Do Cheeks Sag After Bichectomy?

The most accurate short answer to the question “Do cheeks sag after bichectomy?” is this: Bichectomy does not directly cause cheek sagging in every patient. However, factors such as improper patient selection for the procedure, removal of excessive fat tissue from the cheek area, the person already having a thin face, low skin elasticity, advancing age, significant weight loss, and the natural aging process of the face can contribute to the cheeks appearing more hollow, sunken, or displaced downwards over the years.

Therefore, it is not sufficient to consider bichectomy merely as a “buccal fat removal” procedure. The possible effects of the procedure on the facial anatomy 5, 10, or more years later, as well as the face’s current appearance, should also be taken into consideration.

A person considering bichectomy should first have it assessed whether they truly have excessive Bichat fat tissue, the overall width of the face, the structure of the cheekbones, the jawline, skin quality, and their aging tendency.

At Op. Dr. Şükrü İşler Aesthetic Clinic, the first examination or consultation is free. During the free initial assessment, it can be evaluated individually whether bichectomy is truly suitable for your face structure and which approach might be more appropriate for maintaining natural facial proportions in the future.

To get basic information about bichectomy, you can also review the Cheek Thinning page.

What is Bichectomy?

Bichectomy is the surgical removal of a specific portion of the fat tissue located in the deep part of the cheeks, known as the Bichat fat pad. The primary goal is to reduce excessive fullness in the mid-lower part of the face and, in particular, to make the transition between the cheekbone and the jawline more prominent.

The procedure is typically performed through a small incision made inside the mouth. Thus, no externally visible incision is created on the face.

However, the important point is not to completely eliminate the Bichat fat pad, but to plan a controlled contour change to the extent required by the facial anatomy.

For more detailed information about the bichectomy operation process, you can access the content on Cheek Thinning Operation (Bichectomy).

Does Bichectomy Cause Cheek Sagging?

It is not scientifically correct to state that bichectomy automatically causes cheek sagging.

Cheek sagging is a multifactorial process. As we age, changes occur in the skin, connective tissues, facial fat compartments, muscles, and facial skeleton. All these structures play a role in the aged appearance of the face.

Therefore, if a person who had bichectomy years ago experiences sagging in their cheeks later in life, this does not prove that this change occurred solely due to bichectomy.

However, bichectomy permanently reduces the volume in a specific area of the face. If excessive fat tissue is removed from a person who initially already has limited cheek volume, natural volume changes in the coming years may become more noticeable.

Consequently, the issue is often more complex than the question “does bichectomy cause sagging?” The real question to ask is: Is this facial anatomy suitable for bichectomy, considering the long term?

Is Cheek Hollowing the Same as Sagging After Bichectomy?

No. Cheek hollowing and cheek sagging are similar but anatomically distinct problems.

Cheek hollowing is when the face appears more sunken, bony, or hollow due to a reduction in volume in the mid or lower cheek area.

Cheek sagging, on the other hand, is the appearance of looseness that occurs as a result of the skin and deeper facial tissues shifting downwards over time.

Bichectomy does not directly create excess skin or pull the skin downwards. However, as a result of excessive volume removal, the concave appearance of the face may increase. This situation may be described by some individuals as “my cheeks have sagged.”

This distinction is extremely important for treatment planning. Because the treatment for volume deficiency is not the same as the treatment for actual tissue sagging.

To compare options for different problems in the cheek area, you can review the guide titled What Aesthetic Procedures Are Done to Tighten Cheeks?

Does Bichectomy Age the Face?

It is not correct to use a definitive statement like “bichectomy ages the face” that applies to everyone.

In a patient with a suitable facial structure, a conservatively and anatomically correctly planned cheek reduction procedure can make the facial contour more balanced.

However, if the face is already thin or if too much Bichat fat tissue is removed, the volume loss in the mid-to-lower face can cause the face to appear sharper, hollowed, or more mature than it is.

With aging, the face does not only lose fat. Changes in volume, downward displacement, and redistribution can be observed in some fat compartments. Changes in bone support, connective tissues, and skin quality also affect facial appearance.

Therefore, it should not be assumed that an excessively hollow cheek contour, which looks aesthetic at age 25, will appear the same at age 45 or 55.

What Do Scientific Studies Say About Bichectomy and Aging?

Although the scientific literature on bichectomy is expanding, long-term follow-up data, in particular, remain limited.

A systematic review published in 2021 reported that Bichat fat pad removal can provide positive early-stage results in facial contour, but it was emphasized that there is a lack of high-quality scientific studies evaluating long-term outcomes. You can access the study via Buccal Fat Pad Excision for Cheek Refinement: A Systematic Review.

A more recent systematic review published in 2026 also provides important information on this topic. The study evaluated 1,123 patients; it stated that short-term aesthetic satisfaction was generally high, but long-term results were not sufficiently reported. One of the reviewed studies reported a hollow or “gaunt” appearance. You can access the academic publication via this link: Aesthetic Outcomes, Complications, and Reported Long-Term Effects of Buccal Fat Pad Reduction.

Another scientific review from 2026, examining how the Bichat fat pad changes with aging, reported that this fat pad not only shrinks with age but also shows anatomical changes such as downward displacement and pseudoherniation. For a detailed study, the publication How Does the Buccal Fat Pad Age and How Can It Be Managed in Facelift Surgery? can be examined.

A scientific review evaluating midface aging also shows that facial aging is a complex process where bone and soft tissue changes occur together. For the source, you can access the study A Review of Midface Aging.

The common message of these studies is that when evaluating bichectomy, it is important to consider not only short-term facial thinning but also long-term facial anatomy.

What Factors Can Increase the Risk of Sagging After Bichectomy?

There are several factors that can contribute to the face appearing excessively thin or saggy in the years following bichectomy:

Having an already thin or bony facial structure initially
The buccal volume not actually being excessive
Excessive removal of the Bichat fat pad
Low skin elasticity
Planning the procedure at an advanced age or when significant facial aging is present
Significant weight loss in a short period
Frequent weight fluctuations
Failure to notice existing volume loss in the face
Weak cheekbone support
Presence of significant facial asymmetry
Genetic predisposition to early facial sagging
Prolonged intense sun exposure and deterioration of skin quality
Lifestyle factors such as smoking, which can accelerate skin aging

The presence of one of these factors does not mean that bichectomy absolutely cannot be performed. However, it requires a more careful anatomical assessment before the procedure.

Is Bichectomy Performed on People with Thin Faces?

Bichectomy is a procedure that requires careful planning, especially at this point.

In people whose faces are already thin, whose cheekbones are prominent, and whose cheek area is naturally sunken, additional volume reduction may not always provide an aesthetic advantage.

In these individuals, the face may appear overly sharp or hollow after the procedure. With natural anatomical changes that occur as one ages, this appearance may become more pronounced.

Therefore, the request “I want to slim my cheeks a bit more” is not a sufficient indication for bichectomy on its own.

The face should be evaluated from the front, profile, and three-quarter view; the relationship between the cheekbone, jawline, temporal region, undereye, and cheek volume must be analyzed.

How Much Fat Should Be Removed in Bichectomy?

There is no standard amount applicable to every face.

The goal is not to remove as much fat as possible. The goal is to create as much contour as necessary without disrupting the face’s natural anatomical proportions.

For this reason, a conservative approach in surgical planning may be important.

Removing too much fat tissue does not automatically mean a better or more pronounced result. On the contrary, excessive volume loss can create an artificial hollow in some faces.

A successful result in aesthetic surgery often does not mean maximum change, but rather a change that is harmonious with the other anatomical regions of the face.

Which Face Type is Most Suitable for Bichectomy?

Bichectomy can generally be considered for individuals who have genetically pronounced cheek fullness, making their face appear rounder than it is, even though their general body weight is normal or stable.

The procedure may be more meaningful especially in faces where the transition between the cheekbone and the jawline is not well-defined due to dense Bichat fat pad.

However, it is not sufficient to classify face types merely as “round”, “oval”, or “square”.

The source of cheek fullness, besides the Bichat fat pad, could be the facial skeleton, masseter muscle, superficial fat tissue, or general weight distribution.

Therefore, not everyone with a round face is a candidate for bichectomy.

At What Age Should Bichectomy Be Performed?

There is no single ideal age for bichectomy that applies to everyone.

What is important is that facial development is complete, the individual’s facial structure is correctly assessed, and the expectations for the procedure are realistic.

It should also be remembered that the face can naturally be fuller at younger ages. In some individuals, facial fullness in their early 20s may change naturally in later years.

At older ages, skin laxity and downward displacement of facial tissues may have begun. In such a case, performing a procedure solely focused on volume reduction may not provide a solution to the person’s actual problem.

The decision should be based on the individual’s current facial anatomy, not directly on a specific age number.

Is the Result of Bichectomy Permanent?

The surgically removed Bichat fat pad does not regenerate in the same amount. Therefore, the volume-reducing effect created by bichectomy is long-lasting.

However, the phrase “the result is permanent” does not mean that the face will never change throughout life.

Aging continues. Weight may change. Skin elasticity may decrease. Changes may occur in other facial fat compartments. Laxity may develop in the jawline and neck area.

Therefore, the surgical result at age 30 should not be expected to look exactly the same as the face at age 50.

Can Weight Loss Increase Facial Sunkenness After Bichectomy?

Significant weight loss, in particular, can affect facial volume.

When a person who already has a thinned cheek area after bichectomy subsequently loses a significant amount of weight, a decrease in volume can also occur in other fat tissues of the face. As a result, the cheekbones may appear more prominent, the under-eye area may look more hollow, or the cheek area may appear more sunken.

For this reason, the timing of aesthetic facial operations should be evaluated separately for individuals planning serious weight loss in the near future.

Aesthetic decisions made during a period of ongoing weight fluctuations can lead to encountering a different facial anatomy a few years later.

When Do the Results After Bichectomy Become Apparent?

The facial shape seen immediately after the operation is not the final result.

In the first few days and weeks, swelling may occur, causing the cheeks to appear fuller, uneven, or more swollen than expected. As the swelling subsides, the new contour becomes more defined.

To evaluate the results of a bichectomy, time must be allowed for the tissues to heal and for the swelling to resolve. The final facial contour may take several months to become apparent, varying from person to person.

Therefore, it is not correct to make definitive assessments such as “my cheeks are not thin enough” or “my face remained asymmetrical” by looking in the mirror a few days after the surgery.

What Is Done If the Face Appears Too Sunken After Bichectomy?

First, it must be determined whether the problem is genuinely a lack of volume.

When evaluating facial appearance in the early period after a newly performed bichectomy, it may be necessary to wait for the healing to complete.

In cases of significant sunkenness that appears months or years later, the entire face should be analyzed.

If the problem is primarily a lack of volume, volume restoration methods such as dermal fillers or fat injections using the person’s own fat tissue can be considered in suitable patients.

However, if the problem is actual tissue sagging, simply adding volume might not be the correct solution.

Therefore, the difference between “filling the void” and “lifting sagging tissue” must be well-defined.

What Can Be Done If Actual Cheek Sagging Occurs After Bichectomy?

Treatment varies depending on the degree and cause of the sagging.

For mild skin laxity, some non-surgical facial rejuvenation applications can be considered. Information about these options can be obtained from the Non-Surgical Facelift page.

If there is significant tissue sagging, jowl formation, and a compromised jawline, different surgical options may be considered.

You can review the Facelift page for information on surgical approaches to actual facial sagging.

For a detailed comparison of the differences between fillers and surgical facelifts, the Fillers or Facelift for Facial Sagging? guide may be helpful.

Can Sagging After Bichectomy Be Corrected with Fillers?

Not always.

Filler is essentially a procedure aimed at restoring support to missing volume.

If the person is actually complaining about excessive volume loss in the cheek area in the appearance they describe as “sagging,” controlled volume restoration at appropriate anatomical points can help the face appear more balanced.

However, if there is significant excess skin and downward-displaced tissues, progressively adding more filler will not eliminate actual sagging.

In fact, using too much filler in some faces can make the face appear heavy, wide, or disproportionate to its natural contours.

Therefore, it is necessary to first determine whether the problem is volume loss or actual sagging.

Is a Facelift Necessary After Bichectomy?

There is no rule that everyone who undergoes bichectomy will need a facelift surgery in the future.

The need for a facelift is influenced by many variables such as an individual’s genetic makeup, skin quality, rate of aging, sun exposure, smoking, weight changes, and facial anatomy.

Regardless of bichectomy, everyone’s face changes over time during the aging process.

If, in later years, there is significant downward displacement in the cheeks, jowl formation along the jawline, neck laxity, and excess skin, a facelift operation can be considered.

However, such a decision is not made solely based on whether a bichectomy has been performed previously.

Bichectomy or Cheek Liposuction?

These two procedures are not the same.

Bichectomy targets the Bichat fat pad located in the deeper anatomical layer of the face.

Liposuction, on the other hand, can be used to reduce more superficial fat tissue in appropriate anatomical regions.

It is not correct to choose a procedure without knowing which tissue is causing facial fullness.

For some individuals, the problem is not the Bichat fat tissue; it is general excess weight, the jawline, a double chin, or the prominence of the masseter muscle.

Therefore, instead of choosing an operation based on a face shape seen on social media, a personalized facial analysis should be performed.

Why Should Long-Term Planning Be Done Before a Bichectomy?

One of the important characteristics of facial aesthetics is that the procedure performed affects not only the current appearance but also the facial proportions in later years.

Removing more volume when the face is young might initially provide a sharp and photogenic contour. However, the same face can transform into a different appearance over the years due to natural changes in the skin and other soft tissues.

Therefore, the following questions should be evaluated together in operation planning:

Are the cheeks genuinely full due to Bichat fat tissue?
Is the face already thin?
Are the cheekbones sufficiently supported?
What is the skin’s elasticity like?
Is there an existing volume loss in the face?
What is the person’s age and genetic predisposition to aging?
Is a significant weight change expected in the near future?
Is the goal a natural contour, or an overly hollowed cheek appearance?

Proper planning is one of the most important ways to prevent excessive intervention.

How to Maintain a Natural Look After Buccal Fat Removal?

A natural result does not mean thinning the face as much as possible.

The aim is to create a balanced transition between the cheekbone, cheek, jawline, and the overall geometry of the face.

For this, the right patient selection is primarily required. Then, the amount of fat to be removed should be planned according to the individual’s anatomy.

Symmetry is also important. It should be known that the human face is not entirely symmetrical. Evaluating existing left-right differences before the operation ensures that post-surgery expectations are more realistic.

Detailed information about the holistic approach to facial aesthetics can also be obtained from the Facial Aesthetics page.

How Does Aging Occur After Buccal Fat Removal?

Buccal fat removal does not stop aging and is not considered the sole factor that directly accelerates it.

Over the years, skin elasticity decreases, changes occur in the connective tissues of the face, the volume and position of fat compartments may change, and age-related remodeling may be observed in the facial skeleton.

This natural process continues in individuals who have undergone buccal fat removal as well.

The critical point here is how the volume reduction created by the operation will combine with these anatomical changes in later years.

Therefore, conservative and personalized planning, especially considering the long-term outcome, is important.

What Are the Complications of Buccal Fat Removal?

Buccal fat removal is a surgical procedure and, like other surgical interventions, has potential risks.

Complications such as edema, pain, temporary limited mouth opening, asymmetry, infection, bleeding, or hematoma have been reported in the literature. More rarely, complications related to surrounding anatomical structures may also occur.

A systematic review and meta-analysis published in 2025 showed significant differences in complication rates reported across studies. As the methodologies and definitions of complications vary between studies, it is not appropriate to interpret a single rate as a direct risk for every patient.

You can access the relevant academic study via the link Prevalence of Complications of Buccal Fat Removal: A Systematic Review and Meta-analysis.

Detailed knowledge of facial anatomy, appropriate patient selection, correct application of surgical technique, and adherence to postoperative recommendations are important in reducing risks.

What is Examined in Facial Analysis Before Bichectomy?

The decision for bichectomy should not be made solely based on how full the cheek is.

All proportions of the face should be considered together in the assessment.

The projection of the cheekbone, the width of the cheeks, jaw structure, jawline, submental area (double chin), undereye-cheek transition, skin quality, facial asymmetry, and overall fat distribution can be examined.

Previous fillers, thread lifts, facial surgery, or other aesthetic procedures should also be included in the evaluation.

Because the goal is not merely to reduce the cheeks, but to create a balanced appearance across the entire face.

What is Evaluated for Bichectomy During the Free Initial Consultation?

The initial examination or consultation at Op. Dr. Şükrü İşler Aesthetic Clinic is free of charge.

For individuals considering bichectomy, this initial evaluation is particularly important. Because during the free consultation, not only the question of “can the surgery be performed?” but also the question of “is this operation truly the right procedure for your face?” can be addressed.

During the evaluation;

The source of cheek fullness,
The effect of the Bichat fat pad on facial appearance,
Cheekbone structure,
Jawline and facial proportions,
Skin quality and elasticity,
Current facial volume,
Aging tendency,
Weight changes,
Previous aesthetic procedures,
Differences between the right and left sides of the face,
The individual’s expectations and desired facial contour

can be evaluated together.

Thus, it may be possible to avoid an intervention that could lead to unnecessary or excessive volume loss and to plan a more balanced facial contour in the long term.

For a free initial consultation and appointment, you can reach the clinic from the Contact page.

What is the Most Important Point for Those Considering Bichectomy?

Since bichectomy is a trendy aesthetic procedure, it can often be associated with images of very sharp, sunken cheeks, especially on social media.

However, a cheek contour that looks aesthetic on another person’s face may not produce the same result on your face.

The bone structure of the face, fat distribution, jaw projection, cheekbones, and skin quality vary from person to person.

Therefore, the goal of the operation is not to resemble another face, but to create a more balanced facial contour within the individual’s own anatomy.

Instead of excessive intervention, a controlled approach that also considers long-term facial aging is particularly important.

Will Cheeks Sag After Bichectomy? Short Summary

There is no scientific rule stating that everyone’s cheeks will sag after bichectomy.

Bichectomy performed on the right candidate and in the correct amount can help reduce excessive fullness in the mid-lower part of the face.

However, factors such as the person initially having an already thin face, excessive fat removal, advanced age, decreased skin elasticity, rapid weight loss, or natural facial aging can contribute to the cheeks appearing more hollow, sunken, or saggy over the years.

Furthermore, long-term studies in the current scientific literature that strongly demonstrate the decades-long results of bichectomy are still limited.

Therefore, in the decision for bichectomy, not only the current appearance but also how the face might age in the future should be taken into account.

At Op. Dr. Şükrü İşler Aesthetic Clinic, the first examination or consultation is free. Your facial anatomy can be assessed to discuss whether bichectomy is suitable for you, what level of change should be aimed for, and any alternative facial contouring options tailored to your individual needs.

Frequently Asked Questions

Do cheeks definitely sag after bichectomy?
No. There is no scientific rule stating that everyone who undergoes bichectomy will experience sagging cheeks. Sagging is influenced by many factors such as age, skin quality, genetic structure, weight changes, and the natural aging of facial tissues.

Does bichectomy make the face look older in the future?
Such a result is not expected in every patient. However, in individuals with thin faces or when excessive volume is removed, natural volume changes over the years can contribute to the face appearing more hollow or mature.

Why does the face become sunken after bichectomy?
True hollowness can result from excessive reduction of cheek volume relative to the person’s anatomy, subsequent weight loss, or age-related changes in other fat compartments of the face.

Are cheek hollows immediately apparent after bichectomy?
Due to the presence of edema in the early period after the operation, the result cannot be evaluated immediately. As the swelling subsides, the contour becomes more defined, and several months may be required for the final appearance.

Can hollowing after bichectomy be corrected with filler?
If the problem genuinely stems from a lack of volume, controlled filler or other volume restoration methods can be considered in suitable patients. However, in cases of actual sagging, filler alone may not be sufficient.

Can fat injection be performed after bichectomy?
In suitable patients with significant volume loss, volume restoration with the person’s own fat tissue can be considered. Suitability should be determined after facial analysis.

Does bichectomy lift the cheeks?
No. The primary purpose of bichectomy is not to lift sagging cheek tissues, but to reduce excessive cheek fullness in suitable individuals.

Is bichectomy performed on sagging cheeks?
If a person’s problem is more about volume loss and tissue sagging than excess volume, bichectomy may not be the right option. First, the source of the sagging should be determined.

Is bichectomy performed after the age of 40?
The decision is not based solely on age. Skin elasticity, existing volume, the position of the cheek tissues, and general facial anatomy should be evaluated together.

Does the result of bichectomy last a lifetime?
The removed Bichat fat tissue does not return in the same amount. However, because the face continues to age and experience weight changes, the appearance of the face does not remain entirely constant throughout life.

If I lose weight after bichectomy, will my face become more sunken?
Significant weight loss can reduce the volume of other fat tissues in the face, which may contribute to some people’s faces looking thinner or more sunken.

How do I know if my face is suitable for bichectomy?
A definitive decision should not be made solely by looking at a photograph. The source of cheek fullness, cheekbones, jawline, skin quality, and the overall volume distribution of the face should be evaluated during a physical examination.

Can another procedure be done instead of bichectomy?
Yes. Depending on the source of the person’s concern, completely different options such as jawline contouring, balancing facial volume, non-surgical facial rejuvenation methods, or surgical facelift may be considered.

Is a facelift necessary for sagging after bichectomy?
Not in all cases. If there is actual and noticeable tissue sagging, facelift options can be considered; if there is only a lack of volume, a different approach might be more suitable.

Is the first bichectomy consultation at Şükrü İşler Aesthetic Clinic chargeable?
No. The first examination or consultation is free at Op. Dr. Şükrü İşler Aesthetic Clinic. During the initial assessment, the suitability of bichectomy can be evaluated by considering facial anatomy and the person’s expectations.

The question “Do cheeks sag after bichectomy?” needs to be evaluated more comprehensively than a single-word yes or no answer.

Bichectomy is a cheek thinning operation that can define facial contours in the right patient. However, since the procedure creates a permanent volume change, patient selection and the amount of fat to be removed are of great importance.

Especially in individuals with a thin facial structure, those with existing volume loss, or patients who have started to experience facial aging, excessive volume reduction can contribute to undesirable hollowing in the long term.

On the other hand, it is also not correct to directly attribute every cheek sagging that occurs over the years to bichectomy. Facial aging is a multi-layered process that collectively affects the skin, fat tissues, connective structures, and bone support.

Therefore, the most accurate approach is to evaluate not only the current appearance of the face but also its future aging potential before the operation.

At Op. Dr. Şükrü İşler Aesthetic Clinic, the first examination or consultation is free of charge. If you are considering bichectomy or have noticed hollowing or sagging in your cheeks after a previous bichectomy, your facial anatomy can be evaluated, and you can receive information about suitable options for you.

Note: This content has been prepared for general informational purposes. For diagnosis, treatment, or decisions regarding aesthetic operations, a personal evaluation by a plastic, reconstructive, and aesthetic surgery specialist should be performed.

Do Cheeks Sag After Bichectomy?