Removal of Bish's lumps: what surgeons think about this operation

Bish's lump removal – this is a minimally invasive aesthetic operation, which is currently very popular and in demand in the practice of plastic surgeons.
Bish's lumps are symmetrical fatty bodies located between the skin of the face and the mucous membrane of the cheek, slightly below the cheekbone.
It is thanks to Bish's lumps, named after the French anatomist who described their properties and characteristics, that babies have plump cheeks that facilitate the act of sucking. At an older age, not everyone likes such cheeks, and the desire to have a beautiful, thin face with harmonious, pronounced features is the basis for patients to contact a plastic surgeon with a request to remove these same fat lumps.

Bish's lump removal:
• when removal of Bish's lumps can be shown;
• contraindications to the operation to remove Bish's lumps;
• the opinion of plastic surgeons about the removal of Bish's lumps.

When the removal of Bish's lumps can be indicated

First of all, it is important to clarify that Bish's – these are not pathological, but physiological fat bodies, expressed to varying degrees in different people. When trying to lose weight through diet and exercise, the reduction in Bish's lumps is very slow and often mild.

Therefore, the main indication for the surgical removal of Bish's lumps is the patient's desire to improve the shape of the face when:
• the presence of excess fat deposits in the face;
• round face shape and pronounced "plumpness" cheeks;
• age-related changes with the omission of the tissues of the cheeks and the formation of jowls;
• as an additional method of correction when performing other plastic surgeries, such as liposuction of the chin, the introduction of zygomatic implants, facelift, and so on.

Contraindications to the operation to remove Bish's lumps

The following conditions may serve as contraindications to the operation to remove Bish's lumps:

• the young age of the patient (up to 25 years), since before this age, deposits of adipose tissue can decrease on their own;
• deviation of the patient's body weight from the norm by more than 25% in a positive or negative direction;
• likelihood of weight loss or weight gain in the near future;
• inflammatory processes in the neck, face, oral cavity;
• decreased immunity;
• the presence of chronic systemic diseases;
• diabetes mellitus;
• violation of blood coagulation processes;
• chronic liver disease, epilepsy and mental illness.

The opinion of plastic surgeons on the removal of Bish's lumps 

The opinions of plastic surgeons on the removal of Bish's lumps differ significantly and vary from the most positive to skeptical. The effect of the operation is that after the removal of Bish's lumps, the volume of the cheeks and the width of the face in the lower sections decrease, the oval of the face becomes clearer, the proportionality of the face is restored and the result of the operation is preserved for life. On the other hand, the severity of the effect is very dependent on the initial situation and the individual structural features of the patient's face, so a clear effect after removal of Bish's lumps is observed far from 100% of cases. In addition, subcutaneous adipose tissue gradually decreases with age, and the faces of patients over 35 years of age who have previously had Bish's lumps removed may take on a tired, senile appearance.

Most plastic surgeons recommend Bish's lump removal as an adjunct to other facial plastic surgeries, which allows you to get the maximum aesthetic effect.

Before recommending the removal of Bish's lumps to the patient, it is necessary to evaluate how this operation will allow to achieve the desired result in each individual case.