Anatomy and ideal proportion:

Bichat’s balls are fatty masses found under the cheekbone at the cheek level. Some people have larger Bichat balls. Through an incision inside the mouth, under local anesthesia, we can remove these Bichat balls and give you the appearance of hollow and sharp cheeks.

Bichectomy is a frequently requested treatment because it is a simple, short surgery done under local anesthesia and significantly refines the lower face, ultimately giving a slim and slender face.


Under local anesthesia, 1.5 cm incision inside the mouth then removal of Bichat’s balls.


Time frame for final results:
2 weeks to see a significant result, 2 to 5 months to see the final result

Longevity of results :

Before surgery:

Stop smoking 1 month before the operation (risk of skin necrosis important if active smoking)
Do not take Aspirin 10 days before the operation, inform Dr. Lucas of any anticoagulant medication (Sintrom, Coumadin, Eliquis, etc.) to arrange for its stop or replacement.
Take Arnica capsules 5 capsules 5 times a day for 5 days before surgery to prevent hematoma.

Intervention :

Pain: the pain during the intervention will be almost non-existent, with an adapted anesthesia
Duration of the operation: 60 minutes
Anesthesia: local more or less with sedation
Location: operating room

After surgery:

Post-operative pain: 1/10 often responding to Dafalgan

Social eviction :

4- 7 days with swelling
Return to work: 4-7 days
Return to sport: 10 days


Bed rest without major effort (which can cause the opening of small vessels during effort and lead to a hematoma) for 48 hours
Ice for 1 week, as often as possible, to reduce swelling
Arnica capsules 5 capsules 5 times a day for 5 days after surgery to prevent hematoma
Augmentin 1 g twice a day for 3 days
Prednisone 30 mg for 3 days then 20 mg for 3 days
Fresh, non-acidic, soft diet for 5 days
Sutures fall out spontaneously between 1 and 2 weeks
Mouthwash after each meal for 1 week
Permanent cessation of smoking to prolong the effect of the surgery and minimize complications
Check-up by Dr. Lucas on D2, D7, 3 weeks, 3 months, 6 months

Complications of bichectomy:

  • Hematomas: they may need to be evacuated if they are large or too painful.
  • Infection
  • Nerve or vessel damage, salivary duct damage

Combinations and alternatives

If you want a V-shaped appearance of the face (“V line”) with a sharpened lower face, bichectomy can be combined with hyaluronic acid injection of the jawline, Botox ® injection in the masseter to reduce the width of the face, cheekbone injection with hyaluronic acid  and Kybella ® injection to reduce double chin.


Buccal fat pads




“V-line” by bichectomy, botox ® masseter and Kybella ® for double chin


“V-line” by buccal fat removal (bichectomy) and Botox ® masseter


Combinaison of multiple treatments, including buccal fat removal


Buccal fat removal and jawline filler