Although the volume that fat provides to our face plays a major role in a youthful appearance, some individuals can find that their face is round or “chubby.” This is commonly observed in patients that have prominent buccal fat pads. Buccal fat pads are pockets of fat located deep in our cheek region. Usually they are prominent during childhood, and as we get older it progressively decreases in size. However, in certain individuals, it can remain prominent. Unlike superficial facial fat, buccal fat pads do not respond to diet or exercise. As a result, patients with prominent buccal fat pads usually complain of persistent lower face fullness, despite losing weight. The best solution for this situation is to undergo buccal fat removal, also known as a “bichectomy.”
Dr. Couto is a Cleveland Clinic trained plastic surgeon, and one of the few plastic surgeons in Latin America to have completed an American Society of Aesthetic Plastic Surgeon (ASAPS) endorsed subspecialty training in Aesthetic Surgery and Medicine.
During his training, Dr. Couto had the privilege to have mentors that are considered top leaders in the field of facial aesthetic surgery. This includes, Dr. James E. Zins, one the largest contributors to the field of facial aesthetics. Furthermore, because of his strong passion for facial rejuvenation, Dr. Couto has co-authored multiple scientific articles and book chapters about the topic. Furthermore, Dr. Couto has been an invited faculty member of the annual American Society Plastic Surgery (ASPS) face and neck rejuvenation course.
A buccal fat removal or bichectomy is a minimally invasive procedure designed to reduce the fullness and roundness of the lower face. In this procedure, excess fat from the buccal fat pad is removed through a small incision inside of the mouth. Therefore, no visible scars are produced. This is a quick procedure that can be performed under sedation.
Individuals that are unhappy with the round and full appearance of their lower face are great candidates for this procedure. This patient population typically shows up to our office stating that no matter how much weight they lose, their face continues to look full.
The consultation is divided into five parts:
1) Health and Medical History Evaluation
A comprehensive evaluation of the patient’s medical history is performed. During this part of the consultation, we focus on identifying any potential risk factors for the surgery. It is important to notify Dr. Couto of use of any medications, supplements, or other drugs as these can have an impact on the surgery. An example is aspirin or blood thinners, which can increase risk of bleeding after the procedure. These are common risk factors that can affect the surgical result yet can be easily modified with lifestyle changes. Although this procedure has a low risk, our patient’s health and safety will always be our main priority. We like to set our patients for success, not for failure; therefore, modifying any potential risks is essential to obtain the best possible result.
2) Discuss with the Patient About Surgical Goals
Dr. Couto has a deep discussion with the patient to learn about their concerns and goals. Listening to their interest is crucial, since it is our priority to determine if we can meet their expectations. We focus on learning whether the patient is particularly interested in addressing an specific area of the face or if the patient is interested in a face and neck rejuvenation.
3) Physical Exam
Dr. Couto treats the face and neck as whole, not by areas. Therefore, a systematic analysis of the face and neck is performed. A youthful appearance is marked by smooth transitions between different areas of the face and neck.As a result, Dr. Couto not only examines the regions the patient is mainly concerned with, but also those surrounding areas and structures of the face and neck that could help achieve a balanced and refreshing look.
4) Recommendations & Surgical Plan
Following the physical exam, Dr. Couto develops a personalized surgical plan aimed to meet the patient’s expectations, achieve optimal aesthetic results, and maximize patient safety. During this time, Dr. Couto discusses with the patient the indicated surgical techniques and explains in detail everything pertaining to the procedure and its recovery.
5) Pricing and Scheduling Information
Once the evaluation has been completed, our team will provide an individualized price quote that is tailored to the procedure(s) discussed during the consultation and review the steps involved in booking the procedure with us.
A small incision inside the mouth is created to access the buccal fat pads. Once the fat has been encountered, it is meticulously resected. We always emphasize to our patients that the goal of this surgery is to reduce the volume of the buccal fat pad, not remove it entirely. This is accomplished by extracting only the excess fat. Aggressive resection of the buccal fat pad must be avoided, as this can produce unwanted facial deflation and accelerate facial aging.
Several weeks before the procedure, a preoperative appointment will be scheduled. During this appointment, we will discuss the surgical plan again and clarify any questions involving the surgery. Furthermore, we will thoroughly review the preoperative/postoperative instructions and medication regimen and schedule the future post-operative appointments.
We always emphasize to our patients that medication (e.g. aspirin, ibuprofen), vitamins and herbal supplements (e.g. Fish oil, Omega-3, Garlic or Tumeric pills, Ginko Biloba) should be discontinued at least 3 weeks before surgery, as they increase the risk of bleeding. Furthermore, we remind them that smoking, vaping, or using any nicotine products will affect the results and recovery process. Lastly, nutrition is crucial for an effective healing and recovery process. Therefore, we recommend to our patients to optimize their protein intake and avoid foods high in salt/sodium after any surgical procedure. This could be easily achieved with post-operative supplements available in our practice.
We provide our patients with a detailed postoperative protocol to ensure that they have a comfortable and quick recovery. The patient will wear a specialized face compression garment that helps minimize swelling. Mild inflammation is to be expected and can be noticeable for about a week. During this recovery process, patients rarely experience pain or discomfort. It is also very unusual for them to require narcotic pain medications. We normally recommend our patients to take 3-5 days off from work, or even less if working from home. Finally, patients can resume their aerobic exercises (eg. running, spinning, biking) and strengthening/abdominal exercises 2 weeks after surgery.
