By Doctor Herve Raspaldo
Various medical and surgical techniques, carried out either individually or combined, enable us to slim down the face.
Bichectomy or removal of the Bichat fat pads
The Bichat fat pads are fat stores located just underneath the cheekbones that give the cheeks their rounded shape. They are more prominent in some faces than others, and this is the difference between a slim face and one with “hamster cheeks”. A bichectomy (removal of the Bichat fat pads) allows us to remove the deep cheek fat and thus slim down the face.
Chubby cheeks can make a person look more childlike or plumper than they are. We might want to reduce the volume of the Bichat fat pads to hollow out the cheeks and slim down the face, making it look more beautiful with harmonious, V-shaped proportions.
Performing a bichectomy allows us to reduce the fat in the cheeks by removing part of the Bichat fat pads and thus slimming down chubby cheeks. This treatment makes the cheeks look hollower, which is a feature of a slim and slender face, while highlighting the cheekbones.
The surgical removal of the Bichat fat pads involves a small incision inside the mouth, on the inner cheek. It can be carried out under local or light general anaesthetic. The procedure is quick (around 30 to 45 minutes).
Unlike cheek liposuction, which gives a lesser result with a lot of swelling, Bichat fat pad removal gives very clean results and we can immediately see that the cheeks and face are slimmer. The final results are visible 3 months after the procedure.
Facial liposuction
A round face can be corrected with cheek and jowl liposuction. This is the removal of excess fat in the face, the lower cheeks (jowls), the neck and under the chin. Facial liposuction is often carried out on the cheeks and in front of the ears to refine the facial contours. This type of liposuction gets rid of any fat stored in the cheeks and jowls, and reduces the signs of aging such as round, swollen cheeks, which make a face look fleshy. Due to the position of the neck and chin in relation to the rest of the face, facial liposuction might not be enough to remove all excess fat in some patients. We can combine it with non-surgical fat reduction with BELKYRAMD injections. Generally, most patients ask us to slim down their neck and chin as well, while we are operating on their face.
The operation and post-procedure care
Generally performed under local anaesthetic, or a local anaesthetic combined with a drip to relax and make the patient drowsy, monitored by an anaesthetist, we make three small incisions under the chin and under the ear lobes. Then, we suck out the excess fat using a cannula, to sculpt the cheeks and the angle of the jaw. After surgery, there will be a bit of bruising and swelling, but these fade away after one or two weeks.
Refining a square jaw by injecting Botox into the masseter muscles
A hypertrophic chewing muscle (masseter muscle) makes the jaw look wide. Botox (botulinum toxin) injections directly into the muscle reduce its contraction, and therefore considerably reduce its volume and mass, which “hollows out” the cheeks. Botulinum Toxin injections are pain-free, performed in a medical surgery, and we see a reduction in volume after just a few days (around 3 to 4 weeks). The injections will need repeating after 6 to 8 months, but the results are excellent.
In conclusion, we can combine these three complementary techniques to potentiate their effects.
Doctor Herve Raspaldo 
Surgeon in Geneva. Licensed by the French National Medical Association for Surgery of the Face and Neck. Recognised in Switzerland (Geneva and Vaud) as an FMH specialist in ENT Surgery. Expert trainer in surgical anatomy and rejuvenation methods for the face by injection at the University of Nice.
