Bichectomy: What is it? Procedure, Main Function and Treatment

A surgical procedure is indicated when there is excess volume in the middle third of the face (below the cheekbones/zygoma).

The ideal candidates are men and women who want to achieve a thinner face appearance in this area, and it is also recommended for patients with chronic cheek bites.

The extra-oral photographs are part of the preoperative clinical evaluation. They will be compared with pictures taken postoperatively (immediately after the procedure, after 15 days, 45 days, and the final review after four months), when the facial contour and volume reduction will be monitored.


Another essential part of the preoperative clinical evaluation is managing the patient’s expectations regarding the irreversibility of the procedure and its final results. The elimination of Bichat Fat Pad is a better procedure indicated in round, oval and square face shapes.

Two structures must be evaluated before the procedure:

The size of the zygomatic bone: If it is too small, a filling may be required a few months after the discectomy.

The masseter muscle: hypertrophied masseter muscles become more evident after fat removal of the pad.


The Bichat fat pads were first described in 1902 by Marie François Xavier Bichat, a French anatomist and biologist, as fat mass encapsulated in the cheek, located under the zygomatic bone and above the jawline, with several extensions.

3 to 4 ml of fat are removed during the procedure, with a maximum volume of 6 ml. The oral fat pad is the giant pad in the group, which contains 40% of its total volume.

The primary function of the Bichat Fat Pad

Between the buccinator muscle and the masseter, its location makes it easier to chew and breastfeed babies. The fat pads are made of residual fat, which explains why patients, even showing ideal weight, give the false impression of being overweight, connective, and roundness of the face.

This condition causes dissatisfaction in men and women; many have suffered from intimidation and low self-esteem, affecting their mental state and happiness.

“I do not think having a thinner lower third on the face is a ‘trendy pass.’ After all, there has never been a hero or symbol of beauty, male or female, with a round face. “

The best example is Nefertiti, the Egyptian Queen, who is still considered a symbol of beauty with her defined and main line of the jaw.

The elimination of Bichat fat pads

These do not contribute to the aging or future slackness of the skin in the area. These result from the normal aging process due to the loss of collagen and elastin and the displacement of fatty tissues under the skin that are unavoidable with age.

This procedure changes the contour of the face with a decrease in volume, which results in less weight for the tissues to support and, therefore, less warping.

The evaluation is essential before the procedure; any dental point or infection of the gums should be treated before any intraoral surgery.

The procedure is performed under anesthesia.

The procedure is performed under local intraoral anesthesia.

The incision, with scalpel blades or laser beam, measuring between 1 and 1.5 cm between the vestibular fold, starting at the apex of the third or second upper molar and in the direction of the opening of the parotid duct, cuts into the following order: the jugal mucosa, the buccinator muscle and the thin capsule of the oral fat pad.

The capsule is not removed, and the mucosa is sutured. Immediately after the procedure, a therapeutic laser is applied, followed by cryotherapy and a compression band to minimize the risk of edema.


Analgesics, corticosteroids, and antibiotics may be prescribed. Important structures located around the incision are avoided with the appropriate technique: ducts of parotid glands, facial vein, facial artery, and facial nerves.

Most common complications:

  • Bleeding
  • Edema.
  • Equipoise.
  • Hematoma.
  • Emphysema and infections.

Good results can be seen within 15 days of the procedure, excellent results within 45 days, and the final result can effectively be seen after four months when the reduction of facial volume can be observed through photos.