Age 42, strange mound of skin/fat, not interested in fillers as a fix

Hello,Before I answer and make any suggestions, I'd like to point out that you are very pretty and the things we notice about our own faces usually much more apparent to is, than to others.If you are talking about the bump near the corner of the mouth, it looks like the modiolus. This is where the facial muscles come together. A simple excision would not be likely to change this and would result in unnecessary scarring. This would only help if it was truely a collection such as a cyst or lipoma. An ultrasound may help rule these out. If it is the modiolus, the question would be why is it hypertrophic. Is there extra muscle activity on that side from habit or mouth closure? Tightening the lips and other mouth movements might help determine if anything makes this muscle better or worse. A conservative amount of botox would be my first attempt at this if it is the modiolus. Don't give up and jump to direct excision unless there is a clear answer of what is being treated. This is also the area where nerve injury is a risk.I hope that helps.

If I am interpreting your concerns correctly, you're talking about a small bump best seen in the first photo just next to the corner of your mouth. This area is called your modiolus and corresponds to where many facial muscles converge. In general, I'm not a huge fan of using botox below the level of the eyes as weakening lower facial muscles tends to create slightly changes in function (temporarily of course). It also appears that the lip depressors (DAO, and platysma) are relatively strong in your resting pictures and may benefit from botox to soften the appearance you don't like.
The next more aggressive route would be facial fat transfer. You have wonderful volume in your face and the amount you need would not be much, but adding a little fat to the other areas directly around the modiolus (nasolabial fold, marionette line, etc) may help to make the "bump" less noticeable.

Thank you for your question and photographs.

The distribution of the volume is somewhat unusual and the photographs do not seem to show it equally well depending on the lighting.

You have the option to try and get more clarity regarding the nature of the lump using ultrasound. Soft tissue high resolution ultrasound can produce quite valuable information leading to a better decision. Sometimes this is related to buccal fat prominence which can be addressed through an access inside the mouth. Sometimes the buccal fat itself can show a small lipoma.

In some instances, there is an aggregation of fatty tissue under the skin which can be treated using micro liposuction.

One quick test that you can carry out yourself is to have a look at the appearance of the face when you lie down and therefore when the soft tissues of the face shift slightly. If the bump persists, it is more likely to be lipoma, but even such lesion sometimes can be treated with micro-liposuction.

As a final consideration, injections that dissolve the fatty tissue have been shown benefits for localised areas of fatty tissue deposition.

This gives you the orientation that the first step would be to make sure what you're dealing with and build the treatment decision from there.