While liposuction is widely used over many body areas, its applications to the face are much more limited. Between the far fewer isolated fat pockets and the location of motor nerve branches, facial liposuction is a fairly limited technique for fat reduction outside of the neck.
One facial area that can have liposuction done is that of the perioral mounds. As the name implies, it lies to the side of the mouth. It is an area of subcutaneous fat that lies between the skin and the buccinator muscle. It is often confused with that of the buccal fat pads and is a primary reason that buccal lipectomies can be unsuccessful due to a misdiagnosis. The buccal fat pad is a discrete encapsulated fat pocket that sits right under the cheekbones but does not extend down to the horizontal level of the mouth. (except in the rare instance of buccal fat prolapse)
The pooches or mounds besides the mouth can be a source of aesthetic dissatisfaction. While they can occur in faces of all sizes, they equally occur in thin faces where it is harder to imagine such a discrete fat collection could occur. Why they develop is not known but time fat is needed in this area to separate the underlying muscle from the skin.
Perioral mound liposuction is often viewed as not possible or safe due to facial nerve branches. But an anatomic analysis of this area shows that there are not facial nerve branches in this part of the face. The nerve free zone of the lower face is below a line drawn from the earlobe to the mouth corner, a vertical line than drawn down to the jawline and the jawline traced posteriorly back up to the earlobe. The perioral mound area lies in the anterior half of this demarcated facial region.
Perioral mound liposuction is performed with a small cannula through a mucosal incision just inside the corner of the mouth. Fat is removed above the buccinator muscle in a fan-like fashion from the mouth corner. It takes some time and persistence to work the area as it is not like that of larger fat areas like the abdomen. It is a smaller more fibrous fat collection which is measured in single digit cc volumes.
Fat removed from the perioral mounds can be strained and measured. The volume removed is usually between 2 to 3ccs of fat per side. That may not sound like much but is all it takes to reduce a prominent facial fat mound.
Perioral mound liposuction is a safe technique for selective facial fat reduction. Having performed the procedure in over 50 patients, no case of facial nerve weakness has ever occurred. While small in volume extraction it is effective for the discrete subcutaneous fat collection by the sides of the mouth.
Dr. Barry Eppley
Indianapolis, Indiana