Should buccal fat pads (Bichat fat pads) be removed during a facelift?
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Short answer
Removing the buccal fat pads (bichectomy) during a facelift is optional, not required. Some surgeons remove them to slim the lower face, while others actually reposition the fat as a flap to restore cheek volume lost with aging. The decision depends on your individual facial anatomy and goals.
What the research shows
Bichectomy (removal of the Bichat or buccal fat pads) and facelift are two separate procedures that can be performed together or independently. Studies show that surgeons sometimes combine bichectomy with facelift when a patient has excess lower-face fullness or jowling, aiming for a slimmer facial contour [1] [4]. One series of patients undergoing combined lower-face procedures, including facelift, reported that bichectomy was added when the patient's anatomy called for it, and no complications were specifically attributed to adding bichectomy [2].
Interestingly, some surgeons take the opposite approach: instead of discarding the buccal fat, they reposition it as a living (vascularized) flap to restore volume to the mid-cheek area during a subperiosteal midface lift. In a series of nearly 150 patients, this technique showed excellent four-year results and also improved the appearance of jowls [3]. This shows that the buccal fat pad is a flexible tool: it can be removed or repositioned depending on what the face needs.
Factors that affect the decision
Research suggests that the volume of the buccal fat pad does not reliably differ based on body weight (BMI), sex, or ethnicity, but it does correlate with age [5]. This is important because as people age, the face naturally loses fat and volume. Removing the buccal fat pads in a patient who is older or already has a thin face could lead to an overly hollow or gaunt appearance over time [1] [5]. A surgeon should evaluate your specific facial proportions before recommending removal.
What to ask your surgeon
Because bichectomy during a facelift is a choice rather than a standard requirement, consider asking your surgeon these questions before agreeing to the procedure:
- Does my facial anatomy actually benefit from removing the buccal fat, or could it make me look hollow as I continue to age?
- Would repositioning the fat as a flap be a better option for my goals?
- What complications are possible if both procedures are done at the same time [1]?
Getting a clear explanation of the reasoning will help you make an informed decision that fits your long-term goals.
Caveats
The available studies are mostly observational cohort reports, not large randomized controlled trials. Evidence about long-term outcomes of combined facelift plus bichectomy is limited [3] [5]. Results can vary widely based on surgeon experience and individual anatomy, so a thorough consultation with a board-certified facial plastic or maxillofacial surgeon is essential.