Buccal fat removal, or bichectomy, became popular on social media as a way to slim the cheeks. Before considering it, it helps to understand what these fat pads are, what they do and why removing them is not right for everyone.
I will say this from the outset: I no longer perform this procedure. But I receive many questions about it, and understanding it is the best way to make a decision.
What are they?
The technical name is the buccal fat pad. It was first described by Heister in the eighteenth century and later by Bichat in 1802; that is why it is known as the Bichat fat pad in Spanish-speaking countries.
These pads sit in the cheeks, between the chewing muscles, with extensions toward the temples and cheekbones. They have three lobes — anterior, intermediate and posterior — each with its own capsule and blood supply, so each changes differently with age. The portion shown in social media videos resembles an egg yolk in size and color.
What do they do?
Their function changes throughout life.
In childhood, they help babies suck during feeding. This is why babies and young children have such full cheeks.
In young adults, they fill deep facial spaces, allow the chewing muscles to glide past one another and protect important structures: branches of the facial nerve, the facial artery and vein, and a major salivary duct. By this age, they have already lost some of their childhood volume.
Their volume continues to decrease in adulthood. In some people, as facial ligaments loosen, the remaining fat pad descends and deepens the fold between the nose and mouth.
Who could be a candidate?
It depends mainly on two things: age and facial shape.
Under 35. This is when the procedure is most sought after, but it is not always advisable. The pads naturally shrink over time. Early removal may leave hollowing beneath the cheekbones that becomes more noticeable with age, especially in long faces with prominent cheekbones and a defined jaw. In round or square faces, removal may refine the contour, but proportions need careful assessment.
Over 35. There may be a clearer indication when facial laxity causes the pad to descend, bulging in the lower cheek and deepening the nasolabial fold.
What to keep in mind
Buccal fat pads have functions, protect important structures and shrink naturally with age. They also extend toward the temple; removing them can accentuate hollowing there and make the face look tired or older.
If you are considering buccal fat removal, seek a full facial assessment from a board-certified plastic surgeon. They should assess your proportions and explain the potential benefits and risks, both now and in the years ahead.