Bichectomy is a surgery in which the Bichat balls are removed, which are balls of fat located on the cheeks between two facial muscles, in the middle part of both cheeks and that can give patients a rounded and wide facial appearance and when removing them, a molding is obtained that stylizes the facial silhouette, and a seemingly more elongated face is obtained.
What is the operation of the bichectomy?
It is a brief surgical intervention, of half an hour, ambulatory, usually performed under local anesthesia (similar to that used in dental procedures) and sedation.
The surgeon makes two small incisions of approximately 1 cm each inside the oral cavity, through which he removes the bags of fat from the inside of the cheek. It does not leave visible scars since the sutures are done inside the mouth, and there is no need to place any type of dressing or bandage. Subsequently, a careful disinfection of the oral cavity is performed. The appearance of bruises after this procedure is not frequent, so no internal drainage is left. If a significant bruise appears on the cheek, it would be necessary to make an incision to drain it. After the procedure, the patient can return home and continue to perform their usual activities at 24h.
For whom is it indicated?
It is a surgery especially indicated for adults (from the age of 18), of any sex, who have a rounded face with large cheeks, due to the accumulation of fat, mainly in these Bichat bags. The intervention allows correcting this situation by increasing the definition of facial features.
In patients who have lost weight and still have a rounded facial morphology, they can improve their appearance with this technique.
It may also be a good choice for patients who wish to stylize their facial shapes by highlighting the cheekbones and defining the mandibular ridge.
Why is it done?
Patients who usually look for this technique are usually patients whose face shows an excessive roundness that does not improve when they lose weight, giving an appearance of being overweight without having it, also when they are looking to give their face a more youthful appearance or want to highlight or mark plus the cheekbones. Thus, this surgery is indicated when you want to get a thinner and more proportionate face with the finest and delicate features, a more harmonious profile that can also influence the best of chewing, etc.
Risks of bichectomy
In general, this procedure is quite safe, and the risk of complications is minimal. Among the possible complications, we describe some of the following:
• Retention of saliva in the parotid gland. The incision made in the cheek is made in the vicinity of a duct through which drains this salivary gland so that this duct can be affected or abnormally affected. This fact can cause infections and inflammations (Parotiditis) in the parotid gland. If this occurs, it may be necessary to recanalize the drainage duct of the gland.
• There is a small risk of injury to the nerve branches of the sensitivity of the inside of the mouth with the appearance of a lack of permanent sensitivity of the area involved. If it occurs, as there is no sensation in that area, injuries of the inner part of the cheek could happen, due to bites during chewing, for example.
• There may also be lesions of a small nerve branch of the facial nerve. This fact is extraordinarily infrequent, but, if it were to take place, there would be paralysis of the musculature of the face, in the area of the cheek, with transitory character in most of the occasions.
• The appearance of superficial bruising is very common, for example, due to small traumatisms in the operated area or unnecessary overexertion that resolves spontaneously within a few days. If there is a significant hemorrhage, you should go to the hospital.
• Edema or facial inflammation in the operated area that will progressively diminish rapidly.
• Infection: it is rare and if it occurs, additional treatment may be necessary, including antibiotics or surgery.
• There may appear, after surgery, an abnormal accumulation of bodily fluids due to the surgical trauma of the tissues or to hematomas in resolution, which is known as “seromas.” Most absorb spontaneously. If they occur late, they may require surgical treatment with drainage and cleaning of the area.
• Separation of the edge of the wound can happen, although it is unusual.
• Irregularities of the contour and depressions of the skin can occur and will require additional treatments to correct themselves.
• Asymmetries may occur in the final residual volume of the cheeks.
• There is the remote possibility of complications, injuries and even death from any form of anesthesia or surgical sedation.
The use of any medication that may affect coagulation one week before and one week after the procedure is discouraged. The doctor should be informed of the diseases that the patient may have, the medication he/she takes and if there are allergies to drugs or previous anesthetics.
Before the intervention, pre-surgical photos are taken to objectify the results subsequently.
How is the postoperative bichectomy
• The patient will be discharged after the intervention, on the same day. You must be at least 24 hours at rest before returning to your normal life.
• In general, the postoperative course is painless.
• The suture thread is reabsorbed only in the first days.
• After the intervention, there is usually a decrease in sensitivity inside the mouth, around the cheek area. This decrease in sensitivity is transient, disappearing in a few days, although it can produce small lesions in the oral mucosa due to trauma during chewing during this period.
• There must be correct oral hygiene in the days after the intervention to avoid superinfection of the surgical wound.
• A soft diet and sleeping in a semi-sitting position are recommended at least during the first week. Vigorous physical exercises should be avoided in the first 15 days.
• The cheek remains inflamed for one or two weeks, but since the aforementioned fat pocket has been resected, that inflammation is practically imperceptible.
The final results of cheek surgery are visible after 4 to 6 weeks. The intervened region will progressively deflate, and when it disappears, it can be noticed that the face has a real stylization effect and improves its profile.
The extraction of Bichat bags is a reversible method, because if the patient loses weight and the face becomes disfigured when it appears excessively thin or regrets the results obtained, fat can be put back into the same location by extracting it from another part of your body.
This procedure in surgery lasts approximately 45 minutes.