Buccal Fat Pad Reduction

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Buccal Fat Pad Reduction in Sandy Springs and Atlanta, GA

While volume is generally a desirable feature of a youthful and beautiful face, excessively full cheeks can be bothersome for some individuals.  Some people, no matter their age, are bothered by overly full or “chipmunky” cheeks, or a “baby face.”  Partial removal of the buccal fat pad (also known as the fat pad of Bichat) is a minor surgical procedure performed to slim the lower face and cheeks, and it is one of the most effective tools for facial contouring.  Buccal fat pad reduction or excisionalso known as bichectomy surgerycan be an effective way to sculpt overly full cheeks, reduce excess volume in the lower face, and highlight or accentuate the cheekbones.  A relatively short procedure, buccal fat reduction involves surgically trimming a discrete collection of fat located within the cheek, typically through a small incision on the inside of the mouth.  Offering little to no downtime and no visible scars, this procedure offers natural-appearing results.

Benefits of Buccal Fat Excision

  • Treatment of excess, chubby cheek fat
  • More slim and sculpted cheeks, and a more balanced facial appearance
  • May improve confidence and self-esteem
  • Brief surgery, scant to no bruising, and short recovery
  • No facial scars or incisions
  • Buccal fat can also be transferred to other parts of the face, like the upper cheeks, to add contour

Candidates for Buccal Fat Pad Excision

Good candidates for buccal fat pad excision or bichectomy surgery are individuals bothered by excessively full or “chipmunk” cheeks who are motivated to sculpt and slim their facial appearance.  Dr. Fishman determines a patient’s candidacy for buccal fat pad reduction surgery during an extensive personal consultation, which includes a thorough review of the patient’s medical history, physical exam, and a tailored and individualized treatment plan.  As a good candidate for buccal fat pad reduction, you should be in good health, show great physical and psychological maturity, and have realistic goals and expectations of aesthetic treatments.



Buccal Fat Reduction Surgery: Treatment Details

Dr. Fishman starts the buccal fat reduction procedure by anesthetizing the tissues of the cheeks and ensuring your comfort.  Most commonly, she performs the procedure with the help of ProNox (or laughing gas) and injectable local anesthetic in the office; occasionally, buccal fat pad reduction is combined with facelift surgery.  After numbing the tissues, Dr. Fishman makes a small incision on the inside of the cheek and carefully dissects and removes the unwanted fat to sculpt the cheek, then using absorbable stitches to close the cheek incision.  If patients need or desire additional volume in other parts of the face (like the upper cheeks), Dr. Fishman processes the trimmed buccal fat and grafts it to treated areas.

Dr. Fishman most commonly performs the buccal fat reduction procedure in the office with the help of relaxing medications, laughing gas, and local anesthesia.  She performs buccal fat pad reduction in the operating room when in combination with other procedures, such as rhinoplasty or blepharoplasty.

Contact us today to learn more about buccal fat reduction or bichectomy surgery.

After Surgery

  • You should expect some swelling, bruising, numbness and discomfort in the cheeks.
  • Cool compresses and oral pain medication should manage your discomfort.
  • Cheek swelling resolves over several weeks post-treatment, as the cheeks heal.
  • You are encouraged to rest at night with your head elevated for a few weeks.
  • Follow these dietary guidelines:  avoid all uncooked foods (risk of bacteria) and thoroughly wash all raw fruits and vegetables.  Consume liquids and soft foods only for approximately a week after surgery.
  • Use Dr. Fishman’s prescribed anti-bacterial mouthwash to rinse your mouth for several days after surgery.
  • Avoid touching the incisions inside your mouth with your tongue or anything else.
  • Avoid strenuous activity until healing is complete.
  • Sutures usually dissolve on their own within 1-2 weeks.
  • Be patient with your healing, and know it may take several weeks to have all swelling resolve and see your final treatment results.
Buccal fat reduction

Buccal fat pad reduction, also known as bichectomy surgery, has incisions hidden inside the mouth.  The swelling after this procedure is moderate, and most patients are socially presentable essentially immediately after surgery.  Most people look a little extra “chipmunky” for about a week after buccal fat pad surgery.

The patient shown is a young woman who had buccal fat pad reduction and fat transfer to the upper cheek, to add contour to the cheekbones.  The purple marks are leftover surgical markings, and wash off in 1-2 days after treatment.  

Frequently Asked Questions

Men and women of all ages may inquire with Dr. Fishman about cheek reduction (buccal fat excision) surgery.  There are multiple facial contouring options today, and Dr. Fishman will discuss them with you to assure you make the right decision.

Most patients complain of mild-moderate soreness rather than significant pain after buccal fat pad reduction or bichectomy surgery.  Oral medications (such as Tylenol and Motrin) and cool compresses typically manage post-surgery discomfort quite effectively, with most patients returning to work and social obligations in 1-3 days after the procedure.

With the incision is inside the mouth, bruising is minimal and not typically visible.  Swelling of the cheeks may take several weeks or even months to resolve completely, but patients usually resume their daily routines in a few days after treatment.

Buccal fat pad reduction is an oral surgery, and it is very important to ensure no bacteria from foods get into the mouth and incision sites.  Our post-treatment instructions aim for smooth, problem-free healing of the mouth and cheek tissues, with minimal chance for infection or irritation of the freshly healing incision.  Besides infection prevention, your mouth soreness will dictate what you feel like eating for a few days after surgery.

No. Buccal fat pad reduction or bichectomy surgery is an elective cosmetic procedure, and insurance does not cover this treatment.  We offer financing to cover the cost of aesthetic treatments, and can provide you with financing information in our office as part of your consultation with our team.

dr. inessa fishman injects botox

Buccal Fat Pad Reduction Post-Procedure Instructions


For 48 hours after surgery sit up or walk during the day, and at night sleep with the head of your bed elevated with 2-3 pillows (or head above the level of the heart).  This promotes more effective resolution of post-procedure swelling.


Take only medication prescribed by Dr. Fishman and your other physicians.  Pain medications should be taken with food.  Pain (and other) may be constipating; consider taking a stool softener (like over-the-counter Colace) twice daily when taking pain medications.


You may shower, use your regular shampoo and regular skincare immediately after your procedure.  Avoid aggressive exfoliaton or massage of the face for 2 weeks after the buccal fat pad excision. 


Your cheeks will appear swollen, bruised, and discolored immediately after the procedure; this is common, and resolves over 1-2 weeks after surgery.


The inside-of-the-cheek sutures are dissolvable; Dr. Fishman may trim or remove them if they are not fully dissolved at 7-10 days post-surgery.


Eat a soft diet (scrambled eggs, soups, protein shakes, smoothies, etc) for 1 week after your buccal fat pad excision procedure.  Avoid crunchy or scratchy foods (like pizza crusts, raw vegetables, etc). 


Gargle with warm saltwater or Listerine after every meal and twice daily for 1 week after your procedure.


Avoid strenuous activities and contact sports for 2 weeks following surgery.  Walking and climbing stairs are ok immediately after your procedure. 


Avoid smoking, vaping, and the use of nicotine-containing products for 6 weeks before and 6 weeks after surgery.


During healing the cheeks may appear slightly asymmetric due to swelling; this is temporary and slowly resolves over 3-4 months after surgery.  The cheeks may be a little numb, tender and sensitive to touch for up to 6 months following surgery.


Avoid comparing one cheek to the other immediately following surgery.  No two cheeks are perfectly symmetric either before or after surgery; minor variations always exist and generally are not apparent to others.


You may drive when no longer taking strong pain medications.


Avoid direct and unprotected exposure for 6 weeks after surgery.


Heat and exertion may cause the cheeks to swell.  Wear a hat and use sunscreen with minimum SPF of 30 to reduce chances of sunburn.  An easy way to apply sunscreen is with Chapstick with SPF.




Please contact our office:


• If you have increased swelling or bruising.

• If swelling and redness worsen, or if you have increased redness along the cheeks.

• If you have severe or increased pain not relieved by medication.

• If you have any side effects to medications, such as rash, nausea, headache, or vomiting.

• If you have an oral temperature greater than 100.4 degrees.

• If you have any yellow or green drainage from the incisions, or notice a foul odor.

• If you have bleeding from the incisions that is difficult to control with light pressure.

• If a blood clot forms on or under the skin or inside the lining of the cheeks.

• If you have any questions or concerns.