Buccal Fat Removal (Bichectomy) in Ukraine

The buccal fat pad, also called Bichat's fat pad, is a distinct fat body in the cheek that lies deeper than the subcutaneous fat, between the masseter and buccinator muscles. Everyone has it from birth, and it helps a baby suckle; in adults it remains as an anatomical structure whose volume responds to changes in weight much less than subcutaneous fat does.

It is precisely this relative independence from weight that makes the operation popular. You lose weight, your body changes, yet your cheeks stay round, because the volume comes not from subcutaneous fat but from a deep fat body that diet and exercise do not reach. Buccal fat removal takes out the superficial portion of this fat body: afterwards the midface narrows by a few millimetres.

The indications are narrow: full cheeks at a normal weight, when losing weight does not change them, and when you understand the scale of the change. We are talking about a few millimetres in the cheek area, not a reshaping of the face. The surgeon assesses the thickness of the subcutaneous fat, the width of the cheekbone arches, skin elasticity and age.

Who the procedure is not suitable for: a lean face, a narrow face type with prominent cheekbones, a shortage of subcutaneous fat, age over 45. Surgeons also decline when expectations are unrealistic: when a patient arrives with a photo of a model and asks for the same cheekbones, but their anatomy does not allow it. Temporary contraindications are tooth decay, periodontitis and any inflammation in the mouth, acute infections, blood clotting disorders, uncontrolled chronic illnesses, pregnancy and breastfeeding.

MediUkraine is a treatment search and coordination service, not a clinic. We select a medical centre and a surgeon with the right specialism, arrange the date and support patients, including those travelling from abroad. The decision about the operation is made by the doctor after an in-person examination.

The buccal fat pad is not a uniform lump but a structure with a body and several extensions: buccal, temporal, pterygopalatine and pterygomandibular. Buccal fat removal works only with the superficial, buccal portion, which is what gives the cheek its roundness. The deep extensions lie next to large blood vessels and nerves and are not touched at all: trying to remove the whole fat pad does not improve the aesthetic result but sharply increases the risk of injury to neighbouring structures.

Access is from inside the cheek. After local anaesthesia the surgeon makes a 1–1.5 cm incision in the lining of the mouth opposite the upper second molar, about a centimetre below the opening of the parotid salivary gland duct and above the line where the teeth meet. The incision point is chosen so as to avoid both the duct and the area of the buccal branches of the facial nerve. External access is not used for this area: an incision in the skin would leave a visible scar where it could not be hidden.

The surgeon then uses blunt dissection: the buccinator muscle is spread apart with a clamp without cutting it, and with light pressure on the cheek from outside the fat pad comes into the wound by itself. The tissue must not be pulled with force, as this could draw out the deeper extensions, which must stay in place. The surgeon draws out the superficial portion, assesses it and trims exactly as much as was planned at the consultation, usually 2 to 4 ml on each side. The stump is cauterised, the wound is rinsed, and the lining of the mouth is closed with one or two dissolvable stitches.

Both sides are done in one session, and the removed portions are compared by volume right there on the operating table. With this access there are no external scars: the incision lies in the lining of the mouth, heals within 7–10 days and later cannot be felt even with the tongue. No stitches are placed on the skin, so no marks are left on the face, which is the main reason the access from inside the mouth is chosen.

Now for the most important point, which is worth reading before you book the operation. Fat cells that have been removed do not grow back, so the volume taken away does not return: the buccal fat pad does not regrow. This does not mean your cheeks are protected from fullness for ever: with significant weight gain they can become partly rounder again, but because of subcutaneous fat, not the fat pad that was removed. More importantly, the effect is much more modest than most patients expect: the operation narrows the midface by a few millimetres and makes the transition from cheekbone to cheek slightly sharper. It does not create prominent cheekbones: their shape is set by the cheekbone itself, not by the fat in the cheek.

The procedure does not replace either chin liposuction or a facelift. It does not remove a double chin: that is a different, subcutaneous fat that cannot be reached through the cheek. Nor does it lift a jawline that has sagged with age: that depends on the condition of the skin and the deep ligaments, not on cheek volume. If you are promised a sculpted face after this one procedure at the consultation, that is a reason to seek a second opinion.

Age is a separate matter. Over the years the face naturally loses volume: the fat compartments shrink and descend, the skin thins, and it is precisely the lack of volume in the midface that creates a gaunt look. So removing too much fat at 20–25 gives an effect you like now and hollow cheeks after 40–45. Putting the removed fat back is difficult: it requires fat grafting, which is a different operation with a different timeline and different predictability.

Who the procedure really suits: patients with full cheeks at a normal weight, when losing weight does not change the shape of the cheeks, with enough subcutaneous fat, good skin elasticity and an age of roughly up to 40–45. In this group the result is moderate, predictable and lasting, and the likelihood of regretting it over the years is low. Surgeons often advise these patients to start with a smaller amount: if you want more after six months, removing a little more is technically possible.

Who it is not suitable for: a lean face, a narrow face type with hollow cheeks, a shortage of subcutaneous fat, age over 45, and patients who have lost weight in the past year and whose weight has not yet stabilised. In such cases an experienced surgeon declines or suggests a completely different plan, for example restoring volume instead of reducing it. Declining here is not losing a patient but preventing a result that would have to be corrected a few years later.

Sometimes the operation is combined with other procedures in the same session, such as chin liposuction, mentoplasty or blepharoplasty, when the planned changes go beyond one area. The amount to remove is not planned by eye: the surgeon feels the cheek, assesses the fat pad, takes photos from standard angles and agrees with you how much you can realistically expect. This conversation matters more than the operation itself, which is technically straightforward.

Straight after the procedure you stay at the clinic for 1–2 hours under observation and then go home: no hospital admission is needed. Your cheeks feel tight and numb from the anaesthetic, which wears off within a few hours. Painkillers are prescribed for the first 2–3 days.

Swelling builds up and peaks on the second or third day, and at that point the cheeks look larger than before the operation. This is a normal course, not a complication. Most of the swelling goes down within 7–10 days, and the rest within 3–4 weeks. Bruising is uncommon because the surgeon uses blunt dissection through the lining of the mouth, but some patients do get bruises on the skin of the cheeks, which fade within one and a half to two weeks.

For the first 5–7 days your diet should be liquid and warm, not hot: soups, yoghurts, purées and blended drinks. Hard and spicy food are ruled out, as is opening your mouth wide, so as not to strain the stitches. After every meal you rinse your mouth with the antiseptic solution the surgeon prescribed: this is the key condition for a wound in the mouth to heal.

Not all surgeons prescribe a compression mask or elastic bandage; if one is prescribed, it is worn for 3–5 days, mostly at night. For the first few days it is better to sleep on your back with the head of the bed raised. Saunas, swimming pools and sport are put off for at least two weeks, and strenuous activity for a month. Flying is a separate question: it is usually allowed after the follow-up appointment on day 7–10, when the surgeon can see that the incision is healing without complications.

The stitches in the lining of the mouth dissolve on their own within 7–14 days and do not need to be removed. Most people return to work that does not involve physical exertion on day 7–10, when the swelling is no longer noticeable to others. A full return to your usual routine takes from 7 days to 2 weeks.

It is too early to judge the result at one month, or even at two. The shape of the cheek stabilises gradually as the swelling resolves and the tissues remodel: the first changes are visible after roughly 1–1.5 months, and the final picture is usually assessed after 4–6 months, comparing photos taken from the same angles. At this stage some patients say the change is smaller than they imagined, which is exactly why the scale is discussed before the operation, not after it.