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.
Under 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.
Her 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