Post-facelift cheek/buccal fullness/perioral mounds - would conservative buccal fat reduction likely help? (Photos)

Question

50-year-old female, 4.5 years post conservative SMAS facelift with a natural overall result. I continue to have persistent fullness/bulging beside the corners of my mouth that becomes much more noticeable with smiling or pursing. The fullness was starting before the facelift but seems more noticeable over time as my face has leaned out with age. One surgeon felt this may involve both anterior buccal fat prominence and perioral mound fullness rather than isolated buccal fat alone. Another suggested conservative partial buccal fat reduction, while a revision specialist felt more comprehensive correction would likely require layered revision contouring/repositioning. Based on these photos, does this look more like buccal fat prominence, perioral mound fullness, or a combination? In your experience, would conservative buccal fat reduction likely help this type of contour issue in a lean 50-year-old face, or could it potentially make the mouth-corner transition more noticeable? Thank you for your insight.

Carl Truesdale, MD · Answer

Persistent cheek and perioral fullness after a facelift is a common complaint and there are usually three separate things going on. The right intervention depends on which one (or combination) is driving the appearance.
First possibility: residual buccal fat that wasn't addressed at the original operation. If you can pinch a discrete fullness just inferior to the cheekbone and the perioral mound feels like a separate compartment, conservative buccal fat reduction is reasonable. The key word is conservative. Aggressive removal is one of the most common regrets in facial plastic surgery because the natural aging process will continue to thin this area, and what looks balanced now can look gaunt in your 50s and 60s.
Second possibility: lymphatic stasis or residual edema. Facelift swelling can persist quietly in the cheeks for 6 to 12 months. If you're under a year post-op, a course of lymphatic massage and time often resolves more than you'd expect.
Third possibility: the facelift vectors created a soft tissue redistribution that bunches at the cheek and perioral area. This is harder to fix because the tissue was repositioned during the original operation. Sometimes revision facelift with vector adjustment helps, sometimes targeted fillers or selective fat resorption is the more conservative approach.
What I'd do in your shoes: get a second opinion from a facelift surgeon (not necessarily the original) who specifically does revision work. A good consultation includes a video of you talking and smiling, not just stills. The mounds often only appear with animation, which guides the plan.
Don't rush into buccal fat reduction without ruling out the other two causes. It's an irreversible procedure and the natural fullness can be helpful as you age.

Post-facelift cheek/buccal fullness/perioral mounds - would conservative buccal fat reduction likely help? (Photos)

Answers (1)

More Buccal Fat Removal Questions

Would I benefit/be an appropriate candidate for buccal fat removal? (Photos)

21, facial asymmetry - Buccal fat removal or otherwise? (Photos)

20, female. What can I do to lift/reduce my lower face? (Photos)

Where is my buccal fat? Could I benefit from reduction? (Photos)

Consultation for lower facelift - do I need buccal fat removal? (Photos)

WE SEND PRETTY
EMAILS