Like the body the face has numerous fat collections/compartments that lie either right under the skin or within or around deeper structures. Unlike the body, however, the fat locations in the face are more limited and less easily accessed for removal. The most well known facial fat collection is the buccal fat pad which can be partially or totally removed through an intraoral buccal lipectomy procedure.
An anatomically close but often overlooked area of a removable facial fat collection is the perioral mounds. This is a much smaller subcutaneous fat area that lies right below the skin at the level of the mouth and just below the location of the buccal fat pad. Its volume is about a 1/3 (1ml or less) that of the buccal fat pad which is usually closer to 3mls. In thinner people it can be as small as .25mls while in fuller faces it can be as much as 1ml or more.
This small area of subcutaneous fat collection can create fullness or mounds by the side of the mouth. This discrete fat collection can be seen during facelift surgery where the skin is lifted off the underlying subcutaneous fat layer. The elevation of the skin flap must be taken all the way to the corner of the mouth to fully identify it. Given its location it is easy to see how some slight enlargement of it can create a discrete eternal mound appearance.
Perioral mound liposuction is performed by very small cannula extraction using wall suction from a small nick incision inside the corner of the mouth. Total volumes removed is under 1ml and the use of very small cannulas is important to prevent contour irregularities and/or over resection.
Dr. Barry Eppley
Indianapolis, Indiana