Major clinical approaches at the aesthetic level and complications of bichectomy: a systematic review

Abstract

Introduction: According to the Brazilian Society of Plastic Surgery in 2016, 7,362 people underwent bichectomy (BC), which represents 0.5% of the total number of aesthetic surgeries. In an attempt to achieve facial harmonization, BC surgery presents little complexity and is based on some well-defined steps. Even when appropriately indicated, it is still a controversial procedure, as there is no surgical technique adequately systematized in current literature, aiming to make it safe and reproducible. Objective: It was to present the main aesthetic considerations and complications of bichectomy, as well as discuss its safe management to avoid and treat problems. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from November 2023 to February 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 96 articles were found, 40 articles were evaluated in full and 28 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 12 studies with a high risk of bias and 10 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X²=67.9%>50%. It was concluded that on an aesthetic level, performing a bichectomy thins the middle third of the face, outlining and highlighting the bone angulations of the zygomatic region, contributing to a more pleasant facial aesthetics. Surgical removal of the Bichat ball induces a mild inflammatory process controlled by rescue medication, significantly reduces facial volume, and improves the quality of life and satisfaction with facial aesthetics 3 months postoperatively. Several studies have presented the importance of using the Bichat ball as an oral layer to close fistulas and also to cover bone grafts in implant dentistry.