Bichat surgery, more commonly called buccal fat removal, is a cosmetic procedure that removes part of the fat pads in your cheeks to create a slimmer, more contoured facial appearance. The fat pads targeted are known as Bichat’s fat pads (named after the French anatomist Xavier Bichat), and they sit deep in the cheeks between your jaw muscles and the outer skin. The surgery is relatively quick, usually performed through a small incision inside the mouth, and has become one of the more popular facial contouring procedures in recent years.
What Bichat’s Fat Pads Actually Do
Each cheek contains a buccal fat pad divided into three lobes: anterior, intermediate, and posterior. These pads are held in place by six ligaments attached to the upper jaw, cheekbone, and surrounding structures. They’re not just filler. The fat pads act as cushions that protect deeper facial structures from the force of muscle contractions, and they serve as gliding surfaces that help your chewing and facial expression muscles move smoothly against each other.
The total volume of the buccal fat pad in each cheek averages about 11.67 mL. During surgery, surgeons typically remove around 2.6 mL per side, with a range of roughly 1.9 to 3.6 mL depending on the patient’s anatomy and goals. That’s a relatively small amount of tissue, but because of where it sits, even modest removal can visibly change facial contour.
How the Surgery Is Performed
Buccal fat removal is usually done under local anesthesia, meaning you’re awake but your cheeks are numbed. If the procedure is combined with other work like a facelift or neck contouring, general anesthesia may be used instead.
The surgeon makes a small incision (about 3 to 4 cm) inside your mouth, either along the upper gum line or at the level where your teeth meet when you bite. Through this incision, the cheek muscle is carefully separated to expose the fat pad. The surgeon then applies gentle pressure on the outside of the cheek to push the fat into view through the incision, clamps the exposed portion, and removes it. The wound is closed with dissolvable stitches, so there’s no visible scar on your face.
The entire procedure typically takes under an hour for both sides.
Who Is a Good Candidate
This surgery appeals most to people who feel their face looks round or full even at a healthy body weight. Genetics play a large role in how prominent your buccal fat pads are, and some people simply carry more volume in their cheeks regardless of their overall body composition.
Age is an important consideration. Your face naturally loses fat over time, particularly from your mid-30s onward. Removing buccal fat when you’re young can look great initially but may lead to a hollow or gaunt appearance decades later, since the fat won’t grow back. Surgeons generally evaluate whether your facial structure can support long-term volume loss without looking prematurely aged. Older adults face a different concern: reduced skin elasticity can cause the lower face to sag after fat removal, sometimes requiring a concurrent facelift to avoid a drooping effect.
Recovery Timeline
Because the incisions are inside your mouth, the first couple of days involve a liquid diet while the wounds begin to heal. You can gradually transition to soft foods as healing progresses. Your surgeon will likely prescribe a special mouth rinse to keep the incision sites clean and reduce infection risk.
Swelling peaks in the first few days and then noticeably decreases between days five and seven. Most people return to normal activities within a few days to a week. At your one-week follow-up, the worst of the swelling has usually resolved enough for your surgeon to evaluate how things are healing.
That said, what you see at one week is not the final result. Residual swelling can linger for weeks or even a few months. The true contour of your slimmed cheeks gradually reveals itself as all internal swelling resolves, with many patients noting continued improvement over two to three months.
Risks to Be Aware Of
The buccal fat pad sits in a crowded neighborhood. Two structures in particular run very close to it: the parotid duct (the tube that carries saliva from the parotid gland into your mouth) and the buccal branch of the facial nerve (which controls some movement in your cheek and upper lip).
Injury to the parotid duct is considered an underreported complication. If damaged, it can cause saliva to leak into surrounding tissue rather than draining into the mouth, leading to swelling, pain, and sometimes the need for corrective surgery. Damage to the facial nerve branch can cause temporary or, rarely, permanent weakness in facial movement. Both risks increase when the surgeon applies excessive pulling or traction while extracting the fat, or removes too much tissue. This is why experience matters significantly with this procedure.
Other possible complications include infection at the incision site, asymmetry between the two sides, and numbness in the cheek area that usually resolves on its own.
Long-Term Results and Aging
Buccal fat pads do not regenerate once removed, so the results are permanent. However, other fat cells in your face can still expand with significant weight gain, which could partially mask the contouring effect over time.
The biggest long-term concern is facial aging. Everyone loses facial volume naturally as they get older, and removing buccal fat accelerates that process in the cheek area. A face that looks beautifully sculpted at 30 can look hollow or sunken at 50. Conservative removal helps minimize this risk, which is why experienced surgeons tend to err on the side of taking less rather than more. The goal is a subtle refinement that ages well, not a dramatic hollowing that looks good only in the short term.