Bichectomy (Buccal Fat Removal) in Northern Cyprus

The Bichat fat pad (buccal fat pad) is an encapsulated fatty structure with several extensions, located in the mid-cheek on the outer surface of the buccinator muscle. It runs close to the parotid duct; its neighbours include the buccal branch of the facial nerve, the facial artery, and the parotid duct. This anatomical proximity explains why the procedure demands an experienced surgeon.

The Bichat fat pad serves several functions:

• It assists suckling in infancy and early childhood — which is why the characteristic chubby-cheeked appearance in young children is largely attributable to the Bichat pad.
• In adulthood it adds volume to the cheek and contributes to the smooth gliding of the buccinator muscle during chewing.
• After puberty its size becomes relatively stable; it is not affected by changes in body weight in the same way ordinary adipose tissue is. The answer to "will my cheeks slim down if I exercise?" is therefore partly yes — but the Bichat fat pad does not disappear with weight loss.

In bichectomy the fat pad is not removed in its entirety. Clinical practice typically involves partial resection of 30–50%. This limit is critical; exceeding it risks producing hollow cheeks in later years.

This is the most critical piece of information about the bichectomy decision: the portion of the Bichat fat pad that is removed does not return. Unlike ordinary adipose tissue elsewhere in the body, the fat pad is a specialised, encapsulated structure that does not regenerate once excised.

The practical implications are:

• If you gain weight, the cheeks may enlarge overall, but the original Bichat volume does not come back.
• As you age (particularly after your 40s and 50s), the face undergoes a natural process of soft-tissue loss known as midface deflation. In patients who have had bichectomy, this loss is compounded by the effect of the surgery, and the cheeks can appear hollower than they otherwise would.
• If you have regrets, some volume can be partially restored with fat grafting, dermal filler, or fat injection — but the original anatomical appearance can never be fully recreated.

For these reasons, the pre-operative consultation involves very careful assessment of skin elasticity, facial skeletal proportions, age, and long-term expectations. The "I saw it on social media and I want it" mindset is the most commonly encountered — and the most important to manage carefully — in this particular procedure.

Bichectomy is not a procedure performed on everyone who requests it. The correct candidate profile is narrow, because poor patient selection leads to permanent long-term problems:

• Age range: The 20–35 age bracket is generally considered ideal. Below 20, fat distribution may not yet be fully stable; above 35, midface deflation may already have begun.
• Face type: Meaningful results are seen in patients with round, full cheeks — particularly where the transition between the jawline and the cheek is indistinct. Performing bichectomy on a patient who already has a naturally slim face can create a gaunt appearance.
• Skin elasticity: In patients with firm, elastic skin, the skin bounces back when the underlying volume is reduced. Poor skin elasticity may result in a sagging appearance.
• Realistic expectations: The goal is a slimmer, more defined mid-face — sometimes described as a V-line or heart-shaped appearance. However, facial shape is determined by the combined effect of the skeleton and soft tissue; bichectomy alone does not change the shape of the face.

There are cases in which we will say "this is not right for you", and this is among the most valuable decisions a clinic can make. The regret from bichectomy performed on an unsuitable candidate is not the surgeon's to carry — it is the patient's, for years to come.

Your initial consultation can be held online (Zoom or WhatsApp video call) or in person at our clinic. The bichectomy consultation takes longer than many aesthetic procedures because four areas are addressed together:

• Facial proportion analysis: High-resolution photographs are taken and reviewed from the front, side, and 45° angles. Lower, mid, and upper facial proportions, cheekbone projection, mandibular angle, and cheek shadowing are all mapped.
• Skin elasticity assessment: Skin type (oily, dry, combination), elasticity, and age-related changes are evaluated. Skin flexibility is assessed manually using a "pinch test".
• Expectation alignment: The question "which reference image are you using?" is discussed openly. In many cases the patient's expectation exceeds what bichectomy alone can achieve. When this is so, combination options are explored — for example, dermal filler for jawline definition, or a facelift component.
• Irreversibility discussion: The fact that the Bichat fat pad does not regenerate once removed — and that the cheeks may appear hollower with age — is explained in detail. This conversation is an integral part of the surgical consent process.

At the end of the consultation a clear picture is shared: are you a candidate, how much resection is planned, should a complementary procedure be considered, and what is the approximate cost. At this stage, telling you "you are suitable" is as valuable as telling you "you are not suitable."

During the in-person examination, three assessments are carried out:

1. Cheek mapping: The patient is photographed while standing and seated, both relaxed and with a gentle smile. The point of maximum buccal fullness, cheekbone projection, and jawline are marked.
2. Resection volume decision: In clinical practice, 30–50% of the Bichat fat pad is removed. This proportion is determined by the following factors:
   • Younger patient with high skin elasticity: A more generous resection may be appropriate (40–50%).
   • Patient over 30 with signs of midface soft-tissue thinning: A more conservative resection (25–35%).
   • Asymmetry present: Different volumes are planned for each side; symmetry is derived from the patient's own face, not from a single fixed figure.
3. Symmetry check points: The human face is naturally asymmetric; surgery cannot correct this asymmetry entirely. The plan is built around approximating greater symmetry — we do not promise perfect symmetry.

When planning is done correctly, surgery brings the outcome to the fore. The temptation to over-resect is the most common pitfall in this procedure, and the philosophy at Nis Clinic is firmly one of balanced resection.

A typical timeline for bichectomy day:

• 09:00 — Arrival at clinic, oral hygiene check, final photographs
• 09:15 — Local anaesthesia is administered: lidocaine (usually with adrenaline) is infiltrated into the intraoral mucosa. Light sedation can be added if preferred.
• 09:30 — Intraoral incision: A small incision of 1–2 cm is made on the inner surface of the cheek mucosa, level with the upper molar teeth. The incision is entirely inside the mouth; no external mark is created.
• 09:35 — Passage through the buccinator: The muscle fibres are separated by blunt dissection; the Bichat fat pad passively herniates out from within its capsule under controlled pressure.
• 09:45 — Resection: The planned volume (typically around 2–4 ml of fat) is excised symmetrically on both sides. The portion left in place is deliberately retained to preserve the cheek's natural volume in the future.
• 09:55 — Haemostasis: Once bleeding is confirmed to be controlled, the mucosa is closed with absorbable sutures that dissolve spontaneously over the following weeks.
• 10:00 — The patient rests with a cold compress and is discharged the same day.

Total duration is 30–45 minutes. No hospital admission is required; the patient can leave the clinic 2–3 hours after the procedure. This makes bichectomy a particularly time-efficient procedure for patients travelling for medical tourism.

Typical recovery timeline:

• First 24 hours: Noticeable swelling in the cheeks; a "balloon cheek" appearance in the mirror. Mild local discomfort and difficulty chewing. Managed with cold compresses and prescribed analgesia.
• Days 2–3: Swelling reaches its peak. This is typically when the patient sees themselves at their worst — there is no need for concern; it is an expected phase.
• Days 4–7: Swelling begins to reduce noticeably. A soft diet continues (soup, yoghurt, mashed food, smoothies). Hot, spicy, acidic, and hard foods are to be avoided.
• Week 2: The cheeks largely return to a more normal appearance. Most patients can resume social activities from day 10–14. Light exercise can be gradually introduced.
• Month 1: Definition in the facial contour starts to become visible; the true change is not yet complete.
• Month 3: The result is well established. Cheek shadowing and cheekbone projection become visually apparent.
• Month 6: Final result. The surrounding tissue has completed its adaptation; the cheek line is settled.

Oral hygiene is critical throughout recovery. An antiseptic mouthwash is prescribed; rinsing with warm salt water after every meal is recommended. Smoking impairs intraoral wound healing and increases infection risk; patients are asked to abstain for at least four weeks.

Related page: Medical tourism packages — transfers, accommodation and aftercare included

• Age range 20–35: Fat distribution is stable and midface deflation has not yet begun.
• Round, full cheek structure: Patients with evident fullness in the lower-to-mid cheek and an indistinct jawline-to-cheek transition.
• High skin elasticity: Skin that can adapt and retract when the underlying volume is reduced, without laxity.
• Stable weight: Patients whose weight has been consistent over the past 6–12 months.
• Good general health: Individuals without uncontrolled chronic conditions, not taking anticoagulants, and with good oral health.
• Realistic expectations: The goal of "a more defined and slimmer cheek contour" is very different from "a completely different face". Bichectomy produces a moderate degree of change.
• Non-smokers or those who can abstain for four weeks — critical for intraoral wound healing.

• Patients over 35–40: Midface deflation may already have begun. In this group, bichectomy carries a risk that 10–15 years later the cheeks may appear hollower than expected, potentially requiring fat injection, fat grafting, or a facelift. For this age group, alternative plans are discussed — jawline definition with dermal filler, facelift, or blepharoplasty (eyelid surgery).
• Age 45 and above: Bichectomy is generally not recommended. Age-related soft-tissue loss already causes natural thinning of the cheeks; surgical resection can exacerbate this.
• Under 20: Fat distribution may not yet be fully stable. Pubertal cheek fullness may reduce naturally over time; the decision is deferred until the age of 20 or over.
• Very slim or naturally fine-featured patients: Bichectomy may slim the cheeks to the point of creating a gaunt or unwell appearance. In these cases the patient's true goals may be better served by other means; facial proportion analysis is discussed openly.
• Poor skin elasticity: When the underlying volume is reduced, the skin may sag, producing a result that falls short of expectations.
• Active intraoral infection or poor oral hygiene: Dental examination and any necessary treatment must be completed before intraoral surgery.
• Very high expectations or possible body dysmorphic concerns: "Remove more" or "I want a completely different face" are red flags. In these cases, psychological support may be the appropriate first step.
• Previous facial surgery (facelift, residual filler): Anatomical planes may have changed; planning is individualised accordingly.

Telling a patient "this is not right for you" or "consider this in ten years' time" is, for us, the most valuable decision we can make. The regret that follows bichectomy is an irreversible regret, and we do not believe it is right for a surgeon to share that burden with a patient who was not a suitable candidate.

Bichectomy may seem like a minor procedure, but anatomically it requires experience: the buccal branch of the facial nerve, the parotid duct, and the facial artery are all in close proximity. Op. Dr. İbrahim Meyzin is a specialist in Plastic, Reconstructive and Aesthetic Surgery and a full member of the Cyprus Turkish Medical Association (CTMA), Registration No. 969. His philosophy on bichectomy is clear: balanced resection, never losing sight of irreversibility. When a patient asks for "more to be removed", he maintains a position focused on the long-term outcome. He is personally present for every operation — the surgery is performed by the consultant, not a technician.

Full credentials, certifications, and publication list: Doctor profile — Op. Dr. İbrahim Meyzin

While social media has made bichectomy popular, it has also made over-resection cases visible. The number of patients presenting years later saying "my cheeks have collapsed too much" and seeking dermal filler, fat injection, or corrective surgery has grown.

Our position at Nis Clinic on this issue is clear:

• Resection volume is set conservatively — typically in the 30–50% range. We are not chasing "maximum results".
• The surgeon guides the patient, and limits patient-driven demands. When a patient says "remove more", reminding them of the long-term outcome is the surgeon's responsibility.
• Combination options take priority: bichectomy alone is often insufficient. Jawline definition with dermal filler, chin projection, and lipo-shaping can be planned in the same session or separately.
• The decision changes with age. The decision made for a 25-year-old cannot be the same as the decision made for a 38-year-old.

This approach is the opposite of the "performed for anyone who asks" mentality. We may sometimes tell a patient they are not a suitable candidate — and this is one of our quality signals.

Bichectomy prices vary by country, clinic, and the procedures included:

• United Kingdom: €1,500–€3,500
• Türkiye (quality clinics): €600–€1,200
• Nis Clinic (Northern Cyprus bichectomy): average €1,000–€1,500

This figure varies according to the resection volume, type of anaesthesia (local or sedation), and any additional contouring required. The confirmed price is given to each patient individually after consultation and examination — the guide range here is for preliminary planning purposes. The package includes airport transfer, 1–2 nights' accommodation, the procedure, local anaesthesia, medication, follow-up appointments, and six months of WhatsApp aftercare. There are no hidden charges.

If you are looking not for the cheapest option but for a clinic that prioritises balanced resection and honest candidate assessment, you are in the right place. Our clinics are in Nicosia (main clinic), Kyrenia (coastal, medical tourism coordination), and Famagusta (east coast).