At present, the influence of social networks and the fashion industry has changed the perception of the concept of beauty that was had a few years ago, which is why aesthetic procedures that help to achieve this new concept of beauty have increased.
One of the most popular procedures nowadays is the bichectomy, basically it is the excision or extraction of the Bichat fat ball to achieve a thinner or thinner silhouette in the lower third of the face.
The fat ball of Bichat is a mass of fatty tissue, which is interposed between the buccinator muscle and the masseter muscle. Although it was once thought to be a non-functional structure, studies have shown that it has several significant functions; during infancy prevents the collapse of the cheeks and improves the gliding of the muscles during sucking which allows infants to feed, also separates the chewing muscles from each other and contributes to chewing, in turn provides protection and cushioning to important neurovascular structures located in the buccal region.
The Bichectomia is performed under local anesthesia and is generally done intraorally. First, the anesthetic (a solution of lidocaine and epinephrine) is injected (bilaterally) approximately at the level of the upper first and second molars. The cheek is then retracted laterally, and a 1.5-2.5 cm mucosal incision is made, starting at the first molar backwards until the extension of the incision is completed.
After the incision, the buccinator muscle is dissected to advance to the buccal space where the adipose ball of Bichat is located, at the same time external pressure is applied in the area where the adipose ball of Bichat is, in this way it is exposed and it is easy to observe because it has a bright yellow color.
When locating it, external pressure is continued to mobilize it towards the incision, without over-pulling the most protruding portion, it is held and then completely extracted, taking care not to damage the vascular bundle.
A gauze soaked in anesthetic solution is placed inside the wound, and the opposite side is operated on. At the end, the cheeks are evaluated to determine if the expected effect has been achieved. To complete the surgical procedure, both incisions are sutured with absorbable suture.
After bichectomy, it is advisable to apply cold compresses in the region of the operation for two consecutive days, in addition to a soft diet and the use of mouthwashes with antiseptic to minimize edema or inflammation and promote healing. After the operation, people can expect to appreciate the change in facial contour within a few weeks.
Risks of bichectomy
The Bichectomy as surgical procedure has risks that may be conventional or common in surgery, such as bruising and infections. But there are other risks of bichectomy that are closely related to the procedure.
The injury of the parotid duct bad planning incision is one of the risks of Bichectomy and injury of the facial nerve that can cause facial paralysis which may be transitory or not, depending on the severity of the injury.
It is very important that there is a good technique for excision of this tissue, and that when removing it there is not excessive traction on it, this is considered one of the most common complications or risks of bichectomy.
The Bichat adipose ball described anatomically, has a main body and four extensions, one of them is the buccal extension, this is the main responsible for creating fullness in the cheek. Therefore, bichectomy can be more accurately termed as partial removal of the extension.
It is important to remove only tissue that easily protrudes, not only because it is a tissue that protects vital neurovascular structures, but also because it provides significant volume to the face that can be difficult to restore, especially in older people.
For this reason, bichectomy is indicated in those people with large cheeks who really require the removal of excess tissue volume, since it can lead to an exaggerated reduction or reduction of the cheek if this indication is not taken into account. People young through their 30s can counteract excessive tissue loss with youthful skin, bulky soft tissue, and bone.
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