While volume is generally a desirable feature of a youthful and beautiful face, excessively full cheeks can be bothersome for some individuals. Some men and women, no matter their age, are bothered by overly full or “chipmunky” cheeks, or a too-round “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 excision—also known as bichectomy surgery—can 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 permanent and natural-appearing results.
Most commonly, minimally invasive face and neck contouring procedures such as Embrace RF, FaceTite, and AccuTite are performed in our office, with the help of laughing gas (also known as ProNox) and injectable numbing or freezing medications. Dr. Fishman treats the tissues of the forehead and brows, upper and lower eyelids, smile lines, jowls, and the neck with the radiofrequency tissue tightening treatments of FaceTite and AccuTite, and sometimes adds lipoconouting or liposuction to remove excess fat during the same treatment. The combination of FaceTite or AccuTite, liposuction, and microneedling with radiofrequency (called Morpheus 8) is called Embrace RF, and best addresses jowls, the contours of the lower face and jaw, and neck in patients not ready or interested in surgical rejuvenation.
Dr. Fishman sometimes performs Embrace RF, FaceTite, and AccuTite treatments with other procedures such as blepharoplasty (eyelid lifts), chemical peels, or lip lifting. Depending on other procedures, minimally invasive tissue contouring procedures may be performed in the operating room, with the help of general anesthesia.
Not really. Men and women of all ages may inquire with Dr. Fishman about cheek reduction (buccal fat excision) surgery. Older teenagers may be candidates for buccal fat pad reduction, as long as they have appropriate anatomy, favorable mental maturity, and parental consent. On the other extreme, some facial contouring patients who are candidates for liposuction, facelifting or necklifting may also benefit from buccal fat reduction. 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. Strong pain medications are not typically necessary during buccal fat reduction recovery, and most patients stop taking Tylenol and Motrin in 2-3 days after treatment.
With the incision for buccal fat reduction being inside the mouth, bruising is not typically visible and is overall very rare. 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. Dr. Fishman counsels buccal fat reduction patients to expect approximately 1 week of looking extra full or “chipmunky” at the lower cheeks.
Dr. Fishman recommends a soft, bland diet for 1 week after buccal fat reduction surgery to optimize your recovery and decrease the chance of complications. Buccal fat pad reduction is an oral surgery, and it is 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.
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.
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
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.
• 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.
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