Unilateral perioral mound - is liposuction the best solution? (Photos)

Question

I have a lot of facial assymetry that I am going to begin tackling by getting aligners and a rhino/turbino/septoplasty. one irregular feature is this hump on only one side of the mouth. Is this a perioral mound? If so, is liposuction the best solution? i am not interested in facial filler due to migration concerns (plus my interest is in removing, not masking), and it doesnt seem that any before and afters for kybella or RF show any significant reduction

Gary M. Horndeski, MD · Answer

An alternative to consider would be an eccentric lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This takes about 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Anna Chacon, MD, FAAD · Answer

This is unlikely to be a true perioral mound, and liposuction is usually not the best first option for a unilateral fullness near the mouth.

A one‑sided “hump” in this area is most often multifactorial rather than excess fat alone. Common contributors include underlying dental or skeletal asymmetry, muscle imbalance around the mouth, buccal fat pad positioning, or soft‑tissue differences that make one side look fuller.

True perioral mounds are uncommon, typically bilateral, and related to superficial fat. When the finding is unilateral, it’s important to be cautious about that diagnosis.

Liposuction in the perioral region is high‑risk and often low‑reward. The area has very thin fat, important nerves, and constant movement. Over‑removal can lead to dents, worsening asymmetry, or an aged look, and it doesn’t address muscle or structural causes.

Your hesitation about filler migration is reasonable, and you’re also right that Kybella and RF often show limited, inconsistent improvement for small focal fullness in this area.

A practical approach is to complete orthodontic and nasal/skeletal work first, since these changes can significantly affect lower‑face balance. An in‑person evaluation that looks at bite, muscle activity, and fat compartment anatomy is key before considering any fat‑removal procedure.

Bottom line: this is probably not a classic perioral mound, and liposuction is rarely the best solution for unilateral perioral asymmetry. Accurate diagnosis matters more than the specific treatment, especially in this delicate area.

Citrus Aesthetics - San Diego · Answer

What you’re describing can be a unilateral perioral mound, but it’s important to understand that fullness in this area is rarely caused by just one thing. In my clinical experience, asymmetry around the mouth is most often multifactorial, involving a combination of skeletal structure, dental alignment, muscle activity, fat pads, and sometimes prior compensatory facial movement patterns.
Because you’re already addressing underlying contributors like dental alignment and nasal structure, that’s an excellent and very appropriate first step. Changes in occlusion, bite, and airway can significantly influence lower facial balance over time.
When it comes to the perioral region specifically, liposuction is not routinely the first or best solution. This area has very superficial fat, critical neurovascular structures, and plays a major role in facial expression. Aggressive fat removal can increase the risk of contour irregularities, scarring, or even premature aging, especially when asymmetry is present. For that reason, liposuction is only appropriate in very select cases and only after a thorough in-person evaluation confirms that excess localized fat is truly the primary issue.
Your concerns about filler migration are valid, and you’re correct that filler should never be used to “mask” a problem without understanding its root cause. Similarly, treatments like Kybella or RF-based tightening can be helpful in the right patient, but they are not universally effective for perioral mounds, particularly when muscle dominance or skeletal asymmetry is contributing.
This is where a multimodality approach becomes essential. A thoughtful treatment plan may involve observing changes after orthodontic or surgical correction, evaluating muscle activity (such as asymmetrical depressor or orbicularis function), and considering conservative, staged interventions only if truly indicated. Sometimes the best treatment is timing, restraint, and reassessment rather than immediate intervention.
The most important step is an in-person consultation with a highly trained aesthetic provider who understands facial anatomy, balance, and long-term outcomes &mdash; not just isolated procedures. Facial asymmetry deserves a strategic, individualized plan rather than a one-size-fits-all solution.
Aesthetic treatments should always be discussed with and performed by a trained, licensed, and medically certified aesthetic provider. The recommendations above are for educational purposes only and do not replace an in-person consultation, examination, or personalized medical advice.

Unilateral perioral mound - is liposuction the best solution? (Photos)

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