Perioral mounds? Pocket on side of mouth (Photo)

Thank you for sharing your photos and history, this helps give more context. The “pockets” or perioral mounds you’re describing are fairly common and can be influenced by a few different factors:

Anatomy and facial volume shifts: As we age, natural fat pads in the face change and redistribute, which can create areas of hollowness or bulging around the mouth.

Filler history: Even when migration isn’t the main issue, fillers can sometimes highlight or exaggerate these small pockets, especially if there’s uneven tension in the surrounding tissue.

External factors: Sleeping on your face, as you mentioned, and prior trauma such as the dog bite can worsen asymmetry or make an area more noticeable.

Skin and tissue laxity: Collagen and elastin loss can make these folds more apparent over time.

Options to Improve Appearance:
Adjustment of filler placement: Carefully placed filler in supporting areas (like marionette lines or lateral cheeks) may help smooth the transition.

Collagen-stimulating treatments: RF microneedling, as you’ve tried, can be effective but usually requires a series and patience for results. Other options like biostimulatory injectables (e.g., Sculptra, Radiesse) may encourage collagen growth.

Laser or resurfacing treatments: Can help improve skin tightness and texture.

Lifestyle modifications: Minimizing pressure from face sleeping may help prevent further worsening.

These areas can be challenging since they’re influenced by both anatomy and prior interventions, but a combination approach often gives the best results.

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon