What can be done to address my perioral mounds? 40 y/o female (photos)

They are less of an eyesore than you think since they are congenital and symmetrical. I agree that adding filler would be a bad idea, and micro liposuction sounds like it could lead to visible asymmetries afterwards. Thank you for your question. Sincerely, Dr Joseph

This is actually not such an uncommon problem. The use of a robust HA lifting filler injected into and elevating the mental crease (the horizontally running fold above the chin and below the lower lip) can often help to mask the surrounding mounds by creating smoothing transitions.
From the profile view there appears to be some chin recession, so the use of a robust HA volumizing filler to augment the chin would also likely create greater harmony between the projections of the chin and lips and further reduce the apparent appearance of the surrounding mounds.
Before any treatment, I usually recommend a real world trial by injecting normal saline or dilute anesthetic into the mental crease as a way to try to make sure that actual filler treatment there would achieve the desired outcome. You would be wise to make sure to consult with a very experienced, board certified cosmetic dermatology filler expert and best of luck.

Hi there! Have you tried injecting your DAO muscles with a neurotoxin? I usually do 6-8 units of Xeomin in each DAO muscle. I think this could be a good place to start, just make sure you choose a physician injector with experience in this type of injection! Best of luck!