The influence of fat on the shape of the face is but one anatomic component. But because it is relatively easily removed in most cases, the incentive for surgical modification is fairly high. The facial fat compartments that are most easily removed or reduced in size are those in the neck and the cheek.The buccal fat pad is a large discrete collection of fat underneath the cheekbone from which radiates many fingers of fat outward. For patients that have ‘chubby cheeks’ or a full face, reduction of the buccal fad pad may be one area of change that can make a contribution to some degree of facial refinement.
When patients complain about full cheeks, some will occasionally point to an area that is not really the buccal fad pad region. Rather, they are pointing below it down at the level near the mouth area. Sitting at the junction of the end of the nasolabial fold and the lower of more superficial cheek fat is what is known as the perioral mound. It may be better described as a side-of-the-mouth fat collection. The perioral mound should not be confused with the buccal fat pad. They are two distinctly different fat areas. Some may have fullness in this area of their face naturally, others will develop it as they age. It can be a particularly noteworthy area as it sits in an area that is exposed to a lot of motion when talking and smiling.
Unlike the buccal fad pad, the perioral mound is not a discrete encapsulated collection of fat. Anatomic studies have shown that it is more of a thick layer of fat in that region. The size of its fat lobules is more consistent with subcutaneous fat than the larger lobules and more yellow color of buccal fat.
Such localized areas of facial fullness can be present for two reasons. I have seen young patients who have fullness in this area that they want removed and they usually have fuller and more round faces. Fat bulges in this area can occur from a ptosis (sagging or herniation) of the buccal fat pad and this is a recognized clinical entity, albeit more uncommon. Perioral mounds can also be seen in faces that are aging. This is a bit paradoxical in that aging faces are now recognized to have a significant component of facial fat loss. The perioral mound seems to be an area, conversely, of fat accumulation. It may well be that it is facial fat, with the skin, that has fallen from above rather than a true accumulation or growth of localized fat.
Regardless of its origin, treatment of the perioral mound is the same…liposuction. Unlike the buccal fat pad, it is not best excised from inside the mouth due to its lack of a defined capsule. Using a very fine liposuction cannula from a small incision inside the corner of the mouth, it can easily be reduced. Generally only 2 to 3ccs of fat are removed from each side. When doing buccal lipectomies, I advise to treat this area as well to help narrow the lower end of the submalar triangle. Direct excision of the perioral mound can be done during an extended facelift when the skin flap is raised near this area. When a more limited facelift (aka Lifestyle lift) is being done, then the liposuction extraction method is used.
Dr. Barry Eppley
Indianapolis, Indiana