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Go Away Buccal Fat Pad of Bichat!

March 23rd, 2017 Share

Dr. Marie François Xavier Bichat was an anatomist and biologist who, in the late 1700s, described this unique and complex facial pocket of fat. In fact, the buccal fat pad (also known as “fat pad of Bichat“) has 6 facial components, some superficial and some deep into the musculoskeletal facial structures; the most important one for our discussion here is the buccal fat pad over the mid-cheek, between the buccinator and master muscles, the one the plastic surgeon will excise when slimming down one’s face. The other important ones are the superficial and deep temporal extensions which should not be excised, since it would age the patient.

Journal of oral and maxillofacial surgery, Jun 2012 – K. Khiabani

by Dra. Heloíse D. T. Manfrim

The removal of the buccal fat pad of Bichat, a procedure that’s also called “bichatectomy” or “bichectomy” will often convert a chubby round face into a slimmer, more harmonious face. In many cases, it will also give a man or woman a more angular look, something praised nowadays in the modeling industry.

The best candidate for buccal fat pad removal here in Toronto will be a male or female with a full and round face where reduction off the middle third of the face will be beneficial, allowing to obtain a stronger “cheekbone look” (zygoma) and an angular model-like mid-face. The overall effect will be a rejuvenation of the face by allowing the upper cheekbones to be more prominent, creating the desired slight shadow in the buccal fat area and resulting in the praised “angular” look.

The end results will therefore be, in the ideal patients:

1.  Thinner cheeks

2.  Nice improvement in the overall facial appearance, better harmony and a more youthful face

3.  Cheeks will be more defined resulting in more defined cheek bones (zygomas)

4.  Gain in self-esteem

5.  Better confidence

Journal of Oral and Maxillofacial Surgery, K. Khiabani

The procedure is done often under general anesthesia while another procedure is being done or under local anesthesia with IV sedation. The incision in inside the mouth, horizontal in the occlusal plane, behind the parotid duct. Closure is usually done with dissolving sutures and most will have disappeared by the tenth day. Most patients can resume work within 10 to 14 days, or earlier if able to camouflage the slight bruises with make-up. The final results should show within 6 to 12 weeks while all the swelling have disappeared.

There is a theoretical risk of over-resection and making other parts of the face look older, so the plastic surgeon must use proper surgical judgment as to when to stop. For reference, I like to remove something similar to, and no more than, the size of a flat dry apricot or half a marshmallow.

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Dr. Marc DuPere’s patient, Left buccal fat pad

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Dr. Marc DuPere’s patient, Left and right buccal fat pads

Complications that I discuss with patients include over-resection, under-resection, minor bleeding and bruising, nerve and muscle injury, infection, asymmetry, injury to the parotid duct and sialocoele (enclosed cyst of saliva) and buccal mucosal scarring (usually innocuous).

Cost varies depending on the type of anesthesia chosen by the patient.

Some professionals feel that the buccal fat pad removal will age the patients 50 years later, as many of us will get more gaunt in the cheek areas as we get much older. This can be corrected, should it occur, with fat grafting or our fillers such as Restylane® and JUVÉDERM®.

The question therefore is: Do you want to look your best now or when you are ninety years old?

Dr. Marc DuPéré