Thinning the face by fat removal has limited surgical options. The buccal lipectomy procedure is the most well known as it removes a discrete collection of mid facial fat that usually approximates 3 to 4ccs in volume from each side. But the buccal lipectomy is not the only facial fat sculpting procedure. The perioral. region below where the buccal fat resides can also be reduced.
The perioral region is an area of subcutaneous fat that exists to the sides of the mouth down to the jawline. Technically subcutaneous fat exists all over the face but much of it is off limits because of the branches of the facial nerve that runs through it. But the perioral region is unique as no facial nerve branches cross through it. Thus it is capable of being treated by liposuction.
But perioral liposuction requires a slightly different technique than neck liposuction (the closest equivalent) which is more commonly done. The cannula size that is used must be much smaller. Fat is removed quickly from the perioral region and it is easy to over resect the area and/or create irregularities. Traditional small liposuction cannulas, even of the 2mm diameter, increase that risk. I prefer to use liposuction injection cannulas which is closer to 1 to 1.5mm and only has an opening on one side. This removes fat more slowly so the risk of irregularities or over resection is lessened.While the preferred perioral liposuction cannula is made to be attached to a syringe for injection it works well when it is just plugged into a suction tube.
Perioral liposuction is done from a nick incision through the mucosa from just inside the corner of the mouth. This provides the most direct access to treat the area as far back towards the ear/jaw angle as one desires or the length of the cannula allows. The area is first infiltrated with a lidocaine/epinephrine solution for hemostasis.
The perioral region is treated with the small cannula until there appears a slight smooth indentation in the center of the marked area of reduction. One can bimanually feel the area with one finger on the outside and the thumb on the opposite side inside the mouth. The indentation should be able to palpated.
Perioral liposuction is often a complement to buccal lipectomies for a more complete cheek thinning effect. It is also done alone for the thin patient who has discrete fat collections/fullness to the sides of the mouth that is otherwise refractory to other non-surgical methods of fat reduction.
Dr. Barry Eppley