Bichectomy (Cheek Aesthetics)
Buccal Fat Removal (Bichectomy) – Facial Slimming & Natural V-Shaped Contours
As Aesthetic Collective | Derya Turan — Istanbul Aesthetic Agency, we offer personalized bichectomy (buccal fat removal / cheek slimming) solutions for concerns such as fullness in the mid–lower face, cheeks that look wide in photos, or a poorly defined jawline. Performed through small incisions inside the mouth, bichectomy removes an appropriate amount of the Bichat fat pads to create a more slim, defined, V-shaped facial contour. Natural appearance is the priority: excessive fat removal can cause a “tired and hollow” look, which is why planning is made considering factors such as bone structure, skin thickness, and age.
What Is Bichectomy?
Bichectomy is the partial removal of the deep cheek fat known as the buccal fat pad (Bichat’s fat pad) through minimal 1–2 cm incisions inside the oral mucosa. The goal is to create a subtle shadow/contour in the mid area between the cheekbone and the jawline, giving the face a slimmer and more three-dimensional appearance. The procedure is often performed alone, but in many cases it is combined with chin augmentation, jawline contouring, rhinoplasty, or masseter botulinum toxin (masseter slimming).
- Duration: 30–60 minutes.
- Anesthesia: Local (with optional sedation) or general anesthesia.
- Incision: Completely inside the mouth; no visible external scars.
- Goal: Selective slimming of the mid–lower cheek area, enhancing the facial oval.
Who Is a Good Candidate for Bichectomy?
You may be a suitable candidate if you have several of the following:
- Disproportionately full cheeks despite having a normal weight,
- A wider-looking mid–lower face in photos and a desire for V-shaped contours,
- A well-defined cheekbone and jawline area, but fullness in between creating a “flat” or “bulky” look,
- Realistic expectations and facial proportions appropriate for slimming.
Who Should Wait? Individuals with significantly reduced facial fat or very low skin elasticity at an advanced age may develop hollowness after aggressive removal. In cases of obesity, facial volume may fluctuate with weight; therefore, assessment after weight stabilization is more accurate. The procedure should be postponed in the presence of active oral infections.
Consultation & Personalization
Bichectomy is not a “one-size-fits-all” procedure. During consultation, we evaluate:
- Facial proportions: Relationship between cheekbone, mandibular angle, chin, and lips,
- Skin thickness & soft-tissue distribution: Thick vs. thin skin requires different strategies,
- Age & volume-loss risk: After the 30s, natural lower-face volume loss may occur, so planning is adjusted accordingly,
- Masseter hypertrophy: If chewing muscles are pronounced, botulinum toxin can create a more balanced slimming effect.
Procedure Day: Step-by-Step Bichectomy
- Marking & Photography: Light–shadow transitions and asymmetries are evaluated in a seated position.
- Antisepsis & Anesthesia: The inside of the mouth is cleaned with antiseptic rinse; local anesthesia (or sedation) is applied.
- Mucosal Incision: A small incision is made inside the cheek; the surgeon reaches the Bichat pad between the buccinator muscle fibers.
- Selective Fat Removal: Only the patient-specific planned amount is removed—never the whole pad.
- Closure: Dissolvable sutures are placed inside the mouth. The same steps are applied symmetrically on the other side.
Tip: Bichectomy reduces lateral cheek fullness; it does not target double chin or submental fat. If needed, it can be combined with submental liposuction.
Recovery Timeline
- First 24–72 hours: Mild swelling, chewing tenderness, minimal pain; cold compress helps.
- 1st Week: Swelling decreases; dissolvable sutures cause minimal discomfort; soft foods recommended.
- Weeks 2–3: Early contour definition appears; temporary asymmetry is normal due to swelling.
- Weeks 6–12: Final slimming becomes evident; light-shadow transitions sharpen.
Aftercare Tips
- Oral hygiene: Antiseptic mouthwash and gentle brushing; avoid pressure on sutures.
- Nutrition: Liquids/soft foods for the first days; avoid very hot or spicy foods.
- Activity: No heavy exercise for a week; avoid excessive jaw movement.
- Smoking & alcohol: Delay healing, so they are not recommended.
Naturalness & Aesthetic Balance
A successful bichectomy is not about “dramatic, obvious slimming” but about creating elegant shadows and a “naturally slimmer look” in photos. Excess removal in patients with thin skin, low fat reserves, or advanced age may create a gaunt (hollow-tired) appearance. For this reason, the Derya Turan team keeps fat removal conservative and provides cheekbone support (filler/fat transfer) when necessary to add a lift effect to the midface.
Risks, Safety & Precautions
Bichectomy is safe in experienced hands, but like any surgical procedure, it carries risks:
- Bleeding, infection: Rare with proper oral antisepsis and careful technique.
- Asymmetry: Temporary during swelling; persistent cases may require evaluation.
- Excessive hollowing: The most important aesthetic risk—hence the conservative approach.
- Proximity to Stensen’s duct: Protected with anatomically precise dissection.
- Temporary sensory changes: Typically resolve spontaneously.
Combination Procedures
- Masseter botulinum toxin: Slims the lower face by reducing muscle width.
- Chin/jawline enhancement: Defines the lower face with filler or implant.
- Rhinoplasty: Balances the facial profile, enhancing the slimmed appearance.
- Fat transfer: Adds volume/lift to the cheekbones or temples.
How Is Pricing Determined?
Bichectomy prices vary by individual needs; the total cost depends on:
- Anesthesia type: Local + sedation or general,
- Combination procedures: Masseter botox, jawline/chin augmentation, rhinoplasty,
- Surgery duration and clinic/hospital fees,
- Follow-up & aftercare protocols.
After consultation, we provide a written, transparent treatment plan and pricing aligned with your facial proportions.
Patient Story: “Duru’s Light–Shadow Harmony”
Duru (27) felt her face looked “childlike” in photos and that her cheeks formed a broad block between the cheekbones and chin. Examination revealed medium-thickness skin and mild masseter prominence. The plan: conservative bichectomy + low-dose masseter toxin. Recovery was smooth with soft diet and antiseptic rinse during the first week. By week 6, her cheek shadows became more refined and the cheekbone–chin relationship more defined. “My cheek line shows in selfies, but it doesn’t look exaggerated,” she said, describing the natural result.
Frequently Asked Questions (FAQ)
Will bichectomy leave a scar?
No. Incisions are inside the mouth, so no external scars remain.
Are the results permanent?
Yes. The Bichat pad is stable in adults; removed fat does not regenerate. However, weight changes can affect facial fullness.
Will my face look too slim?
A conservative removal plan prevents over-slimming. In thin-skinned or low-volume patients, volume support may be recommended.
How long is recovery?
Most people return to daily life within 2–3 days. Final contour settles in 6–12 weeks.
Is pain or swelling significant?
Mild to moderate swelling and discomfort are expected; both decrease rapidly in the first week.
Are there dietary restrictions?
Soft/liquid foods for the first days; avoid very hot or spicy foods.
Is masseter botox necessary?
Not mandatory; however, if the masseter is prominent, it contributes to additional slimming.
Why Choose Aesthetic Collective | Derya Turan?
- Natural-result approach: Avoiding over-slimming, focusing on refined light–shadow transitions,
- Personalized planning: Conservative fat removal tailored to skin thickness, age, and bone structure,
- Comprehensive vision: Harmonized facial aesthetics with jawline, chin, masseter, and rhinoplasty planning,
- Hygiene & safety: Oral sterilization protocols, gentle tissue handling, close follow-up.
In Summary
Bichectomy (cheek slimming) is an effective procedure that makes the face appear more refined, sculpted, and photogenic when performed on the right candidate and with the right amount of fat removal. The key is personalized planning, conservative extraction, and smart combinations when needed.