Buccal Fat Removal (Bichectomy): Benefits and Postoperative Care

This procedure involves the removal of the Bichat fat pads—small fat deposits located in the cheeks. These pads are responsible for the round facial shape typical of babies and help lubricate facial muscles during infancy, but they serve no purpose in adulthood.

Normally, these fat deposits decrease as we grow. However, in some cases they remain prominent, giving the face a round or full appearance. That’s why bichectomy is often performed as an aesthetic procedure to slim the face. It’s also used to feminize facial features, since it helps accentuate the cheekbones and soften the facial contour, achieving a shape that’s socially associated with feminine features.

A bichectomy creates a slimmer, more elongated, and refined appearance, with more prominent cheekbones, by removing the fatty deposits that prevent a well-defined facial contour beneath the cheekbone (malar) area. This makes it an ideal procedure for trans women who want to highlight their cheekbones and refine their features.

Since the surgery removes fat and reduces facial volume, it’s not recommended for people with significant facial sagging, as results may be unsatisfactory. However, it’s important to note that removing the Bichat fat pads does not affect facial muscle movement or expressions. The results are subtle and natural, and there are no visible scars, as the only noticeable effect is a slimmer facial contour.

The many benefits of bichectomy have made it a popular procedure among actors, models, and celebrities. Here are its main advantages:

• Facial slimming
  Removing the Bichat fat pads reduces cheek volume, resulting in a slimmer face. This is the primary reason most people choose this surgery.
• Improved facial contour
  By slimming the face, the entire contour becomes more defined. It’s an ideal aesthetic treatment for those with round faces who wish to appear more stylized and slender.
• Enhanced cheekbone projection
  When the fat pads located just beneath the cheekbones are removed, that area becomes hollowed, making the face appear thinner and the features more sculpted.
• Permanent and natural results
  The results are long-lasting, as once the Bichat fat pads are removed, they do not grow back. The outcome looks completely natural, providing balance and harmony to the face.
• No visible scars
  The incisions are small and made inside the mouth, which means there are no visible scars.
• Quick recovery
   It’s a simple, low-risk procedure with a short recovery time. The patient can return to normal activities after a few days, following medical advice such as avoiding sun exposure, refraining from intense physical activity, and maintaining a soft-food diet.

The removal of the Bichat fat pads—or part of them—is performed through a small incision inside the mouth, specifically on the inner cheek. From there, the surgeon accesses and extracts the fat deposits. The incision is small and leaves no visible scars, as it’s located inside the mouth and closed with absorbable sutures. This makes it nearly impossible for an untrained eye to notice that any surgery has been done.

Bichectomy is considered a minor, minimally invasive surgery, typically lasting 30–45 minutes and performed under local anesthesia. It’s an outpatient procedure that does not require hospitalization.

This surgery can also be combined with other procedures to further refine the facial structure, such as cheek and chin lipofilling, during the same operation. It’s also commonly performed alongside rhinoplasty.

After surgery, it’s common to experience mild discomfort similar to that felt after a dental extraction, as well as some swelling in the area. It’s recommended to rest during the first 24 hours and maintain excellent oral hygiene throughout the first week. During this time, patients should follow a soft diet and avoid straining the facial muscles—for example, whistling, spitting, or making exaggerated facial expressions. The IM GENDER team will provide detailed postoperative guidelines to prevent any complications.

The results of bichectomy become visible after about 4–6 weeks, once all swelling has subsided. There will be no visible scars, as the surgery is performed inside the mouth. The final appearance will show a slimmer and more defined facial contour with enhanced cheekbones.

Bichectomy is one of the most in-demand facial feminization procedures due to its simplicity and the effectiveness with which it refines facial features. It’s therefore very popular among trans women, who also often undergo other procedures such as rhinoplasty, chin surgery, tracheal shave, hairline feminization, blepharoplasty, and lip lift.