastic mesh or by bichectomy, which also increases the emphasized projection without volume addition. Bichectomy increases the highlighted projection and will give the augmented projection without adding volume. The isolated bichectomy leaves the patient with slightly marked and some highlighted cheeks. The improvement of the delicate concavo-convex curve implemented by the surgery increases by around 75% the harmony and belle époque effect obtained with the self-configuration of the basal structures during the growth phases. This surgery can also be an interesting intraoperative option for very young patients for ethnic cheek augmentation associated with malar silicone implants.
Definition and Procedure
Bichectomy is a surgical procedure in which buccal fat pads, commonly known as the Bichat fat pads, are removed from the cheeks—either totally or partially—and are subsequently reshaped to achieve a slimmer face. This operation is also known as buccal fat removal, and it is aimed at giving a mesofacial or meso-carafacial sculpted look to patients who wish for fuller cheeks that better match their overall morphology. In most cases, bichectomy can be performed for athletes to achieve a more sportive look. It is performed by a maxillofacial or plastic surgeon and requires pre-operative tests in advance.
To perform this minimally invasive procedure, local anesthesia or sedation with local anesthesia is preferred. The duration of the operation is uncertain but may last for 15–20 minutes. The incisions are vertical with a nasal to oral wing direction, and they are placed by retracting the mouth. Right and left buccolateral incisions are closed with single-stitched 4/0 millimetric needles, and their opposite sides are basted in mucosa. Buccal and ambient treatment is executed according to the Buccal Botox procedure by performing skin abrasion. The bichectomy operation can be performed under general, local, or tumescent anesthesia. The most preferred is tumescent anesthesia. The technique is decided according to the patient’s facial condition and expectations, whether topographic or intraoral. The aim of the bichectomy operation should not be to project a single person’s facial pattern.
Suitability for Bichectomy
Buccal fat removal – hereditary accumulation of buccal fat is not just increasing with appetite; it could happen in some healthy individuals. Genetics tends to have a buccal fat pad with good potential for a pouting look and could pose difficulty in determining the exact volume of reduction. Although no international guideline is established, frequently the surgeon would evaluate the suitability of the patient in terms of buccal anatomy, and a relatively low body mass index tends to correlate with a lean buccal face. Similarly, a patient with a short face tends to benefit more from bichectomy because it gives a different aesthetic outcome in reducing face length rather than face width. Buccal fat anatomy contributes to gender differences; males tend to have leaner buccal fat compared to females.
Age – Age is an important factor in determining the fitness of a patient for bichectomy. This is because younger individuals tend to opt for a different aesthetic trend, and bichectomy certainly is one of them. The younger tend to grow leaner and more sculpted, while the older tend to look more rejuvenated. The consulting surgeon tends to assess your emotional readiness alongside the expectation of not looking too different. Remember, although the buccal fat could shrink with facial aging, for some older individuals, Botox is enough. Suitable individuals for bichectomy are certainly expected to understand the possibility of needing surgical intervention again for later removal of aging buccal fat. Psychological factors must be considered, especially for the younger individuals who opt for bichectomy. Patients might get shocked to see a lean face inside; swelling can occur due to multiple procedures, thus affecting the final aesthetic outcomes. A good and suitable candidate for bichectomy tends to be more emotionally stable. Fewer expectations lead to a lower trend of dissatisfaction. There are many signs and symptoms that could hint at the bigger frame of emotional stability issues.
Factors to Consider
The research in this area dictates that the candidate-patient should filter a few factors before continuing their validation process. Personal satisfaction with the goal and possibilities from the surgery is paramount. The patient should clearly know what they want and what outcome they expect. The integrity of their health is another factor of concern. The patient must be thoroughly evaluated by a physician who may rule out any contraindications for conducting the surgery. A psychological evaluation is important before the surgery. Evaluating body image dissatisfaction, the implications and expectations the patient has may be a key piece in understanding who the right candidates for surgery are.
By choosing this type of surgery, you should consider selecting a qualified professional and a proper facility. Considering the procedure, priority should be given to the surgeon’s qualifications rather than the object. The professionalism of the surgeon and the surgical clinic is even more important given the delicate areas targeted by this aesthetic surgery. Careful analysis of the results and realistic expectations of the surgery are key points. The procedure has definite benefits, but with careful analysis and great emotional and personal implications, the patient may be truly taken into account. Finally, a preoperative surgical consultation is recommended as a step to engage with the surgeon prior to the operation.
Recovery After a Bichectomy
Recovery after the surgery of a bichectomy (buccal fat pad removal) is an important subject. Consequently, it is imperative for you to acquaint yourself with the healing process. The following could be a timeline overview of what happens over time post-surgery.
First 48 hours: You can expect to have moderate swelling. This is all very typical. If you notice bruising or discomfort at this stage, it is generally of moderate intensity as well. During this phase, it is also very important to rest following all of the instructions. A face-down position to reduce swelling is important, along with keeping the mouth clean. Only eat soft food; do not smoke or chew gum. Pain management is fundamental, and the patient can perform ice massages through the tailbone area, alternating it with the cheeks as per the guidance.
After the first 48 hours: Moderate swelling can still persist during this stage between 2-10 days since the surgery was performed. Noticeable bruising may still be present as well. Other times, it typically goes away naturally at around 3-4 weeks. During this stage, the moderate discomfort that is often experienced during the first 48 hours tends to go down. During this period, patients will see their doctor regularly to check for all issues after surgery. In general, there are no feeding restrictions. Soft foods and liquids are the first option. No hard or crunchy foods, no foods that you need to chew a lot or large bites, no spiced foods, and no carbonated beverages. You cannot cut an apple or chew a steak during the first ten days. Your surgeon or nurse will instruct you on how to plan your food for safety. It is important to try to eat smaller amounts more frequently. Pain can usually be managed by taking a prescription medication for this issue. In the first week, it is usually the most noticeable. Drink plenty of water and take your medications on a daily basis. Avoiding smoking, which lowers the capacity of blood oxygen, is also an important action. Makeup can be applied after five to seven days. The stripless tape can be used to attract the scars. When getting out for the first time after that, starting with a low profile is crucial. Exercises should be gradually introduced back into your daily routine. Your body will alert you when you do too much. In general, return to exercises in a gradual way. The scabs will begin to peel off the surgery areas after roughly 7 to 10 days.
Expected Timeline and Tips
Though recovery from buccal fat removal may seem long, it is predictable. Patients can expect the following healing time:
First day: Swelling peaks. Quick improvement of discomfort can be noticed throughout the day.
Second to third day: Swelling persists and you might notice it on the Adam’s apple and infraorbital ridge as a secondary effect. Sutures may or may not start to dissolve and fall. If not, it will be done gradually as the days go by.
Seven to ten days: Most of the swelling will be gone, but the lips may still appear loose. This is normal. Most of the expected complications will also have popped up or started healing.
Fourteen to twenty-one days: You may resume most of your activities, such as exercising or more social and demanding activities.
Six weeks to eight months: The month of your “surgical change” will be six weeks post-op and lasts up to eight months. After this period, your final result will be established.
Available tips to speed up recovery: lots of ice bags over the cheeks, keep head elevated while resting or sleeping, resume daily activities as soon as possible, and follow medical instructions, primarily related to medication. Also, see your surgeon for your scheduled follow-ups. Aside from the rules already mentioned, such as medication administration and not performing strenuous activities, this narrative additionally provides detailed information on what to foresee in terms of downtime, diet progression, and other expected changes, in order to minimize the patient’s anxiety and distress. It also allows for the patient to be prepared to reintegrate his or her social activities. The inclusion of postoperative instructions is important for ensuring that after the surgical intervention, patients are able to follow a smooth and rapid reintegration of solids and free liquids, ensuring an appropriate nutrition intake.
Aftercare
The efficacy and safety of the procedure depend significantly on the aftercare and the amount of time the patient invests in their recovery. Here are some post-operative instructions for after the bichectomy:
After the operation, it is possible to encounter discomfort arising from edema and the oral cavity removal. If needed, an oral painkiller medication will be recommended, which can often be managed with 5-7 days of paracetamol if it is adequately feasible.
You would need to ensure that you have plenty of time to relax after the operation. Judging from the degree of pain and inflammation, you should be able to return to your regular activities in the five days following the operation.
Under any conditions, you should not remain alone and rely on immediate assistance when post-operative issues develop to avoid severe complications.
Immediately after a bichectomy operation, it is prudent to avoid excessively energetic sports, very hot fluids, or washing the oral cavity. Lateral slow or steam inhalations of hot drinks are recommended if necessary, although rapid absorption is not encouraged.
Avoid smoking or eating hard meals (small, doughy, dry, dense fruits). On the 3rd and 4th day after the operation, most patients may consider a necessary appointment with a competent nutritionist for a postoperative diet consultation.
Intraoperatively, we guarantee the right to advise any dental specialist. You should obey their particular instructions if there are any complications with dental fillings or an abscess that could occur during the recovery phase of a newly diagnosed problem.
Maintain dental hygiene by thoroughly rinsing your mouth with warm saline frequently. You may brush your teeth before going to bed using a soft silicone bristle toothbrush if you want to give more time. Moreover, it is important that you keep within the recommended guidelines of postoperative care as mentioned below in order to undergo a proper and risk-free recovery period. Following the procedure, the necessary measures under the supervision of a healthcare professional should be taken. Any issues caused by aftercare errors can only be managed with monetary expenses until being monitored by a specialized medical doctor. Make sure you constantly get in touch with a specialist and undergo visits in a timely manner. If you report any new symptoms or irregularities at the time of consultation, the doctor should consider the entire issue in the light of your report so you can better comprehend it.
Post-Operative Instructions
What to Expect – It is normal to experience swelling and discomfort, particularly fatigability in the first 48 to 72 hours. It is essential that you understand and adhere to these post-operative instructions to aid in your recovery. Plan to be as quiet as possible, avoiding everything that is not strictly necessary for the first 72 hours.
Discomfort – Take medication every 8 to 12 hours for any discomfort expressed as a “bearable pain” according to the instructions provided.
Incisions – Keep incisions clean and dry after the first 24 hours. It is common to observe mild bleeding the first day.
Diet – Carry on a liquid diet for the first 12 hours and then a soft diet for 24 to 48 hours, with cool foods and beverages.
Follow-Up – A follow-up appointment usually takes place 10 days after surgery; later on, a follow-up schedule shall be established with the surgeon.
Rest – You are allowed to do simple activities during the first 24 to 48 hours depending on your own comfort, like watching TV, reading, etc. As the days pass, a progressive return to full activities is allowed, lasting no less than 7 days.
Drinking and Eating – No drinking through a straw or fizzy beverages for the first 7 days, and no alcohol for 10 days.
Smoking – Refrain from smoking for a minimum of 10 days post-surgery due to the detrimental effects on healing and general bodily function.
Frequently Asked Questions
Is bichectomy surgery safe?
Bichectomy is a completely safe and reliable surgical procedure, provided that it is performed by a licensed surgeon who has the knowledge and experience needed to carry it out. A professional surgeon will be able to guarantee a safe surgery with a procedure free of complications, ensuring ideal results once the patient has fully recovered.
Will my face become slimmer permanently?
Bichectomy does indeed allow for a permanent slimming of the face as it reduces the size of the cheeks; however, it should be noted that the effects of the surgery on the patient’s facial appearance will ultimately depend on the person’s natural physical features, which can change over the years.
Will a bichectomy leave me with facial paralysis?
Bichectomy does not result in a lack of facial musculature movements but does have a temporary paralyzing effect. This is due to the placement of local anesthesia, which is necessary to ensure that the patient does not experience any physical discomfort or suffer any emotional trauma caused by the procedure. On the other hand, even if the patient’s face becomes numb, they will be able to see, hear, and speak; therefore, pressure should not be experienced during the process as the patient will soon be able to feel the effects subside.
What type of anesthesia does a bichectomy use?
To carry out a bichectomy, it is necessary to use local anesthesia. Local anesthesia allows the patient to remain awake throughout the entire surgery yet not feel any pain in the area of the cheeks, allowing the surgical procedures to be seamlessly completed.
What and when will I notice the results of a bichectomy?
At first, you may experience slight inflammation due to the anesthesia, yet the results will immediately and clearly be visible. It will take about two weeks for the patient to fully regain the natural appearance of the face before being able to realize the aesthetic improvements in their facial appearance. It should be noted that they should be supervised by a healthcare professional to ensure that the results have a long duration. If you have any further questions or would like to clarify any other issues, do not hesitate to request a consultation in which a member of the specialized team will be able to address your needs.
