Highlighting your cheekiness

OP. DR. YUNUS DOĞAN

All about bichectomy

Have you ever played “Chubby Bunny?” We’ll explain it for the more (or less, depending on your upbringing) cultured reader: participants take turns putting jumbo marshmallows in their mouths, one at a time, and repeating the phrase “chubby bunny.” You can watch Rebel Wilson and Jimmy Fallon compete here.

The winner is the last person who can still successfully and intelligibly say the phrase with a mouthful of marshmallows. And to the chubby-cheeked victor goes the spoils: immeasurable fame, limitless respect, and a gooey mouthful of sugary satisfaction to savor or spit out. But sometimes we just can’t spit out our chubby cheeks.

While there are instances where a flabby face corresponds to other fleshy features, sometimes a meaty mug just doesn’t match the rest of our bodies. Those precious “chipmunk cheeks” we were praised and pinched for in our youth can linger long after the cuteness factor has worn off. Then what? Are we doomed to keep our round faces around forever? Nope! If you’ve come full-circle with that baby face and want to age up, you might want a bichectomy.

This article is the ninth in a series highlighting some of the most popular plastic surgery procedures. In the Highlighting series, we tell you ALL the alternative names of the surgery so you learn the medical terminology as well as develop a little street cred with slang terms. We share a little history of the procedure and describe the general process. We mention possible complications and give you an idea of the typical recovery time.

Also known as/similar or related names are:

Bichat Ball removal, Bichat’s protuberance removal, Bichat’s fat removal, Bichat’s fat pad removal, buccal fat removal, buccal fat pad removal, buccal lipectomy, cheek reduction, facial contouring surgery, facial lipoplasty, Hollywood cheek.

First recorded bichectomy

German anatomist Lorenz Heister first identified the buccal fat pad in 1792, mistakenly describing it as glandular tissue. In 1802 it was correctly identified by its new namesake and French anatomist, Xavier Bichat, as a fat pad.

Bichectomia do not have a storied history compared with other aesthetic surgeries: war heroes did not die on the battlefield waiting for chiseled cheekbones or slimmer faces. Buccal fat was not removed to save a life from a terminal illness, but it did probably make someone’s life a little easier.

The first documented surgery related to Bichat’s pad was in 1977, when the fat was repositioned to fill what is known as oro-antral and oro-nasal communications, or gaps running from the mouth up into the sinus cavity. The National Library of Medicine has more detail about this procedure as well as some clinical photographs, if you’re interested.

After discovering how moving the fat pad was beneficial, surgeons’ next step involved complete removal for aesthetic purposes. While some doctors believe that removing buccal fat can help you stop biting the inside of your cheek, this procedure is purely cosmetic and has yet to be proven medically necessary for billing purposes.

According to online Brazilian journal SciElo, Bichat’s fat pad helps babies to suckle, allowing specific facial muscles to move freely in that motion. This pad can assist in mastication (chewing) but it’s not a necessary component and usually decreases in size as we age and our faces grow. In cases where the fat pads remain larger than we’d like, surgeons can remove them, creating a slimmer, more tapered facial appearance.

General process

Bichectomy performed on its own is usually done in a doctor’s office under local anesthesia. You could be awake! When you’re sufficiently numb, the doctor makes an incision in your cheek, locates the fat pad and uses forceps (similar to tweezers but not for chin hairs) and pulls out the fat pad. This is repeated on the other side, assuming you desire symmetry. Your incisions are closed with sutures that are usually dissolvable and you go home.

If you’re combining a bichectomy with other plastic surgery procedures, you may have a different process that involves general intravenous sedation and a hospital stay. You should know what’s going to happen well in advance, as long as you have a good relationship with your surgeon. How do you pick The Right Surgeon? Read this.

What could go wrong?

Complications that may occur include:

• Numbness or sensation changes - as your surgeon has made incisions in your cheeks, some nerves may have also been cut. Over time, the numbness and sensation changes may resolve naturally.
• Infection at the incision site - this is a complication with any surgery and is best prevented with proper hygiene and sterilization measures. If infection does result, your doctor should give you antibiotics.
• Premature aging of your face - while plump cheeks can project an overweight image early in life, they can help you retain a youthful appearance as you age. Removing this fat may make you look older sooner rather than later.

What could go right?

Chew on these bennies:

• Thinner cheeks to match your smokin’ bod.
• Thinner cheeks that don’t get in the way of everyday mastication.
• Thinner cheeks for increased self esteem.

Recovery time

If you’re only having a bichectomy, you will go home the same day of this outpatient procedure. Johns Hopkins has an informative article here that details everything about the procedure from start to finish. Hopkins suggests you’ll be fully healed within three weeks. Plan on eating soft meals for the first day or two after this type of plastic surgery. Bruising and swelling are normal and should subside within a few weeks. You should start to see results after two months.

The last stitch

Bichectomy can give you a slimmer appearance right now, erasing that baby face. However, saying “bye, bye buccal fat” might fast-forward too quickly, making you look older than you really are. Facial fat can be precious in the long term, justifying itself and proving its worth in your later years. Ponder this procedure longer than a Hollywood minute before you grin and bare it for that Hollywood cheek.