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Unlike the body the face has limited opportunities for fat removal. It is not that there is not fat in the face, as many fuller faces can attest, but that the ability to remove it is restricted by the numerous motor nerves that course through the face. Also unlike the body the largest reservoir of fat in the face that can be removed is done by an excisional technique and not by liposuction. (buccal lipectomy)

Besides the nerve issue, the fat in the face has a more fibrofatty composition that is not as easily extracted as the subcutaneous fat layers elsewhere in the body. But this does not mean that liposuction in the face can not be done but that it must be done very selectively and with the understanding that its effects at fat reduction will be limited.

One area of the face that can be treated by liposuction are the perioral mounds. This area is often confused with that of the buccal fat pad which lies higher. Located at the horizontal level of the corner of the mouth it is a semicircular area of subcutaneous fat. It can be effectively reduced by very small cannula liposuction  of 2mms or less. This size cannula avoids any irregularities and is effective for the 1 to 3ccs of fat that is typically extracted from this facial area.

An even less appreciated and more discrete subcutaneous fat collection is that known as the mouth parentheses. These very discrete subcutaneous fat collections occur on the side of the upper lip and wrap around the corner of the mouth. These small protrusive mounds are bothersome to may who have them and they often occur in thinner faces.

The mouth parentheses deformity y can be effectively reduced through very small cannulas done through access from the inside of the corner of the mouth. I prefer the use of fat injection cannulas to do the extraction in such small fat areas. Their one-sided hole design acts like a ‘scraper’ to remove the fat from the underside of the dermis. It can then be reversed and used to do the same from the orbiculares muscle.

Regular wall suction can be used with the cannula and it creates the removal of small globules of fat as seen in the suction tubing. Its removal results in a small volume of fat in the 1 cc to 2cc range.

Dr. Barry Eppley

Indianapolis, Indiana

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