Buccal Fat Removal & Chin Lipo Under Local Anaesthesia

Patient Overview

• Patient: Fazilet

• Age: 35 years old

• Gender: Female

• Procedures: Buccal fat removal (bichectomy), double chin liposuction, internal laser skin tightening, temporary thread lift for neck — all under local anaesthesia

• After photos taken at: 5 months post-surgery

• Location: Istanbul, Turkey

Full Facial Contouring Without General Anaesthesia

One of the most common barriers that prevents patients from pursuing facial contouring surgery is the prospect of general anaesthesia — being put to sleep, intubated, and spending hours in an operating room under pharmacological unconsciousness. For patients whose concerns involve soft tissue volume rather than bone or deep structural work, this level of anaesthesia is often unnecessary. Fazilet's case demonstrates how comprehensive facial slimming — buccal fat removal, double chin liposuction, internal laser tightening, and temporary thread lifting — can be performed entirely under local anaesthesia, with the patient awake, comfortable, and home the same day.

At thirty-five, Fazilet consulted Dr. Cem Berkay Sinaci, a European board-certified plastic surgeon (FEBOPRAS) and member of ISAPS and ASPS, seeking a defined jawline and slimmer facial contour. Her surgical plan involved four complementary procedures — yet all were performed under local anaesthetic infiltration, avoiding the risks, recovery time, and cost that general anaesthesia adds to any procedure.

Bichectomy and Chin Liposuction: The Foundation

The structural foundation of Fazilet's facial contouring involved two procedures that directly remove volume from the areas creating her rounded contour.

Buccal fat removal — also called bichectomy — excised the deep cheek fat pads that gave her lower face its width. Performed through small intraoral incisions with no external scars, the procedure slimmed her mid-face and allowed her cheekbones to emerge as the defining structural landmark of her facial contour.

Double chin liposuction addressed the submental fat beneath her chin and along the jawline. Through puncture incisions measured in millimetres, the fat layer that was blurring her mandibular border and softening her cervicomental angle was removed, revealing the jawline definition that the excess fat had been concealing.

Together, these two procedures created the fundamental change in facial volume — less in the cheeks, less beneath the chin — that transforms a round facial silhouette into a sculpted one. But Dr. Sinaci's plan did not stop at fat removal. Two additional techniques were layered on top to optimise the skin response to the reduced volume beneath it.

Internal Laser Tightening: Heating the Skin from Within

When fat is removed from beneath the chin through liposuction, the overlying skin must contract to conform to the reduced volume. In young patients with excellent skin elasticity, this contraction occurs naturally and reliably. But even at thirty-five, the degree of skin retraction is not guaranteed to match the degree of fat reduction perfectly. This is where internal laser tightening adds a measurable advantage.

During the liposuction procedure, a laser fibre is introduced through the same cannula access points. The fibre delivers controlled thermal energy to the undersurface of the skin — the dermal layer where collagen fibres are concentrated. This heat does not burn or damage the skin. Instead, it raises the tissue temperature to the threshold at which existing collagen fibres contract and shorten, producing an immediate tightening effect.

More importantly, the thermal stimulus triggers a secondary biological response: neocollagenesis. The heated tissue recognises the thermal energy as a controlled injury and responds by producing new collagen over the following weeks and months. This new collagen is tighter and more organised than the old collagen it supplements, producing a progressive skin tightening effect that continues long after the procedure.

For Fazilet, internal laser tightening ensured that the skin beneath her chin did not simply drape loosely over the reduced fat volume. Instead, it contracted actively — both immediately through collagen shortening and progressively through new collagen formation — conforming tightly to the jawline that the liposuction had revealed.

Temporary Thread Lifts: A Scaffold for Healing

The most innovative element of Fazilet's procedure was the use of temporary absorbable threads in the neck — not as a permanent lifting device, but as a biological scaffold that guides how the tissue heals after liposuction.

The concept is straightforward but clever. After liposuction removes the submental fat and the laser tightens the undersurface of the skin, temporary threads are placed beneath the neck skin to hold it in a tighter, more elevated position. The threads themselves are absorbable — they dissolve over the following weeks to months. But during the time they are present, they serve as an internal framework that keeps the skin positioned exactly where the surgeon wants it while the healing process locks that position into place.

As the tissue heals around and along the threads, collagen is deposited in the pattern the threads establish. By the time the thread material dissolves, the collagen scaffold it generated has taken over, maintaining the tighter neck position permanently. The threads are temporary. The tightening they produce is not.

This technique transforms the healing period from a passive process — where the skin simply settles wherever gravity and tissue mechanics dictate — into a guided process where the surgeon determines the final skin position through strategic thread placement. The result is a tighter, more defined neck contour than liposuction and laser alone would produce.

Why All Four Together Under Local Anaesthesia

The decision to perform all four procedures under local anaesthesia reflects a philosophy of minimal intervention for maximum result. Each technique in Fazilet's plan is minimally invasive — small incisions, no deep structural dissection, no bone work, no muscle manipulation. The cumulative operative time remains within the range that local anaesthesia comfortably supports, and the patient avoids the grogginess, nausea, and recovery time that general anaesthesia frequently produces.

Local anaesthesia also offers a practical advantage during facial contouring: the patient can sit upright during the procedure. Gravity affects how facial soft tissue hangs, and assessing contour with the patient upright provides a more accurate preview of the final result than evaluating the same tissue with the patient lying flat under general anaesthesia. Dr. Sinaci can check symmetry, jawline definition, and neck contour in real time with Fazilet in a natural position — an intraoperative advantage that improves precision.

For patients who are anxious about being awake during surgery, mild oral sedation can be added to local anaesthesia to produce a relaxed, comfortable state without the risks of general anaesthesia. The patient remains conscious and responsive but feels calm and detached from the procedural sensations.

The Five-Month Result

At five months, every component of Fazilet's procedure has reached its mature outcome. The buccal fat removal has produced its full slimming effect — the post-operative swelling that temporarily masked the cheek reduction resolved months ago, and the sculpted mid-face contour is permanent.

The chin liposuction result is fully settled. The skin has retracted completely around the reduced submental volume, and the jawline definition is at its final state. The fat that was removed will not return.

The laser-stimulated neocollagenesis has completed its course. The new collagen generated by the thermal stimulus has matured and integrated into the dermal structure, and the skin tightening it produced is permanent.

The temporary threads have dissolved, but the collagen scaffold they generated during the healing period maintains the neck contour they established. The neck skin sits in the tighter position the threads held it in, locked there by the body's own healing response.

The convergence of all four mechanisms at five months produces a jawline and neck contour that exceeds what any single technique could achieve. Fazilet's face is slimmer, her jawline is defined, and her neck is tight — all achieved under local anaesthesia in a single session with a recovery measured in days rather than weeks.

Facial Contouring Under Local Anaesthesia in Istanbul

Fazilet's five-month before and after result demonstrates that comprehensive facial slimming does not require general anaesthesia, prolonged hospitalisation, or dramatic surgical intervention. Buccal fat removal, chin liposuction, laser tightening, and temporary thread lifting work together as a layered approach — each technique enhancing the others — to produce defined, lasting facial contour through a procedure that the patient walks into and walks out of on the same day.