Bichectomy (Buccal Fat Removal)

A bichectomy, commonly known as buccal fat removal, is a precise facial cosmetic surgical procedure aimed at reducing fullness in the lower cheeks. By carefully excising a portion of the buccal fat pad (Bichat fat pad), an oral and maxillofacial surgeon can sculpt the midface, accentuate cheekbones, and create a more contoured, chiseled facial profile. At Oral & Facial Surgery of Miami in Coral Gables, board-certified surgeon Dr. Johanny Caceres performs bichectomies using minimally invasive intraoral incisions that leave zero visible external scars.

Buccal Fat Anatomy, Facial Contours, and Candidacy

The buccal fat pad is a deep encapsulated adipose deposit located beneath the buccinator muscle in the lower midface. Unlike superficial subcutaneous facial fat, buccal fat is genetically determined and largely resistant to dietary changes or athletic weight loss. Individuals with hypertrophic buccal fat pads often feel their lower cheeks appear disproportionately round, creating a youthful but persistent "baby face" appearance.

Ideal candidates are adults with good skin elasticity and realistic aesthetic expectations who wish to soften round cheek fullness. During your clinical consultation in Coral Gables, Dr. Caceres performs a comprehensive facial analysis to ensure that reducing buccal volume will harmonize naturally with your zygomatic arch (cheekbones) and mandibular jawline without causing premature hollowness in later years.

Surgical Technique and In-Office Buccal Fat Pad Extraction

Bichectomy is an outpatient procedure performed entirely through the inside of the mouth. Dr. Caceres creates a small incision (approximately one to two centimeters) in the inner cheek mucosa opposite the upper second molar.

With gentle pressure applied externally against the cheek, the fibrous capsule of the buccal fat pad is identified. Dr. Caceres meticulously teases out the desired volume of fat while safeguarding adjacent vital structures, including the parotid duct (Stensen duct) and facial nerve branches. Once the targeted portion is excised, the intraoral incision is closed with fine dissolvable sutures that vanish naturally within one to two weeks.

Local Anesthesia and The Patient Experience

Bichectomy is routinely and comfortably conducted in our surgical office suite under local anesthesia, often supplemented by nitrous oxide or mild oral sedation. For patients experiencing surgical anxiety, intravenous (IV) twilight sedation is readily available in our fully equipped surgical facility.

The procedure is brief, typically requiring thirty to forty-five minutes from start to finish. Because all incisions remain entirely within the oral cavity, there are no external dressings or visible wound sites.

Post-Operative Recovery Milestones and Healing Timeline

Recovery following a bichectomy is relatively rapid. Mild to moderate swelling develops over the first 48 to 72 hours, resembling a slight dental visit fullness. Most patients manage any post-operative discomfort with mild over-the-counter or prescribed pain medications and cold compresses.

Patients can typically resume non-strenuous desk work and daily routines within two to three days. A soft diet and antiseptic mouth rinses are recommended for the first few days to protect the intraoral sutures. While initial swelling subsides significantly after one to two weeks, final facial contouring emerges progressively over eight to twelve weeks as internal tissues completely settle and tighten.