Does bichectomy cause sunken cheeks in later years?

Buccal fat removal is one of the aesthetic procedures frequently researched by people who want to make their facial contours more defined in recent years. However, one of the most important questions about buccal fat removal is whether the operation may cause hollowness in the cheeks in later years. Many people considering buccal fat removal are concerned that they may experience volume loss, a tired appearance, or an older facial expression years later, especially because of comments they come across online.

In fact, the answer to this question is too individual to be given in a single sentence. This is because the most important factors that determine the long-term appearance after buccal fat removal are the patient’s facial anatomy, skin quality, aging process, the volume of the Bichat fat pad, and how much tissue is removed during surgery. At Dr. Faylim Tansu Uzel Clinic, when buccal fat removal planning is performed, not only the patient’s current facial shape but also the natural changes that may occur in facial tissues over the years are taken into consideration. Therefore, the goal is not to make the face excessively thin, but to achieve a more balanced and aesthetic appearance while preserving natural proportions.

Is Volume Loss Experienced in the Face After Buccal Fat Removal?

Volume loss in the face after buccal fat removal is among the most frequently asked questions by patients. At this point, it should first be stated that not every buccal fat removal operation causes facial hollowness. It is not correct to attribute volume loss that appears in the cheeks over the years solely to buccal fat removal. The human face naturally changes with age. Subcutaneous support tissues may decrease, collagen production may slow down, the distribution of fat tissues may change, and volumetric changes may be seen in the facial bones.

These changes also occur in people who have never undergone any aesthetic operation. Therefore, the face looking thinner or more tired in later years is not always related to buccal fat removal. The main point here is whether the operation is performed on the right person and with the right technique. If an aggressive buccal fat removal approach is preferred in people who already have a thin face, prominent cheekbones, and insufficient volume in the cheek area, an undesired hollow appearance may occur in the following years. On the other hand, with proper patient selection and controlled surgery, natural, balanced results that can preserve their aesthetic appearance for a long time can be achieved after buccal fat removal.

What Is the Main Purpose of Buccal Fat Removal?

Buccal fat removal is an aesthetic facial contouring procedure that aims to reduce the Bichat fat pads located in the deeper part of the cheeks in a controlled manner. The important point here is that the procedure is not performed to completely hollow out the face, but to reduce excess volume and make facial proportions more balanced.

After a properly planned buccal fat removal operation, the following effects may be targeted:

• A clearer and more balanced appearance of facial contours
• More noticeable perception of the cheekbones
• A sharper and more aesthetic appearance of the jawline
• Reduction of the round appearance in the lower face area
• A more elegant overall facial expression

These effects do not appear at the same level in every patient. This is because one of the most important factors determining the result of buccal fat removal is the person’s initial facial structure. Results may be more noticeable in patients with a round facial form, prominent cheek volume, and strong skin support. In people with a thinner facial structure, a much more conservative approach may be required. Therefore, buccal fat removal should not be considered a one-size-fits-all procedure in which a standard amount of fat is removed.

What Changes Occur in the Face During the Aging Process?

Facial aging is not limited only to the formation of wrinkles on the skin. Over time, subcutaneous tissues, fat pads, connective tissue, muscles, and bone structure change together. Therefore, the aging process can affect both the volume and the shape of the face. In particular, the decrease in supportive tissues in the midface area may cause the cheeks to appear flatter or more hollow.

As age progresses, collagen and elastin production slows down. Skin firmness decreases, and soft tissues may shift downward under the effect of gravity. While fat tissues in the face decrease in some areas, they may also shift in others. Natural reduction in bone volume can also cause facial contours to lose their former definition. This process progresses at a different pace for everyone. Genetic structure, weight changes, sun exposure, smoking, sleep patterns, eating habits, and skin care directly affect facial aging.

For this reason, attributing every volume loss that appears in the face years later to a buccal fat removal operation is not a correct approach. Buccal fat removal is a procedure targeting a specific part of the Bichat fat pad. However, the aging process is a much broader biological change that involves the entire face. For a healthy evaluation, the patient’s facial anatomy, surgical technique, and aging dynamics should be considered together.

Why Can the Cheeks Look Hollow After Buccal Fat Removal?

A hollow appearance in the cheeks after buccal fat removal is often caused not by the procedure itself, but by incorrect patient selection or removal of more fat tissue than necessary. Especially in some cases where more aggressive surgical approaches were preferred in previous years, more hollowing than expected could occur in the mid-cheek area. This is one of the main reasons for some of the concerns about buccal fat removal today.

If a decision is made based only on the desire for thinner cheeks without carefully analyzing the face of the person who will undergo buccal fat removal, the long-term result may not be satisfactory. For example, removing a large amount of Bichat fat in a patient whose face is already long and thin may make the face look weaker and more tired. Similarly, more conservative planning is needed in people with low skin elasticity or those who have already begun to experience noticeable volume loss.

In the modern buccal fat removal approach, the goal is not to completely eliminate the supportive structure inside the cheek. The aim is to reduce excess volume without disrupting the existing proportions of the face. This difference is highly important for the long-term success of the operation. Buccal fat removal performed with the right technique can make the face more balanced and defined instead of making it look hollow.

Is the Entire Bichat Fat Pad Removed?

In modern buccal fat removal surgery, removing the entire Bichat fat pad is generally not the goal. This is because Bichat fat tissue is an anatomical structure with different extensions within the face and is related to the natural support of the midface area. Removing this tissue completely is not a suitable approach for every patient. On the contrary, in the current surgical approach, reducing only the necessary amount in a controlled manner is preferred.

In many cases, the removed portion consists of only a certain part of the fat tissue. Preserving the supportive anatomical structures located in the upper region is important to prevent disruption of the natural transitions of the face. Thanks to this approach, volume support around the cheekbone can be better preserved, and the risk of the midface area appearing excessively hollow in later years can be reduced.

How much tissue will be removed during buccal fat removal is determined according to the patient’s facial width, cheek volume, cheekbone prominence, jawline, and overall facial proportions. In other words, in a successful buccal fat removal operation, the surgeon’s goal is not to “remove as much fat as possible.” On the contrary, the goal is to achieve a natural and long-term balance by reducing the right amount of tissue from the right area.

Does Buccal Fat Removal Cause Facial Sagging?

It is not correct to say that a buccal fat removal operation performed with proper patient selection and an appropriate surgical technique directly causes facial sagging. Facial sagging is more closely related to skin elasticity, connective tissue quality, the aging process, weight changes, and the effect of gravity. Buccal fat removal, on the other hand, is the controlled reduction of a specific fat tissue inside the cheek.

In suitable patients, the facial oval may become more defined after buccal fat removal. The cheekbones may appear more prominent, and the jawline may be perceived more clearly. However, in order to achieve this result, the overall supportive structure of the face must be preserved. If the patient has noticeable skin laxity, advanced volume loss, or a very thin facial form, buccal fat removal alone may not be the right choice, or a more limited application may be planned.

For this reason, detailed facial analysis before buccal fat removal is highly important. The patient should not be evaluated only in terms of the cheek area, but the entire face should be examined. The forehead, cheekbones, midface, jawline, skin quality, and overall facial proportions should be assessed together. In the planning carried out at Dr. Faylim Tansu Uzel Clinic, the aim is also to create a facial balance that will remain natural in the long term rather than short-term sharpness.

In Which Patients Is a More Conservative Buccal Fat Removal Approach Preferred?

Buccal fat removal should not be planned in the same way for every patient. While more noticeable slimming can be safely targeted in some face types, a more conservative, in other words more protective, approach should be preferred in some patients. The reason for this is to preserve long-term facial support and prevent the appearance of excessive volume loss in later years.

More conservative buccal fat removal planning may especially be considered in the following patient groups:

• People with low body fat percentage and a naturally thin face
• Patients with prominent cheekbones and an already hollow-looking lower cheek area
• Individuals with reduced skin elasticity or those in an older age group
• People who have previously undergone facial aesthetic surgery
• Patients with a history of frequent weight gain and loss

In this patient group, the amount of fat to be removed may be kept more limited, or in some cases, different facial contouring procedures may be considered instead of buccal fat removal. The important point here is not to apply the patient’s request directly, but to plan the most appropriate and safest result for the facial anatomy. An experienced evaluation reduces the risk of unnecessary volume loss.

Are Buccal Fat Removal Results Permanent?

The fat tissue removed during buccal fat removal does not regenerate. Therefore, buccal fat removal is considered among aesthetic procedures that provide permanent results. However, the concept of permanence should be understood correctly here. The Bichat fat tissue reduced through the operation does not come back; however, the person’s face continues to age. For this reason, natural changes may be seen in the skin, muscle structure, connective tissue, and other fat tissues over the years.

Weight gain and loss can also affect the appearance after buccal fat removal. When a person gains noticeable weight, volume increase may occur in other fat tissues of the face. When weight is lost, a thinner appearance may emerge across the entire face. These changes do not mean that buccal fat removal has failed; they reflect the natural biological changes of the face over time.

For a permanent and natural-looking result, postoperative lifestyle habits are as important as preoperative planning. Healthy nutrition, stable weight, regular skin care, and sun protection contribute to preserving facial aesthetics in the long term. When performed correctly, buccal fat removal can offer a long-lasting effect that makes facial contours more defined.

May Additional Rejuvenation Procedures Be Needed After Buccal Fat Removal?

In the years following buccal fat removal, some patients may benefit from additional rejuvenation procedures. This does not mean that the effect of buccal fat removal has disappeared. It is more related to the management of the natural aging process. Over time, skin quality may decrease, midface support may weaken, or general volume loss may occur in the face. In such cases, procedures aimed at improving skin quality or providing volume support may be considered.

PRP, salmon DNA treatments, collagen-stimulating injections, and volume-supporting filler applications in suitable cases are among the methods that may be preferred in this process. However, these procedures are not necessary for every patient. Some patients can preserve their natural appearance for years after buccal fat removal without needing any additional procedure. In some patients, supportive treatments may come into consideration depending on age, skin structure, and genetic factors.

The important point here is not to evaluate facial aesthetics through a single procedure. Buccal fat removal is a facial contouring procedure; skin quality, collagen production, and the overall aging process are separate topics. Therefore, when long-term aesthetic planning is performed, the face should be evaluated as a whole.

Buccal Fat Removal Treatment in Istanbul Beyoglu

For people considering buccal fat removal treatment in Istanbul Beyoglu, the most important stage is proper evaluation. At Dr. Faylim Tansu Uzel Clinic, buccal fat removal operations are planned individually according to each patient’s facial proportions, cheek volume, cheekbone prominence, jawline, skin structure, and aesthetic expectations.

Before the operation, not only the complaint the patient sees in the mirror but also the overall anatomical balance of the face is evaluated. This is because a successful buccal fat removal result is not measured only by the thinning of the cheeks. The result must look natural, be compatible with other areas of the face, and preserve its aesthetic balance over the years. Therefore, it is important to make a lasting plan suitable for the patient’s own facial structure rather than short-term trends.

When performed by experienced hands, buccal fat removal can help achieve more prominent cheekbones, a clearer jawline, and a more balanced facial form. However, it should not be forgotten that it may not be suitable for every patient. Therefore, examination and facial analysis are the most critical parts of the operation decision.