A child with ‘chubby cheeks’ is adorable but when they get older it is not always pleasant to have what are known as ‘squirrel cheeks’ produced by Bichat balls or bags, fat deposits that are located at the level of the cheeks, below the cheekbones and between the muscles that are responsible for chewing. When this fat is greater than normal, the face appears excessively wide and round. The growth of this fat is related to overweight and obesity, but it also occurs in thin people. In these cases, there is usually an associated genetic component. To surgically reduce excess fat and obtain a more defined face, a bichectomy can be used -or removal of the Bichat fat bags-. Dr. Eduardo Álvarez, head of Plastic Surgery at Quirónsalud Murcia, assures that this operation is performed with a minimally invasive technique and presents a very comfortable postoperative period for the patient. The doctor explains that “Bichat fat works as a cushion or shock absorber against the support of the baby’s face during breastfeeding, lubricating and facilitating the function of the chewing muscles. In adulthood, it’s more of an aesthetic issue than a functional one.” It should be reserved for markedly round faces that do not define the facial contour or the cheekbones »Eduardo ÁlvarezHead of Plastic Surgery at Quirónsalud MurciaOf course, the plastic surgeon warns: «This surgery tends to be underestimated and, for its performance, it is necessary to have adequate knowledge anatomical of the area to be treated”, and adds, “Bichat fat is close to several endings of the facial nerve, involved in the movement of our face. Very close to the parotid duct, which channels saliva to our mouth, and also adjacent to some blood vessels of a certain entity that we must respect. For this reason, we recommend its performance by a specialist in Plastic, Aesthetic and Reconstructive or Maxillofacial Surgery », he assures. How is the surgeryThe removal of this fat deposit is performed inside the mouth, through a small incision between one and two centimeters in length in the mucosa. It is a surgery of less than an hour, which can be performed under anesthesia local or with sedation depending on the characteristics of the patient. The stitches are reabsorbable and no external bandage or splinting is required. Who is it for? In the opinion of Dr. Eduardo Álvarez, “the candidates must be carefully selected. It is not a surgery that should be done in all cases and you have to think a lot about the future. One of the clearest signs of aging is the loss of facial fat and, at certain ages, we will miss this lost fat very much, either naturally or eliminated with this type of surgery, such as the one at hand. We will then go into all those filling techniques to try to compensate for it». «Therefore, in my opinion, it should be reserved for markedly round faces that do not define the facial contour or the cheekbones. In many cases, if the Bichat fat is not expressed strongly, we will be losing something very valuable for the future and advancing our aging process », he concludes.