Bichat’s Fat Pad
2 December 2019 onur
Plastic surgeons are highly skilled in media, publicity and finding mottos.
We do not learn about “marketing” in plastic surgery specialty, but we certainly have the potential to make advertisers jealous.
What I love most about this blog is that it gives me the comfort of answering some questions “via a link”.
Do I perform “bichectomy”?
In this article, I will explain Why, How and When.
“Bichectomy” is the surgical removal of the buccal extension of the Bichat’s fat pad. I list the key points about this procedure below.
- The Bichat’s fat pad is a deep fat tissue system that starts from the temporal area, extends to the cheek and supports the recessed areas of the skull. The buccal extension of the Bichat’s fat system may be too prominent and herniated in some people. This herniation may make the inner half of the aesthetic depression drawn between the earlobe and the edge of the mouth, which we want to be relatively hollow, fuller than desired. In that case, the buccal fat pad can be removed or relocated.
- The patients demanding this procedure are mostly young patients. In healthy young individuals, the Bichat’s fat pad does not have as significant an impact on the facial contour as the patient assumes. Since it is called the “deep” fat system, this structure is often masked by the tissue layers accumulated on it. The young patients requesting this procedure almost want a different face model. You do not stand a chance to switch to a new face model via facial aesthetics today and say you are bored with it tomorrow. Therefore, you should make sure whether you really want such a change, whether the cheek shape you see on the cover of a magazine is achievable on your face, and whether it will suit you even if it is.
- Patients think that when this fat pad is removed, their faces will instantly become thinner and assume a V shape. However, the face/cheek width is affected by numerous factors including but not limited to the jawbone angle, the position of the jaw tip, the volume of the chewing muscle (masseter), the size of the buccal salivary glands, the individual anatomy of subcutaneous fat layers, the genetic form of the face and the aging characteristics. You cannot make the face thinner from the opposite view simply by removing the buccal fat.
- The Bichat’s deep fat system does not expand the face laterally, but rather pushes it forward. It is a basic principle that surgeons dealing with facial aesthetics are cognizant of: As the skeletal surface of the face protracts, the face appears thinner from the opposite view while it appears broader as the skeletal surface of the face retracts. In other words, significantly reducing the buccal deep fat may make the face appear broader, contrary to what is desired.
- The removal of buccal fat assigns a rather angular appearance to the face. Since the angular character is more compatible with the aesthetics of the male face, the aesthetic results of this procedure are more satisfying in male patients (at least in my experience).
- The buccal extension of the Bichat’s deep fat system fills canine fossa, the depression of the maxillary bone. This depression already erodes during the aging process and gets hollower. Any fat reduction in this area may result in a sudden deepening of the nasolabial fold between the cheek and lips. Some patients express this situation by saying, “I look older after the procedure.”
- During the aging process, your face will lose so much volume that you will be longing for each and every gram of fat. In the treatment of the aging face, we may even need to enlarge the deep compartment containing this fat with external adipose tissue support. I use this fat to achieve better volume in patients whom I give a deep plane facelift. I also use this fat to fill the depression of the skeleton between the cheek and nose in patients whom I give a midface lift. Therefore, the use of this fat in younger ages eliminates the possibility of its surgical use in later years.
- In an attempt to protect their patients from the “net volume loss” effect, a considerable number of surgeons who remove the Bichat’s fat pad process the removed buccal fat or the adipose tissue from another part of the body and inject them into the higher parts of the face. Let me remind you that anything which creates a net volume loss on the face (liposuction, lipolysis, focused ultrasound that destroys the subcutaneous fat mass, Botox, bichectomy, etc.) will cause the signs of aging to appear earlier in the long run.
- The removal of the buccal fat pad is a surgical procedure. This is done through an intraoral incision. This procedure is easier than the other surgeries we do, but it is a surgical procedure after all. As with any surgical procedure, it has its own risks and complications as well as a unique healing process. Make sure you ask and learn about these. For instance, after the procedure, you cannot immediately go out for lunch with your friends because there will be an incision in your mouth.
Please feel free to contact us as you wish regarding questions about the buccal contour and face shape.
Take good care… of yourself and your beauty.