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

Question

Hello, I am a 40 year old female looking to address my peri oral mounds that seem to be getting worse every year. I am seeing more and more shadowing. I have had some plastic surgeons mention filler while others have told me they have seen filler make things worse. One plastic surgeon recommend micro liposuction. I am not even sure if it's truly fat causing these mounds as it seems to be where a lot of muscle connects when I smile. Thank you for your professional opinion.

Anna Chacon, MD, FAAD · Answer

Hi,

Thank you for sharing your photos and details. Perioral mounds—sometimes called marionette area fullness—can be tricky because, as you mentioned, they’re influenced by a combination of fat, muscle, and changes in skin elasticity over time. What you’re noticing as shadowing is often a natural part of aging, as the soft tissue around the mouth and jaw shifts downward and muscle attachments become more visible.

In terms of treatment:

Filler: Carefully placed filler can sometimes smooth out shadowing and provide subtle lift, but it’s not always ideal in areas where the muscle movement is significant. Overfilling can indeed worsen the appearance, so it requires an experienced injector.

Micro-liposuction or fat removal: This is less commonly used in this area and is more aggressive. It can sometimes help if true fat pads are contributing, but it comes with higher risk and recovery considerations.

Energy-based or skin tightening treatments: Devices that target collagen tightening may help the overlying skin appear smoother and reduce shadowing, though results are subtle.

Combination approach: Often, the best results come from combining modest filler with skin tightening or other techniques rather than a single procedure.

It’s also important to remember that the underlying structure—bone, muscle, and fat—plays a large role, so what works for one person may not work for another. Approaching this gradually and conservatively usually provides the most natural-looking results.

The key is tailoring the approach to your unique anatomy, movement patterns, and aging changes.

Eric M. Joseph, MD · Answer

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

Nelson Lee Novick, MD · Answer

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.

Kendall Phelps-Polirer, MD · Answer

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!

Leonard Grossman, MD · Answer

My recommendation is to have fat grafting in the surrounding area, bringing everything to a “normal” level. This will not only get rid of the mounds, but make your face look somewhat more youthful, and hopefully retain your appearance for a long period of time. This is some thing that would perform quite a bit in our practice. I hope this helps and good luck from New York City Plastic Surgery.

Kenneth R. Francis, MD, FACS · Answer

Dear rosepetal,
There are some very nice results obtained with microliposuction of the superficial fat compartments in the perioral region.  I would revisit that with whoever recommended it.  Good luck!

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

Answers (6)

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