Bichectomy or Midface Lift?

Bişektomi mi, Orta Yüz (Midface) Lift mi

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Full or wide-looking cheeks can make the face appear rounder and sometimes give the impression of being heavier than it is. In some people, this is due to genetic facial structure, while in others it occurs as the midface descends with age. Today, two main approaches are used to slim this area or achieve a younger, balanced, triangular facial appearance: bichectomy (removal of inner cheek fat pads) and midface lift. However, these two procedures are not alternatives to each other; they serve different face types and aesthetic needs.

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Choosing the correct method is an important factor that determines the future of the face. An incorrect intervention can make the cheeks appear sunken, weak, and aged; the right application, however, enhances the face’s radiance, defines its contours, and creates balanced, elegant lines. Therefore, when selecting a treatment, not only the current appearance but also the patient’s facial structure, aging pattern, and tissue quality should be considered.

What Factors Contribute to a Full Cheek Appearance?

Some face types naturally have fuller cheeks. In particular, in individuals whose cheekbones are set further back, the volume in the cheek area becomes more prominent, making the face appear rounder. Additionally, as midface tissues sag with age, volume can accumulate under the cheeks, leading to an increase in volume in an unintended area. This appearance, also known as “hamster cheeks,” can be particularly bothersome in photographs.

Weight gain and loss cycles can also affect the appearance of this area. Facial fat behaves differently from body fat; in some people, cheek volume may remain even if they lose weight. Therefore, not every case of full cheeks is solely due to fat tissue. Sometimes, loosening of muscles and connective tissue, reduced skin elasticity, and downward displacement of the midface also contribute. Correctly identifying the source of the problem is the first step in choosing the right solution.

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What is Bichectomy? Who is it Suitable For?

Bichectomy is a procedure in which a specific portion of the buccal fat pad inside the cheeks is removed. Its purpose is not to hollow the face but to reduce unnecessary volume along the mid-cheek line, creating a slimmer, more elegant facial contour. It is particularly effective in young patients, those with prominent cheekbones, and those who want a V-shaped facial appearance.

This procedure is used to make the lower half of the face appear slimmer; however, it is not suitable for everyone. In patients with thin skin, low cheek volume, or significant signs of aging, excessive fat removal can lead to future sagging and an aged appearance. Therefore, when planning a bichectomy, skin thickness, genetic aging patterns, and bone protrusions must be carefully evaluated.

The effects of bichectomy become more noticeable over time; as swelling decreases, the lower cheeks slim down, and the face gains sharper contours. However, if the procedure is not performed on the right patient, it can result in an artificial and “sunken” appearance; therefore, choosing an experienced surgeon is very important.

What is a Midface Lift? Who is it Suitable For?

Midface lifting is a procedure applied when the cheeks have descended due to aging or tissue sagging. The goal of this technique is to restore the cheeks to their natural position, soften the under-eye transition, and reestablish the contour of the cheekbones.

A midface lift is particularly effective for patients with under-eye hollows, deep nasolabial folds, and sagging cheeks. Unlike bichectomy, it does not slim the lower face; it rejuvenates and lifts the upper cheek area. Instead of reducing cheek fullness, it relocates the volume to the correct position.

This procedure restores the natural triangular appearance of the face and provides a youthful effect. When applied correctly, the face looks both firmer and naturally fresh. Especially in middle-aged and older patients, an approach that focuses on volume repositioning and support, rather than just fat removal, should be preferred.

Which Method is Preferred in Which Situation?

Treatment selection should be fully personalized. Not all full cheeks require bichectomy, and not all sagging can be resolved with a midface lift. The following factors are evaluated when making a decision:

Face shape and bone structure
Skin thickness and elasticity
Aging process and tissue sagging
Cheek volume distribution
Relationship between the under-eye area and midface

Choosing the wrong procedure can age the face; the right choice provides a natural, balanced, and long-lasting aesthetic result.

Combination Approach in Full Cheek Treatments

Bichectomy + Masseter Treatment
When reduction of inner cheek fat and thinning of the jaw muscle are planned together, the lower face appears more refined. However, precision is crucial; the natural jaw structure must be preserved. The goal is not a “shaved” face but to create a refined contour.

Midface Lift + Fat Transfer
If there is volume loss and sagging in the midface, this is the most successful approach. Fat tissue provides both volume and rejuvenation. This combination makes the face appear refreshed, firm, and rested.

Recovery Process and Expectations

Swelling and mild edema are expected after both procedures. While results from bichectomy become clear within a few months, recovery after a midface lift progresses gradually as the tissues settle.
The outcome should be a balanced and attractive appearance that supports the natural contours of the face. A well-planned procedure does not make the face unrecognizable; it makes it look more refreshed, refined, and youthful.

These articles are written for informational purposes. To determine whether the procedure is appropriate and to identify the treatment suitable for you, you should consult your doctor.