The Bichat fat pad is a fat pad involving the entire hemiface. It stretches from the temporal region to the cheek, passing through the zygomatic malar tunnel and the pterygomandibular fossa. In a Buccal fat extraction or Bichat fat pad resection, the facial plastic surgeon removes the fat pads that augment the lower cheeks. These are pads of fat in your cheeks and along the sides of your face that give it the rounded appearance.
Many young and normal- weight people may have fat pads that augment the lower cheeks, and give a rounded appearance. Some of this fat can be surgically removed through minimal incisions inside the mouth, making the face look thinner and younger.
The surgeon makes an incision about 2 to 4 cm. long between the cheek and gums (maxillary vestibule), starting above the second upper molar towards the back of the mouth, so that there is no visible scarring. Cheek slimming surgery is usually done on an out-patient basis. Commonly, sedation and a local anesthetic medication are administered in the operating room during a buccal fat pad extraction. When this procedure is performed in conjunction with other procedures, it might be necessary to use general anesthesia.
The patient is carefully monitored, controlled and treated by the surgeon, and anesthesiologist, during recovery from anesthesia. The patient wakes up quickly and comfortably, feeling no pain and experiencing no anxiousness. Anesthesia can be a reason for preoperative anxiety. However, pre-operative routines make possible safer surgical procedures. In the first visit, Dr. Espinosa may order some lab tests to evaluate your general state of health, in order to take precautions and avoid any complication with anesthesia. Subsequently, a pre-anesthetic evaluation will be ordered to determine the appropriate anesthetic plan. On the day of your surgery, your health history will be reviewed by Dr.
Espinosa, the anesthesiologist and the nursing staff to ensure a safe and uncomplicated experience. Your vital signs will be carefully monitored by the anesthesiologist during and after surgery. He will treat any possible medical problem which you may develop during surgery. You will be under your anesthesiologist's supervision until surgery is completed and during your recovery phase. Because anesthesia affects your entire system, it is important for your anesthesiologist to know as much about you as possible. Please inform him about your allergies, medications and past anesthetic experiences. Our Santa Bárbara Medical Center is an accredited surgical center fully equipped to ensure you excellent care. When your procedure is completed, you will be taken to the recovery room. Later, you will rest in a comfortable room. Some medications will be prescribed to minimize any discomfort. You will be carefully monitored to observe any adverse side effect to anesthesia. You will stay in our medical center until Dr. Espinosa feels sure you have completed your recovery phase. You will receive specific home-care instructions and medicine prescriptions. Be sure to arrange for someone to drive you home and to stay with you at least for the first night following the surgery.
What should I expect after surgery?
Most cheek slimming procedures are done on an out-patient basis. After surgery, you will wake up quickly and comfortably, feeling no pain and experiencing no anxiousness. Then you will be taken to a recovery room to be closely watched for 1-2 hours or until your physician considers you may go home. Be sure to arrange for someone to drive you home and to stay with you at least the first night following the surgery. As hours pass by, it is possible you will feel some temporary discomfort that will be controlled with pain medication. As with all surgeries, swelling will be an issue, but this will resolve with days. Remember that it is completely normal for you to feel some tightness or numbness due to swelling. This is part of your healing. Keep your head elevated during your recovery. Some minimal bleeding may occur during the first two days following surgery, which can be considered completely normal. You may be asked to use an antiseptic mouthwash several times per day, until the incisions are healed. Internal sutures will resorbable. Dr. Espinosa will be in permanent contact with you to be certain you are comfortable. Please, do not hesitate to communicate with us if you are concerned about something you consider significant.
Frequently Asked Questions - Buccal Fat Pad Extraction
Am I a candidate for cheek slimming?
If you feel you have these fat pads in your cheeks and along the sides of your face that give you a rounded appearance, and you are not comfortable with this condition, you may consider having a cheek slimming. However, your physician will determine what is reasonable and safe in your specific case. A detailed examination and computer imaging analysis will be performed to identify the problem. Your surgeon can tell you if you really need to have this procedure or a different one, such as a malarplasty or neck skin treatment. Remember, the natural expression of your face must be preserved. Good health and realistic expectations are prerequisites.
How long will I stay in the operating room?
The cheek slimming surgery usually takes from 1-1 ½ hours. When this is performed in conjunction with other procedures, it may take little longer.
What should I expect after surgery?
Most cheek slimming procedures are done on an out-patient basis. After surgery, you will wake up quickly and comfortably, feeling no pain and experiencing no anxiousness. Then you will be taken to a recovery room to be closely watched for 1-2 hours or until your physician considers you may go home. Be sure to arrange for someone to drive you home and to stay with you at least the first night following the surgery.
When can I return to normal activity?
Most patients are able to return to normal activity quickly. However, this will depend on the individual patient. You should resume gradually your normal daily activities after 4-5 days. Take your time to recover. Healing from surgery may take some time. Because swelling may still be present, patients who are very concerned about privacy take more time to recover. Schedule your surgery, so you have proper time to recover. It may take some weeks for you to observe the results. Satisfactory results after cheek slimming will be noticed day by day.
Dr. Espinosa´s special instructions:
Instructions before surgery:
Avoid taking Aspirin (acetyl salicylic acid) or anti-inflammatory medicines.
Stop smoking at least one month before your surgery.
Inform your surgeon about drug allergies, medical treatments, and current medications.
Always have realistic expectations about the results of surgery.
Instructions after surgery:
Before you leave the medical center, make sure you have your surgeon’s prescriptions,
medical certification, and date of your first post-operative visit to the office.
During the first few days after surgery you should have a liquid diet. Then a soft diet is recommended
for five days. Avoid foods that require prolonged chewing.
Cold compresses may reduce swelling. You will be instructed by Dr. Espinosa to use a surgical
glove filled with crushed ice, as a compress, over your chin.
Keep your head elevated during your recovery. Sleep on your back with your head elevated
the first 48 hours. It is necessary to sleep strictly on your back so as to prevent swelling. Sleep on two pillows
to keep your head elevated or use a wedge-shaped foam pillow. You must sleep face up.
You must rest at home during the first 3-5 days.
You will be given prescriptions for use following surgery, including an oral antibiotic,
swelling medications, and pain medications. If you have severe pain, inform Dr. Espinosa immediately.
Keep your mouth clean. You must use dental floss and toothbrush from the first day following surgery. Brush
gently near the surgical area. Rinse your mouth after every meal, (one half of chlorhexidine mouthwash to one half of
physiologic saline moisturizing).
You may feel changes in sensation, including tightness and numbness. Because the nerves
around the operated area of the skin are involved, a temporary loss of sensation may occur.
Remaining sutures will be removed 5-7 days following surgery.
You must avoid any activity that increases the risk of being hit. Lifting heavy things, animals or children may affect the area of surgery.
Excessive exposure to sun in the first 2 months following surgery may result in prolonged facial
swelling and injury to the skin. Therefore, you should always protect your skin with a strong sun-screen. Exposure
to sun should be limited or skin discoloration may occur. You must be protected under an umbrella or a hat. Wear sun glasses.
Try to keep out of the sun as much as possible.
Avoid strenuous activity, including exercise and sex. Do not carry or
lift heavy objects for 3 weeks. Light aerobic exercise is allowed just 3 weeks
following surgery. Return to normal aerobic exercise after 6 weeks. However, Dr.
Espinosa will observe your recovery and will let you know when you can resume your usual physical activities.
You can resume your normal daily activities gradually in about 8-10 days,
as long as, you avoid strenuous activity and protect yourself from hitting.
You should expect swelling in the operated area for three weeks. You will
be approximately 90% healed after 3 weeks. You may start to see results quite quickly,
but you will not see the final benefits of your surgery for 6 months following surgery.
Benefits of your surgery for 6 months following surgery. The information provided here is not a substitute for a consultation.
Please, do not hesitate to communicate with us if you are concerned about something you consider significant. Your post-operative appointment is really
important. Remember, the success of your surgery depends very much upon post-operative care. It is crucial that you follow your surgeon’s instructions.