In the last decade, according to the Chilean Society of Plastic Surgery, the number of people who enter the operating room in search of an aesthetic intervention has tripled. And since the beginning of this century, minimally invasive treatments have increased by 200%.
Known as the Hollywood cheek procedure – what Angelina Jolie, Jennifer Lawrence and almost all the Kardashians have gone through – bichectomy for some years, an intervention that promises to leave a harmonious face with thinner cheeks, highlighting cheekbones and jaw, it has also gained strength in Chile.
“It’s nothing new,” says Ángel Lazo, a plastic surgeon at Clínica Santa María. “It is fashionable in the country, but it has existed for several years and is very common,” he says. “They have been made since the 60s, in Europe or North America”, places where “it is common for girls to take their clothes off at 19 or 20 years old. Bichat. There it is not something censored or frowned upon, because it is a very normal practice ”.
In the area of the cheeks, just below the cheekbones, there are small bags formed of adipose tissue called Bichat Balls. “We all have them and they are lodged between the muscle and the mucosa of the cheek,” explains Lazo.
Bichectomy, then, refers to the “removal of this tissue, which sometimes bulges the oral cavity very significantly,” adds Juan Carlos Gallardo, surgeon at Clínica El Arrayán.
The incision is made on the inner wall of the cheek, from where the fatty tissue is released and removed, “smoothly and without pain,” according to Gallardo. “Finally, stitches are placed, which are removed after 7 days, in the first control.”
What is the function of Bichat bags? Being a fatty tissue, they act as pads during chewing movements, facilitating the sliding of the masseter and buccinator muscles, which are the ones that act while we grind the food in our mouth. They are also essential during breastfeeding, responsible for the suction that the guaguas make when drinking milk, and that is why they are usually so chubby. As it grows, the normal thing is that the bags decrease in size in proportion to the rest of the face.
In adults, says surgeon Lazo, “this bag is small: it weighs between 8 and 10 grams, and has a volume between 8 and 10 cm³.” According to him, this fabric “has no major function on the face, other than giving a little support and filling to the cheek; therefore, when it is removed, it does not generate any functional sequelae ”.
Although it is not very risky, the truth is that it is located in a delicate area of the face, very close to some endings of the facial nerve, blood vessels and the parotid duct, the space through which saliva travels from the parotid gland to the mouth. .
In any case, people remove them “to refine the cheek a bit and give a feeling of sinking under the cheekbone, which looks more harmonious,” he says.
“According to the medical literature, it is recommended that this intervention only be carried out by people under 40, hopefully at most 35 years old,” says Lazo. After this age, the skin loses elasticity “and the tissues begin to thin.”
The doctor from the Santa María Clinic explains that “if someone has a thin face and you take out their bags, they will look very sunken, like a sick face.” There the effect that is produced is to look much older and not to obtain a more stylized and youthful appearance ”.
“Normally, people under 35 years of age are very favored with this surgery, since a much more angular and defined face is obtained,” says Carlos Gallardo. As there is still no loss of bone volume or fat tissue, and there are no structural alterations of the skin – such as loss of collagen, elastin and hyaluronic acid – most likely there are no complications.
“Although the facial anatomy is very diverse and different in each patient,” says the doctor from Clínica El Arrayán, this intervention is usually only done “in people who have great prominence of their cheeks, who have an adequate volume of their cheekbones and that do not have great deflation of their midface, since it could give a prematurely aged appearance ”, he points out.
That is precisely one of the main consequences of bichectomy. Faced with the massification of this intervention in Brazil, which was not always performed by accredited professionals or with accurate diagnoses, the Society of Plastic Surgery of that country made a strong advertising campaign, where they warned that “bichectomy can generate important anatomical distortions that with aging would worsen, giving the face a more aged appearance compared to chronological age ”.
For Lazo it is important that the patient is not overweight. “Many people take them off unnecessarily, because they have expectations that their face is going to change a lot”, but then they notice that the differences are more subtle than they expected. “
When an overweight person wants to undergo a facial surgical intervention, the doctor says that for these patients not only do you have to remove the Bichat Balls: it depends on the case and the result you want to obtain, but “it can be accompanied by liposuction or to resect the excess mucosa ”.
Bichectomy is a procedure whose postoperative process is usually quick. “It is more or less than a week, time in which the face will be inflamed and a little delicate. After those seven days, I should be fine by now, ”says Lazo. The effects, according to him, are noticeable after a month, “always thinking that this is going to be a subtle and moderate change.” The first check-up is usually on the seventh day after the intervention and the stitches are removed during it.
“In countries like Mexico or the United States, bichectomy is done by very young people”, the Santa María doctor warns, “between 18 and 20 years old.” Although this procedure is not new, it has gained more strength in recent years through social networks.
Probably, on your Instagram account you see more and more options or offers of this type of intervention —especially if you asked a search engine— and it is that in recent times it has become a “cry and silver” for some professionals, those who are not always qualified to perform these interventions.
“Sadly, nowadays bichectomy has become a BBB business, being that it is not like that: it is not so cheap, nor necessarily beautiful, nor is it suitable for all people,” says Lazo. Although there are people who get carried away by the “tempting prices”, or by the simplicity of the procedure —which takes about an hour—, it is something that must be performed by a doctor “plastic surgeon, a head and neck surgeon or a specialist of the anatomy of the face ”, since otherwise many complications can arise.
“The ideal is for this surgery to be very gentle and gentle, because by inflaming, hitting or bruising the tissues, extraction becomes more difficult,” says Lazo. On average, an experienced professional usually removes them in about fifteen and twenty minutes, however, “there are times when the bag is not delivered so easily, and all that excess handling causes it to partially come out or break, causing an area to be more sunken. and the other less ”.
Lazo and his team receive many consultations for the results of asymmetric bichectomies. “A very patient, he takes them out in places without certification and they arrive dissatisfied,” he says. When this procedure is not performed by professionals specialized in the anatomy of the face, “you can injure the parotid duct, the parotid gland, injure branches of the facial nerve or produce bruises due to excessive manipulation.”
Before performing this intervention, “every patient must have a prior evaluation, where their treating surgeon can explain in detail the procedure, postoperative care and possible associated complications,” adds Gallardo. “Despite a correct choice of patient, a correct intervention and adequate perioperative care, infrequent complications such as bleeding, bruising, infections, collections on the cheek, and others even more infrequent, such as injury to facial nerve branches and paralysis may occur. secondary, lesion of the parotid gland duct or significant facial asymmetries ”.
According to this article from the Mexican College of Oral Surgery, a complication derived from bichectomy is fibrosis that occurs after a hematoma, “which would bring aesthetic dissatisfaction in our patients, since fibrosis will represent the volume previously occupied by the adipose panniculus ”. In other words, if it is done wrong, all that has been gained can be lost.
You also have to have clean teeth, without cavities “or great inflammatory or infectious points of view,” says Lazo. As it is a wound that will remain open, “the person who performs the extraction must be competent and be able to handle any eventual complications.”