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Dr. Barry Eppley

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Posts Tagged ‘perioral mound liposuction’

Case Study – Perioral Mound Liposuction

Tuesday, March 15th, 2016


Background: Fat collections exist throughout the face interpersed amongst the various tissue planes. Large deeper pockets of fat exist with the well known buccal fat pad with its various fingers throughout the deeper face extending up into the temporal regions. Thinner more widespread fat exists under the facial skin as well as right under the intraoral mucosal lining.

Attempts to thin a fuller face or provide increased facial definition through soft tissue manipulation can be done with fat removal. But unlike fat removal in the body below the neck which uses exclusively liposuction, fat removal in the face is not quite as straightforward. Besides its much smaller volume removals, the techniques to do so can also be somewhat different.

Fat removal in the face is historically and still most commonly perceived as that of buccal lipectomies. While buccal lipectomies can create an impressive amount of large globular fat extraction, they are often the wrong facial slimming technique for what the patient wants to achieve. Such is the case with the more discrete perioral mounds, small subcutaneous fat collections by the side of the mouth that have nothing to do with te=he buccal fat pads.

Case Study: This 33 year-old female was bothered by small areas of facial fullness to the sides of her mouth. She was already a very lean person and these would not be affected by weight loss. She initially thought that buccal lipectomies would create a reduction in them with the result of a more inward/slimmer appearance to this part of her face.

Perioral Mound Liposuction result front view Dr Barfry Eppley IndianapolisUnder local anesthesia with IV sedation, perioral mound liposuction was performed using small micrcannulas. (techically these were 2mm fat injection cannulas) Small stab incision were made from just inside the corner of the mouth to access this facial area. Approximately 1cc of fat aspirate was obtained from each side.

Perioral Mound Liposuction result oblique view Dr Barry Eppley IndianapolisHer postoperative results show reduction in the size of the perioral mounds after a month or so of healing and swelling dissipation. While the change was small, so was her original   problem but the improvement was very noticeable to her. Microliposuction would be the appropriate treatment for a ‘micro‘ facial fat problem.

While many areas of the fat can not be safely or effectively treated by liposuction, the perioral region is not one of them. The safest liposuction zone on the face can be defined by a  straight line drawn from the corner of the mouth to the tragus of the ear, a vertical line from the corner of the mouth down to the jawline and a bottom line along the jawline connecting these two other lines. There are no facial motor nerves in this area of the face. This is exactly where perioral mound liposuction is performed.


1) The perioral mounds are small subcutaneous fat collections by the side of the mouth.

2) Perioral mound fat collections are often confused with the buccal fat pads.

3) Perioral mound liposuction is performed with the use of microcannulas from inside the corner of the mouth.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: Facial Reshaping by Buccal Lipectomies and Perioral Mound Liposuction

Wednesday, December 31st, 2014


Background: The shape of the face is controlled by a variety of anatomic structures. Its foundation is influenced by the size and contour of the deeper facial bones, the thickness of the muscle and fat that lies above it and the amount and tightness of the overlying skin which envelopes it all. While everyone’s facial shape is unique, there are general types of facial shapes that are well known from oval, oblong, round, rectangular, square, triangular (inverted and heart-shaped) and diamond shape.

While the beauty of any of these facial shapes can be debated, many people find that a more inverted triangular or heart-shaped face is the most aesthetically pleasing. Having cheeks that are more prominent n width and projection that the portions of the face that lie below it is the hallmark of this facial shape. For those with a round face that desire such a facial change, one looks to fat removal to help with this transition.

Facial Fat (Cheek) Compartments Dr Barry Eppley IndianapolisFat removal of the face is not like the rest of the body. It is more localized into various compartments and has multiple motor nerves to consider when doing it. It is also not a high volume or voluminous source of fat that is capable of making by itself dramatic facial shape changes. Historically facial fat removal was associated with the buccal lipectomy procedure which is large volume by facial standards but does not require liposuction to remove. Other more superficial and lower volume facial fat areas exist, such as the perioral mounds, which can only be treated by small cannula liposuction.

Case Study: This 28 year-old female wanted to create a thinner more v-shaped facial shape. While she already had more of an inverted triangular facial shape, she did not like the fullness below her cheeks and by the sides of her mouth.

Buccal Lipectomy and Perioral Mound Liposuction result front view Dr Barry Eppley IndianapolisUnder general anesthesia, high maxillary vestibular incisions of 1 cm length were made below the parotid ducts. Splitting the buccinator muscles exposed the buccal fat pads which were teased out and removed. Through small incisions (3mms) inside the corners of her mouth, after having been initially infiltrated with a lidocaine and epinephrine solution, small cannula liposuction was used to remove fat from the nasolabial fold down to the jowl area. Each side produced about 2 to 2.5 cms of fat from each side.

Buccal Lipectomy and Perioral Mound Liposuction result submental view Dr Barry Eppley IndianapolisIt usually takes about 6 weeks until the full results from these fat removal procedures were seen. The final results of any facial liposuction/fat removal procedure are seen when the treated tissues feel soft with no hard areas, it feels completely normal to smile without stiffness and the overlying skin sensation feels completely normal. (not numb)

Facial fat removal can be effective at reshaping a somewhat fuller face but it can not really take a round full face and make it substantially thinner. It works best in moderately full to thinner faces where small fat reduction volumes make a more noticeable difference.

Case Highlights:

1) Reshaping or thinning a rounder face can be successfully done by specific site fat removal in properly selected patients.

2) A buccal lipectomy removes upper cheek fat while perioral mound liposuction removes lower cheek/jowl fat.

3) These procedures can make a round face less round and a thinner face more defined based on the limited amount of fat that can be removed.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies in Plastic Surgery – MicroLiposuction of the Perioral Mounds

Tuesday, August 19th, 2014


The removal of fat from the face by liposuction is historically seen as very limited in what it can accomplish. The large buccal fat pads can be removed by open excision but the remainder of facial fat is largely subcutaneous in location and small in volume over a large surface area. Liposuction of submental and neck fat is commonly done and very effective. Its ease of removal is largely because it is a relatively broad surface and an area that can collect substantial fat in some people. There is also little risk to any facial nerves as long as one stays below the jawline.

But above the jawline, subcutaneous fat removal by liposuction is not as generous. Fat pockets are small and often intertwined with more fibrous tissue. In addition the ability to hide small access incisions for cannula entrance is more limited. But these restrictions aside, there are facial areas where small amounts of fat can be removed.  A few ccs of fat removed may not be seem significant but on your face in the right location, its effect can be meaningful to create facial contouring/thinning effects.

Perioral Mound Liposuction Dr Barry Eppley IndianapolisOne such facial area that can have effective liposuction is the perioral region, specifically the perioral mounds. These small collections of fat beside the mouth and below the buccal pad fats create a puffiness or fullness. They are actually above the jowls although they can merge into them as well. By accessing this facial area through a small incision inside the mouth, the mound fat can be reduced and an outer convexity turned into a concavity if desired. It is important to stay in the subcutaneous space above the buccinator muscle to get the fat reduction effect.

Perioral Mound Liposuction cannula Dr Barry Eppley IndianapolisBecause this is a small area, it is necessary to use very small cannulas for perioral mound liposuction. Some may call these microcannulas or even nanocannulas depending upon what type of traditional liposuction cannula to which it is being compared. When the cannulas are this small, they will be only one hole located at the tip on one side. Multiple hole cannulas at this small size are difficult to manufacture and are prone to fracture. The area is thus treated by a double pass method, first down on the muscle and then secondly turned over and worked off the underside of the skin. (which is usually the most productive pass) A productive perioral mound liposuction may only pull out 1 to 1.5 ccs of fat at most.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Case Study: Corner of Mouth Lifts with Perioral Mound Liposuction

Wednesday, May 28th, 2014


Background: All areas of the face eventually show the signs of aging. But the mouth area in women is affected more by aging than that seen in men and is affected by sagging, thinning and wrinkling. The once fuller lips of youth give way to thinner lips with less vermilion show and vertical lip lines. The corners of the mouth turn down and jowling develops from the descent of tissues from above. Collectively put together this creates an older and unhappy mouth appearance.

While many plastic surgery procedures exist to treat the aging face, the most recognized ones do not have any influence on the mouth area. A facelift is a great procedure to improve the neck and jowls but does not affect the more central mouth region. Cheek lifts improve midface volume and sagging but will not turn a frown into a smile.

An aging mouth can only be improved by a direct approach and not peripheral pulling or lifting. This requires a series of different small procedures performed directly on the various aging mouth issues. Corner of the mouth lifts, laser resurfacing, lip lifts and advancements, lip volume augmentation and perioral mound liposuction all make up a collection of procedures under the category of perioral rejuvenation.

Case Study: This 57 year-old female wanted to improve the look of her mouth. She felt it looked old and constantly frowned. The corners were turned down and she had moderate jowling and fullness to the side of her mouth. She had excellent lip volume for her age and good skin with very few vertical lip wrinkles.

Corner of Mouth Lift with Perioral Mound Liposuction Dr Barry Eppley IndianapolisUnder general anesthesia (she was having numerous other facial procedures), she had a corner of the mouth lift combined with perioral mound liposuction.  The corner of mouth lift was performed using a small triangular cutout of skin obliquely oriented along the depressed mouth corners. Through a small mucosal incision just inside the corners, a 2mm cannula was used to remove 1.5ccs of fat from each perioral mound area down to the jowls.

Corner of Mouth Lift with Perioral Mound Liposuction result oblique view Dr Barry Eppley IndianapolisThese small mouth-related procedures produced a subtle but visible change in the appearance of her mouth giving it a more pleasing and youthful appearance. The smile line was now level and the convexities (bulges) on the side of the mouth were turned into more shapely concavities.

Corner of Mouth Lift with Perioral Mound Liposuction fersult side view Dr Barry Eppley IndianapolisThe relatively obscure corner of the mouth lift  has been around for over 75 years and, despite its simplicity, is the only procedure that can produce a permanent improvement for downturned mouth corners. It is a very small area of skin excision but it has to be marked out and executed very carefully to avoid visible scarring. Even when done well, there is a 20% to 30% incidence of minor touchups to the scar(s). Perioral mound liposuction is even less well known but less than 2ccs of fat removal can get rid of undesireable fullness and tissue sagging.

Case Highlights:

1) Aging of the mouth causes a variety of changes including downturning of the corners of the mouth, lip lines, marionette lines and jowling.

2) Perioral rejuvenation includes a variety of procedures including correction of frowning with a corner of the mouth lift.

3) Perioral mound liposuction can help get rid of the sagging fullness to the side of the mouth.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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