Who is a good candidate for buccal fat removal (bichectomy)?
Updated: 10 hours ago
Medical editor: Dr. Semih Yıldız, plastic, reconstructive and aesthetic surgeon (FEBOPRAS) · Last updated: October 2026
A good candidate for buccal fat removal is a healthy adult at a stable weight whose round lower cheeks are caused by buccal fat, rather than by general body fat, strong jaw muscles, a wide bone structure or sagging. The cheeks need enough fullness that a partial reduction slims them without hollowing them. Not smoking, or being able to stop, and healthy teeth and gums matter too.
Most of the work in deciding suitability lies in finding out where the fullness comes from. Before buccal fat removal in Istanbul, Dr. Semih Yıldız looks at your photos, medical history and what you hope to change, and you agree on a plan well before the operation day.
Where round cheeks come from
A full lower face can have several causes, and often more than one at once:
Buccal fat: a deep fat pad in the lower cheek, below the cheekbone. This is the only one a bichectomy changes.
Fat under the skin: spread over the face and neck, and it rises and falls with your weight.
Jaw muscles: a large chewing muscle (masseter) widens the angle of the jaw, particularly in people who clench or grind their teeth.
Bone structure: wide cheekbones or a broad jaw set the basic width of the face.
Sagging tissue: with age, fullness moves down towards the jawline and forms jowls.
A simple check gives a first clue. Place your fingertips over the angle of your jaw, below and in front of the earlobe, and clench your teeth. If the area hardens and bulges, part of the width you see is muscle. The fullness that a bichectomy reduces sits further forward, in the soft area between the cheekbone and the jaw.
Face shapes that tend to suit it
Bichectomy tends to suit faces with soft, rounded fullness in the lower cheeks and reasonable bone structure underneath. In these faces, removing part of the fat lets the cheekbones and jawline show more clearly, and the change looks like a natural refinement rather than a different face.
It suits long, narrow or naturally slim faces far less. There is little fullness to reduce, and removal can lead to a hollow look in later years.
Age: when it makes sense
Bichectomy is an operation for adults. In teenagers the face is still growing, and as it grows the buccal fat becomes relatively smaller, so roundness at that age often softens without treatment. Waiting until the face has matured gives a clearer picture of how much fullness will actually remain.
From middle age onwards, a full lower face is more often caused by sagging than by excess buccal fat. Removing fat does not lift tissue, so in that situation a facelift addresses the cause, and a conservative bichectomy is sometimes combined with it. Age alone does not decide, though: what counts is the anatomy of your face now and how it is likely to age.
Weight, health and habits
Weight matters in two ways. It should be stable, because the fat under the skin of the face changes with weight and can make cheeks look rounder or slimmer regardless of buccal fat. And if a large weight loss is still ahead of you, it is wiser to reach your goal first, because only then does it become clear how much fullness remains. Cheek fullness that persists at a stable, healthy weight is the classic reason for the operation.
A few health points also affect suitability:
Smoking and nicotine products need to stop at least 4 weeks before surgery and stay stopped for at least 4 weeks afterwards, as they slow healing inside the mouth.
Gum or tooth infections should be treated first, because the incisions are made inside the cheeks.
Some medicines and supplements that affect bleeding, such as blood thinners, aspirin, ibuprofen and fish oil, may need a pause, so the team needs a complete list of what you take.
Alternatives when bichectomy is not the answer
If your fullness has a different cause, another treatment may suit you better or may be combined with a conservative bichectomy:
Width at the angle of the jaw from a strong chewing muscle can be reduced with masseter Botox, which relaxes the muscle; the effect is temporary, so the treatment is repeated.
Fullness under the chin responds to double chin liposuction, which can be combined with a bichectomy.
A small chin can make the whole face look rounder; chin augmentation or chin filler can balance the profile.
Sagging along the jawline is treated by lifting the tissue rather than by removing fat.
General roundness of the face from excess weight improves most with weight loss.
How suitability is assessed
The assessment starts online. Clear photos of your face from the front and from the side, taken in even light and without filters, show where the fullness sits, and together with your medical history they are usually enough for a first opinion. A photo from a few years ago, or from a time when you weighed more or less, can also help, because it shows how much of the roundness has stayed the same.
The plan is then confirmed in person. On the day of surgery, after the pre-operative tests, your cheeks are examined at rest and when you smile during the face-to-face consultation, and the agreed amount is confirmed before anything is removed.
What a realistic result looks like
When the indication is right, the change is a moderate slimming of the lower cheeks that makes the cheekbones and jawline look more defined. It does not alter the bone structure, and it takes time to show: a slimmer outline usually emerges at around four weeks, while the final shape needs 3–6 months to settle.
If several of the points above apply to you, an individual assessment is the logical next step. Our bichectomy page explains how the operation is performed and how to prepare for it.
Frequently asked questions
Can men have buccal fat removal?
Yes. The same criteria apply to men and women: genuine fullness in the lower cheeks, a stable weight and good general health. The amount removed is planned to keep a strong, healthy contour rather than a hollow cheek. Width at the angle of the jaw, which is common in men, usually comes from the chewing muscle and is not changed by a bichectomy.
Does a bichectomy help with a double chin?
No. A bichectomy works only on the lower cheeks. Fat beneath the chin is a separate area and is treated with double chin liposuction, which can be combined with a bichectomy if both are suitable. If the neck skin itself is loose, liposuction alone may not be enough, and this is assessed at the examination.
Do I need a dental check-up before a bichectomy?
It is recommended. Because the incisions are made inside the cheeks, a healthy mouth lowers the risk of infection during healing, so any gum or tooth infection should be treated before surgery. If you have dental treatment planned, mention it as well, so that it can be timed around the operation.
If you are not sure where your cheek fullness comes from, front and side photos of your face are enough to start a free online assessment.
This article provides general information and does not replace a medical consultation. Results vary from person to person.
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