Excess puffiness/fat at corners of the mouth (perioral), what are my cosmetic options?

This is the hardest area to treat. There is no easy solution. Fillers can be used around the bulges to camouflauge them. In older patients a facelift can sometimes help. RegardsDr. J

Hello and thank your your picture and question.  The photos provided are not really helpful because of the angles you took. Based on this limited information, your concern is due to loss of fullness in your cheekbones and early skin sagging.  Different concerns require different treatments and the best way to approach the is to see an expert physician for an in person consultation  that you feel comfortable with. You may need a combination of  fillers and lasers. Best, Dr.Avaliani

Fillers around the area can help but will have to be carefully placed and depended if there is any fat migration that might be an issue also. 

Please feel free to submit a picture so we can have a better idea of what you mean but from your description, this is something we do not have a good solution for. In some cases, lip filler can help add volume and make these areas less noticeable. Hope this helps.

Honestly, I am not aware of any solution for this.  Most likely as you age this will become less prominent.  Perhaps a facial plastic surgeon would have some insights.  Best of luck.

You may be losing volume in the midface and the treatment could involve filler such as Restylane.  You do not need to lose weight.

It's hard to give you a complete recommendation based on these photos alone. That being said, volume loss in the midface maybe an issue. I would consider treatment with HA fillers like Restylane Lyft to the cheeks and chin. This would address midface volume loss, lift the face and improve chin projection.