Bichectomy: An alternative for facial harmonization

Abstract

Introduction: Bichectomy-a procedure to remove Bichat's fat pad or buccal fat pad-has increasingly gained more fans and aroused public curiosity. According to the Brazilian Society of Plastic Surgery (SBCP), in 2014, about ten bichectomies were performed per month. In the following year, this number tripled, and in this year, more than 40 of these surgeries are performed per month. In recent years, several studies (Alvarez and Siqueira, Rev Bras Cir Plast 33(1):74, 2018; Faria et al., Rev Bras Cir Plast 33(4):446, 2018; Guerrerosantos and Manjarrez-Cortes, Clin Plast Surg 16(2):343, 1989; Thomas et al., Indian J Plast Surg 45(1):122, 2012) have been published, among others, regarding the removal of Bichat's fat pad, which is a surgical procedure considered simple and safe, if performed by trained and experienced professionals. The main purpose of this procedure is the search for beauty and facial harmony, where patterns are influenced by cultural, geographical, and temporal forces. It is indicated mainly in the fat cheeks and usually in young people. They are not indicated in lean patients in particular in the elderly, since it can accelerate the facial aging. Buccal mucosa biting, of relative frequency, can be corrected by the removal of Bichat's fat pad. The mask of Phi (Marquardt, Mascara de Phi: A Beleza que so a Matematica Explica. www.unifespa.edu.br/images/Anais), is very useful in the surgical planning, as well as in the evaluation of the obtained result. Method: The intraoral access route is adequate and safe for this procedure, allowing good transoperative vision. Thirty minutes before surgery, the patient takes orally a soothing and sedative tablet; then relaxation is induced by meditation technique (Horibe and Horibe, Mente e Corpo. In: A Juventude Alem do Tempo. Sao Paulo: Editora Gente. p. 90, 2010). The removal of Bichat's fat pad should be conducted by a precise indication and always with the patient's awareness of the benefits and risks. The surgical time of the procedure is approximately 60 minutes. Analgesics and anti-inflammatories are prescribed on average for 3 days. Antibiotics are prescribed preventively for at least 6 days post-operation. The mean time of operative recovery has been 14 days (Matarasso A. Buccal fat pad excision: a esthetic improvement of the midface. Ann Plast Surg. 1991;26(5):413). Results: Careful dissection ensures successful surgery and avoids complications. They are considered satisfactory when there is a decrease in the "volume" of the cheeks, a condition that generally pleases patients. Alvarez and Siqueira (Rev Bras Cir Plast 33(1):74, 2018), mention transient complications in 7.5% of the cases, and in the literature, there are references of hematoma, sialocele, and temporary neuropraxia that did not require surgical reintervention (Stuzin JM, Wagstrom L, Kawamoto HK, Baker TJ, Wolfe SA. The anatomy and clinical applications of the buccal fat pad. Plast Reconstr Surg. 1990;85(1):29). Conclusion: Bichectomy is a relatively safe surgical procedure, but surgeon's awareness about anatomical details and the possible risks of this procedure is important. Jackson (Plast Reconstr Surg 103(7):2061, 1999), says that although the result is subtle, on round faces, the result is very good, provides facial harmony, makes it more beautiful, and gives satisfaction to the patient.