Would I benefit from a facelift or from liposuction to perioral mounds? (photos)

That is not your natural fat. That is retained filler that migrated out of your lips. You think that you have always had these. That is highly improbable. It is much more likely to related to a past fiiler treatment. One can also see you have retain lip overfill. As these treatments age, they hold more and more water. There is also retained filer along the jaw line. Removing that material will make you look years younger.

Based on what you've described and taking into account your history of significant weight loss and the long-standing presence of the fullness around your mouth area, it’s very likely that what you’re seeing are perioral mounds—localized fat or soft tissue pockets that sit just lateral to the mouth, often creating a heavy or aged appearance in the lower face.
Given that these have been present since childhood and have persisted even through major body changes, liposuction alone may not be sufficient, especially if there is also some degree of skin laxity or underlying tissue descent (which is common after major weight loss). In your case, a lower facelift would likely be the most effective approach. This procedure lifts and repositions the deeper facial structures—not just the skin—addressing both sagging and volume displacement. It would allow for a more defined jawline and smooth transition from the cheeks to the mouth and jaw area, reducing the prominence of the perioral mounds.
While you're still young at 30, your unique facial anatomy and weight loss history make you a reasonable candidate for a strategically planned lower facelift—especially one tailored to restore natural contours without making you look overdone. If needed, subtle liposuction or conservative fat sculpting can be done in conjunction, but the lifting and tightening from a lower facelift will likely be the key component for long-term improvement.
Of course, to determine the exact approach, a physical examination is essential to assess skin elasticity, tissue tone, and the exact cause of the perioral volume. But based on your history and description, a lower facelift could be the most definitive and natural-looking solution.

With your face in repose, it is clear that the deep soft tissues of your midface have descended, replicating the aging process despite your years. Liposuction is a bad alternative to a proper rejuvenative surgery, and as I said, you don't have excess fatty deposits.