Bichectomy is a cosmetic surgery that removes the buccal fat pads from your cheeks to create a slimmer, more contoured facial appearance. The buccal fat pads are walnut-sized deposits of fat that sit between your cheekbones and jawbone, giving the lower face its roundness. The procedure takes 30 to 45 minutes, is performed through small incisions inside the mouth, and leaves no visible scars.
How the Surgery Works
The entire procedure happens inside your mouth. The surgeon makes a small horizontal incision, roughly 1.5 centimeters long, on the inner lining of each cheek. While making the incision, the surgeon presses gently on the outside of the cheek to push the fat pad toward the opening. The yellow fat pad is then carefully exposed and eased out of the narrow space between the cheek muscle and the surrounding tissue. Typically 3 to 5 cc of fat is removed from each side.
Once the fat is excised, the incision is closed with a couple of dissolvable stitches. A critical detail of the technique: surgeons only remove the portion of fat that protrudes passively through the incision. Pulling aggressively on the fat pad risks damaging nearby structures, including the parotid duct (which carries saliva from a major gland into your mouth) and branches of the facial nerve that control movement around your lips and cheeks.
Bichectomy can be done under local anesthesia alone, with sedation, or under a short general anesthetic. Most people choose local anesthesia or sedation, which keeps the procedure quick and avoids the recovery effects of going fully under.
Who It’s Best Suited For
The best candidates are people with naturally round or full lower faces who want more defined cheekbones and a tapered jawline. This is a contouring procedure, not a weight-loss procedure. If your cheek fullness comes from overall body fat rather than prominent buccal fat pads, losing weight will likely achieve what bichectomy cannot.
Two groups are generally not good candidates. People with naturally narrow or thin faces risk looking gaunt rather than sculpted, because there isn’t enough surrounding facial volume to balance the removal. And people over a certain age face a different problem: buccal fat naturally diminishes as you get older, so removing it in your 40s or 50s can accelerate the hollow, aged look that many people spend money trying to reverse with fillers. The procedure tends to work best for younger adults with genetically full cheeks that don’t respond to changes in body weight.
Recovery Timeline
Plan to take a week to 10 days off work. The incision sites inside your mouth heal relatively quickly, but the swelling and stiffness take longer to resolve. Most people experience noticeable swelling, jaw stiffness, and mild pain in the first week. If non-dissolvable stitches were used, they come out at five to seven days.
You can eat and drink normally after surgery as long as your incisions are healing well, though a low-sodium diet with plenty of fruits and vegetables helps reduce swelling and supports healing. Avoid cannabis-containing foods or supplements for at least two days before and throughout recovery, as they can interfere with the healing process.
Here’s where patience matters: even after the incisions heal, inflammation can linger for several weeks. The final results don’t appear for three to six months, because your skin needs time to settle into the space left by the removed fat. By the six-month mark, residual swelling has fully subsided and the contoured look stabilizes.
Risks and Complications
A 2024 systematic review in the Journal of Cranio-Maxillofacial Surgery analyzed outcomes from 308 patients who had buccal fat removal. About 25% experienced some form of complication, though most were temporary and expected parts of recovery rather than serious surgical problems. The breakdown:
- Swelling: 38% of patients, the most common post-surgical effect
- Trismus (limited jaw opening): 30%, typically resolving within days to weeks
- Pain: 19%, generally manageable with standard pain relief
- Asymmetry: about 12%, meaning one side heals or appears slightly different from the other
- Facial nerve injury: under 1%, which can cause temporary or permanent weakness in the muscles around the mouth
- Infection, hematoma, or other rare complications: under 1% combined
The asymmetry figure is worth noting. Because the surgeon removes fat from both sides independently, even small differences in the amount removed or how each side heals can produce a visibly uneven result. This is one reason why choosing an experienced surgeon matters: the procedure itself is straightforward, but calibrating symmetry requires a practiced eye.
Long-Term Considerations
Bichectomy is permanent. Once the buccal fat pad is removed, it does not grow back. This is both the appeal and the risk. In your 20s and 30s, the sculpted look may be exactly what you wanted. But facial fat continues to diminish naturally with age, and by your 40s, 50s, and beyond, many people lose volume in the midface regardless. Removing the buccal fat pad now means you start that aging process with less cushion than you would have had otherwise.
Research on long-term outcomes beyond 10 years is limited. What experts generally agree on is that conservative removal, taking only the fat that naturally protrudes rather than aggressively extracting as much as possible, produces better long-term results and reduces the risk of a hollowed-out appearance later in life. The surgery does not always deliver satisfactory results when done aggressively, and revision options are limited once the fat is gone. Some patients eventually turn to dermal fillers or fat transfer procedures to restore volume they wish they had kept.
If you’re considering bichectomy, the key question isn’t just how you want to look now. It’s whether you’ll still want that degree of facial slimness in 15 or 20 years, when your face will have naturally lost volume on its own.