A bichectomy, also known as the Hollywood Cheek procedure or buccal fat pad removal, is the removal of excess fat from the cheek to augment the cheekbones and make the facial contours more proportionate. Buccal fat is fat located between your cheekbones and jaw bones in your face. These fat pads are what gives your face the shape it has. Everyone has fat here, but some people have more fat than others.

The procedure, a type of plastic surgery, is usually done to give a more attractive, rejuvenated and proportioned appearance to the face. It helps to get rid of a full and chubby facial appearance. While more women undergo this surgery, it can also be performed on men. But because they have a different bone and fat structure, less fat is extracted.

The bichectomy, which is usually a very simple and painless procedure, takes about 45 minutes. It is done by making an approximately 1cm incision in the inner cheek with care taken to avoid the parotid duct. Around 40-50 percent of the fat in that region is removed. Although it is usually done with local anaesthesia to save cost, it can also be done with general anaesthesia.

As with every other surgery, choosing a doctor is very important because a lot goes into this procedure. The area in the cheek from which fat will be removed and how much fat, if filling will be necessary and how much filling will be required are all very important decisions that need to be made by a professional.

Bichectomy Before and After Pictures

While we can’t show any before and after photos on this site, you can find a lot of fantastic bichectomy before and after pictures on the website of Dr. Sheila Nazarian.

Bichectonomy before and after
What will the final bichectomy result look like?

She specializes in plastic surgery and her clinic is located in Beverly Hills. It’s a perfect resource to learn more about the “Hollywood Cheek” procedure. The best part is that she has a dedicated resource showcasing dozens of bichetomy before and after pictures and transformations.

Here’s where you can see the before and after pictures.

Sometimes the results are subtle. But in almost all after pictures, you can notice a slightly slimmer face. The cheek bones are more visible and the facial traits more expressive.

Bichectomy Gone Wrong: How One TikTok Star Regrets Having Undergone the Procedure

While the before and after images above showcase what a successful bichectomy looks like, a TikTok star by the name of Jessica Frozza had a different experience.

The TikTok creator that goes by the name @perolasdafrozza. She mentioned on TikTok:

“In the first year, you find mass. Except, after that, I swear to God, my face has become much more flacid. My face has sagged, I don’t recognize my face. Today I have to continuously undergo a procedure to stimulate collagen in the Bichat balls. I look like a skull. Why didn’t anyone warn me?”

Now she’s educating and warning people about the surgery. On a blog post by Upsocl, you can see a before and after picture of a bichectomy gone wrong.

In one photo, Frozza shows how her face is sagging. It almost appears as if she has two dents right under her cheeks, making her face look artificially boney and unnatural. However, Frozza’s experience might not be representative of a majority of people who undergo the procedure.

Despite this, it’s important to weigh all the benefits and risks and speak to an expert surgeon.

Bichectomy Risks

As you can see, bichectomy risks include being left with saggy or “skull like” face. In the case of Frozza, she’s continuously taking steps to undo the damage. Other risks and bichectomy side effects could include inflammation, a swollen face and other complications.

Most of the time, the swelling doesn’t last very long and bichectomy side effects aren’t permanent. While there are risks, it’s important to keep in mind that most before and after pictures only show a slight slimming effect.

The “Hollywood Cheek” procedure got its name from celebrities undergoing it

The “skull” effect that Frozza suffered from might be the exception and not the norm. Despite this you should be aware that a bichectomy is a surgical intervention that requires an experienced and skilled plastic surgeon that knows what they’re doing.

If you’re serious, book an appointment with an experienced plastic surgeon. And it’s always a good idea when dealing with health-related decisions to get one or two second opinions from other doctors and specialists.

Are You a Good Candidate for the “Hollywood Cheek” Intervention?

If you have round cheeks and this creates a fullness to your face that you do not like, you may consider undergoing this form of plastic surgery. In general, it’s advisable that you are between your mid 20s to 40s.

The ideal candidate should maintain a stable and healthy weight. It is not ideal to have a bichectomy if you have a narrow face and no fullness in your cheeks. Also, it is not advisable for older patients as the ageing process might have already caused a general volume loss in the cheek and mid-face area.

Whatever the case might be, typically during your first visit, you will be assessed by the plastic surgeon. Based on what your expectations are and the clinical findings, this will determine if you are an ideal candidate for this surgery.

And your plastic surgeon can make you aware of potential risks and side effects.

What Happens Before the Procedure?

Before the bichectomy you should meet with your plastic surgeon and discuss what you would like to achieve with the surgery, as well as what to expect during and after your bichectomy. During your first visit, your face will be examined and some photographs will likely be taken.

Other questions will also be asked, such as questions about your general health, your family health history and if you’ve had any surgeries in the past. Some basic health information will also be taken such as your blood pressure and information about any medication you are currently on.

Bichectonomy surgery
Usually, local anaesthesia is used

It’s important to be honest about all your medications, including herbs and supplements. Also be upfront about your expectations from the surgery. During this visit, you should ask the surgeon questions you have regarding the surgery so they can provide recommendations that meet your desired goals and also assess any risk associated with your bichectomy.

And as mentioned earlier, getting a second opinion form someone who isn’t financially incentivized from performing surgery is usually a good idea. This way you’re not relying on the advice you get from a single expert.

What to Expect During the “Hollywood Cheek” Makeover

So what actually happens during the bichectomy? First of all, depending on what you decide, you could either have a local aesthetic or general anaesthesia. But most of the time, a local aesthetic is given. For the next step, a small incision will be made on the inside of your mouth on both sides. This is done to ensure that there are no visible scars, and this exposes the buccal fat pads.

Related Topic: Blackhead Extraction

Then your doctor will gently press on the fat pads, further exposing them and allowing them to be cut out and removed. Dissolvable sutures will be used to stitch up the incisions and if you need to, you will be asked, after a certain period of time, to come back and have your sutures removed.

Even though the risks associated with this surgery are not very high and the results are mostly satisfactory, there are still risks. So the surgeon has to be highly skilled and understand the anatomy of this region. The surgeon needs to know the correct point to enter from to ensure minimal tissue trauma, bleeding and if possible completely avoid damage of any sorts.

What Does Bichectomy Recovery Look Like?

The time it takes for the tissue in the mouth to recover is usually about three weeks but most patients can return to doing all their normal activities after 5-7 days. To further optimize healing, it is strongly recommended that you stop smoking two weeks before your surgery and also two weeks after. Smoking can increase the risk of complications.

For the first week post-op your diet should comprise mostly of soft, cold-food or liquid foods. This is done to prevent the tissue at the incision sites from getting irritated or dislodging the stitches before its time to take them out. Then slowly you can increase the consistency of your diet as the tissue heals.

It is paramount to follow to a tee whatever instructions your doctor gives you and take any medication prescribed to prevent infection. It’s expected that you experience discomfort although very minimal but you are not expected to have any bruising. The swelling can last up to six weeks after your surgery but usually subsides after peaking on the third day.

It might take as much as three months for the area to be completely healed and the final results to be evident.

Bichectomy Price

The price of a bichectomy varies depending on various factors but it might cost somewhere between $2,000 and $5,000 depending on the skill and experience of your surgeon. And because the surgery is cosmetic in nature rather than medically necessary, these costs are not covered by most insurance companies.