SMAS lifting

A V-shaped face, where the cheekbones protrude slightly and the face tapers downwards, is considered attractive by many people nowadays. Those who are not blessed with such a V-shape from birth and have rather full cheeks can get rid of them permanently with buccal fat removal. As part of the surgical facial slimming procedure, the so-called Bichat’s fat is removed from the cheeks. The result is a slimmer face shape with accentuated cheekbones and clearly defined contours.
As a specialist in plastic and aesthetic surgery, Dr. Nichlos has the necessary expertise for the procedure. He attaches particular importance to very natural-looking results and takes the individual shape of the patient’s face into account. Make an appointment now and come to our practice in Frankfurt for a no-obligation consultation on the options for facial narrowing!
Buccal fat removal (bichectomy) is a relatively new plastic surgery procedure to remove full cheeks (“hamster cheeks”) and narrow the face. The aim is to achieve a more V-shaped face.
This method of facial slimming originally comes from the USA, but is also becoming increasingly popular in this country. In this treatment, excess fatty tissue is removed via an incision from the inside of the cheek. This emphasizes the cheekbones, the chin area appears narrower, the facial features more contoured and the face looks younger overall.

Dr. Emmanouil Nichlos has specialized in buccal fat removal for over 17 years and has extensive experience in aesthetic facial surgery.
By selectively reducing the buccal fat pads, Dr. Nichlos achieves defined facial contours and a slimmer profile. During the healing phase, patients who have recently undergone surgery receive personalized care, and Dr. Nichlos is available at any time, including 24/7, if needed.
Bichectomy is a relatively standardized surgical procedure that only varies in the details. Basically, the fat lying deep in the cheek (“buccal fat pad”) is removed through a small surgical procedure. Access is gained via a small incision in the oral cavity. This has the advantage that no externally visible scars remain later.
The amount of fat removed varies depending on the individual anatomy and the desired effect. In rare cases, the amount of fat to be removed may differ on the left and right.
Self-dissolving threads are used for suturing, which dissolve by themselves within 7-14 days, so that no thread pulling is necessary.
So-called “hamster cheeks” or “chubby cheeks” do not cause any discomfort, but can greatly disturb the aesthetic perception of the women and men affected. Buccal fat removal is performed for aesthetic reasons. Narrowing the cheeks makes the contours clearer and sharpens the profile. The operation is also suitable for compensating for asymmetries or concealing a pronounced chewing muscle.
Important: A bichectomy is suitable for removing genetically determined cheek fat that persists despite a healthy diet, plenty of exercise and a normal weight. If you are very overweight, you should first lose weight; often the “chubby cheeks” disappear with the extra pounds. If not, buccal fat removal could be a suitable treatment method.
After a thorough examination in our practice in Frankfurt, Dr. Nichlos will advise you on the possibilities of buccal fat removal and whether this treatment method is suitable for you to achieve the desired changes.
During the personal consultation, Dr. Nichlos will inform you about the treatment procedure and explain what you need to pay attention to before and after to ensure the best possible result. This includes informing us about any previous illnesses and medications you are taking and refraining from alcohol and nicotine before and after the procedure. Of course, you will have the opportunity to ask any questions you may have during the consultation and also later.
The specialist will then plan the narrowing based on your wishes and your individual face shape.
Buccal fat pad removal takes about 30 to 60 minutes and is performed by Dr. Nichlos in the modern operating rooms of the Berger Klinik under local anesthesia (with twilight sleep if desired).
As soon as the anesthesia takes effect, Dr. Nichlos makes a small incision on the inside of each cheek in the oral cavity and removes the fat pads above it. He then sutures the incisions with self-dissolving stitches. The first changes are visible immediately after the procedure, the final result of the operation can be assessed after approx. 3 weeks.
You will usually be able to socialize again the day after the treatment and do not have to plan for a long downtime. However, you should refrain from eating solid food on this day so as not to damage the fine stitches in your mouth.
Cool the cheeks carefully so that any swelling that may occur on the face after the operation subsides more quickly. Allow yourself some rest in the days following the procedure and avoid any form of physical exertion for about 2 weeks.
Ensure good oral hygiene and rinse your mouth thoroughly after eating for the first few days. This will minimize the risk of infection during the healing process.
Buccal fat pad removal is considered a low-risk treatment method, but should only be performed by a specialist with extensive anatomical knowledge, sensitivity and experience such as Dr. Nichlos to minimize the risk of bleeding and tissue trauma.
However, slight swelling or bruising in the surgical area cannot be ruled out after the procedure, which usually subsides after a few days. Commercially available painkillers can help with any wound pain that may occur.
The cost of buccal fat removal (bichectomy) depends primarily on the extent of the treatment and the patient’s individual anatomy. During this procedure, the buccal fat pad is permanently removed to slim the facial contours and accentuate the cheekbones.
At our practice in Frankfurt, the cost of buccal fat removal typically starts at:
The final price may vary depending on individual facial structure and the desired treatment outcome. Following a personal consultation, Dr. Nichlos will create a personalized treatment and cost plan that transparently outlines all services.
The cost of a buccal fat removal consists of various medical services. These typically include:
Since the procedure is performed at a specialized clinic, additional anesthesia and clinic fees apply.
For surgical cosmetic procedures, financing through monthly installments is generally available.
Financing is provided by an external financing partner and can be tailored to your individual financial situation. This allows you to conveniently pay for the treatment in monthly installments.
We would be happy to inform you about the requirements and the financing process during a personal consultation.
The treatment is suitable for women and men who have very full cheeks despite their normal weight and want a more defined facial contour.
As a rule, the procedure is advisable from around the mid-20s, when the facial features are fully developed and stable.
Buccal fat removal is performed on an outpatient basis under local anesthesia. The buccal fat tissue is removed through small incisions in the oral mucosa. The procedure takes around 30 to 60 minutes.
The result is permanent, as removed fat cells do not grow back. However, age-related changes such as sagging skin can affect the result in the long term.
An initial change is usually visible shortly after the procedure. The final result can be seen after 1 to 3 weeks, as soon as the swelling has subsided.
Thanks to local anesthesia, the procedure is painless. There may be slight discomfort in the days afterwards, which can usually be treated well.
Healing is usually uncomplicated. Swelling and bruising subside within a few days. You will usually be able to socialize again after 2 to 4 days.
No. Access is via the oral mucosa so that there are no externally visible scars.
Possible risks include swelling, hematomas or infections. If too much tissue is removed, the face may appear sunken in old age.
Yes, the treatment is often combined with a jawline optimization or chin sculpting to achieve a harmonious result.
No. This is an aesthetic procedure that is not covered by statutory health insurance. Dr. med. Nichlos is also not licensed by health insurance companies.
Dr. Emmanouil Nichlos, MD, is a board-certified plastic and aesthetic surgeon in Frankfurt who has specialized in buccal fat removal and facial contouring procedures for over 17 years.
The content on this page has been personally reviewed by him and reflects the current state of medical knowledge as well as the professional standards of plastic and aesthetic surgery.
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Do you want slender cheeks with defined cheekbones? Dr. Nichlos can help you achieve the coveted V-shape with a surgical facial reduction. He will remove excess fat from your cheeks and reshape them according to your wishes. Call us now or use our online form to request an appointment and receive a no-obligation consultation on the possibilities of this trendy operation!
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