Bichectomia (also called buccal fat removal or bichectomy) is a cosmetic surgery that removes fat pads from the cheeks to create a slimmer, more contoured facial appearance. The procedure targets the buccal fat pads, two rounded masses of fat that sit between your cheekbones and jawline, giving the middle third of the face its fullness. It’s a relatively quick intraoral surgery, meaning the incisions are made inside the mouth, leaving no visible scars.
What Buccal Fat Pads Actually Do
The buccal fat pads aren’t just filler. They serve a few mechanical purposes: they act as gliding pads when your chewing and facial muscles contract, they cushion deeper structures from the force of muscle movement, and they fill the deep tissue spaces between the muscles of the cheek. Each fat pad has three lobes (anterior, intermediate, and posterior) and is anchored to the skull by six ligaments connecting to the upper jaw, cheekbone, and surrounding structures.
In some people, these fat pads are naturally larger or more prominent, giving the face a round or “chubby” look even at a healthy weight. This fullness tends to decrease somewhat with age as the face loses volume, but in younger adults with prominent buccal fat, the roundness can be a persistent cosmetic concern.
Who It’s Designed For
The procedure is best suited for people who have excess volume in the middle third of the face, below the cheekbones, and want a more angular or sculpted look. It works well on round, oval, and square face shapes. Both men and women get it done. Beyond aesthetics, it’s also sometimes recommended for people who chronically bite the inside of their cheeks.
Two things matter during the evaluation. First, the size of your cheekbones: if they’re naturally small, removing the fat beneath them can leave the midface looking flat rather than sculpted, and a filler may be needed months later to compensate. Second, the masseter muscle (the large chewing muscle along the jaw) needs assessment. If it’s already enlarged, removing the surrounding fat makes it more visually prominent, which can work against the desired slimming effect.
How the Surgery Works
Bichectomia is performed through the inside of the cheek. The surgeon makes a small horizontal incision, roughly 1 to 1.5 centimeters long, in the inner cheek tissue near the bottom of the gum line between the first and second molars. The cut is shallow, just deep enough to allow a blunt instrument to gently separate the fibers of the buccinator muscle (the main cheek muscle) without cutting through them.
Once the muscle fibers are separated, the surgeon uses curved instruments to locate and grasp the buccal fat pad. Gentle rotational movements coax a portion of the fat out through the opening. When resistance is felt, the remaining connection is carefully separated and the fat is removed. In published cases, surgeons have extracted around 1.5 to 2 grams from each side. The incision is then closed with sutures that dissolve on their own. Some surgeons use a laser instead of a scalpel for the incision, which can reduce bleeding during the procedure.
The whole process typically takes under an hour and is done under local anesthesia in most cases.
Recovery Timeline
The first three days are the most uncomfortable. Swelling peaks during this window, and you’ll experience mild to moderate soreness. You’ll be limited to a liquid diet for the first day or two while the incisions inside your mouth begin to heal, then gradually transition to soft foods.
By the end of the first week, swelling starts to decrease noticeably, though bruising may peak before it fades. Most people return to normal daily activities within a few days to a week. By the end of week two, much of the visible swelling has resolved, although some puffiness can linger, particularly in the mornings. Full healing of the incision sites takes about three weeks.
The cosmetic results take longer to appear. Early contour changes become visible around weeks two to three. A more defined look emerges between weeks four and six, when most residual swelling has cleared. The final, settled result continues to refine over two to three months as the cheeks adjust to their new shape.
What It Costs
The average surgeon’s fee for buccal fat removal is $3,142, according to the American Society of Plastic Surgeons. That figure covers only the surgical fee itself. Anesthesia, facility costs, and other related expenses are additional, so the total out-of-pocket price is typically higher. Because it’s an elective cosmetic procedure, insurance does not cover it.
Risks and Complications
The buccal fat pad sits in a crowded anatomical neighborhood. Two structures are particularly vulnerable during surgery: the parotid duct (the tube that carries saliva from the parotid gland into your mouth) and the buccal branches of the facial nerve (which control movement in parts of the cheek and lip). Both run in close proximity to the fat pad, and damage to either can cause serious problems, including difficulty with facial expressions or saliva flow.
The risk of injury increases if the surgeon applies too much traction or pulling force while extracting the fat. Over-resection, removing too much fat, compounds this risk and can also lead to an uneven or overly hollowed appearance. Choosing a surgeon with detailed knowledge of the anatomy in this area is critical.
The Long-Term Aging Concern
This is the most important consideration that many people overlook. Buccal fat removal is irreversible. Unlike procedures such as breast implants that can be removed or rhinoplasty that can be revised, extracted buccal fat cannot be put back, and the resulting changes are permanent.
The face naturally loses volume with age. Skin loses elasticity, bone resorbs, and fat compartments shift and shrink over time. The fullness that buccal fat provides in your twenties and thirties becomes increasingly valuable as the face ages. Removing it early can disrupt this natural trajectory, creating hollowing in the cheeks that would not normally appear for decades. Dr. Rod J. Rohrich, a professor of plastic surgery at UT Southwestern Medical Center, has warned that removing buccal fat “can cause premature aging and midface distortion in the long term.”
As surrounding tissues continue to age around the now-absent fat pad, the hollowing becomes more pronounced over 10 to 20 years, potentially giving the face a gaunt or skeletal appearance. This is why the procedure works best for people with genuinely excessive buccal fat, not simply those chasing a trend. A qualified surgeon should be able to project how results will evolve with aging, not just how they’ll look in the months after surgery.