Perioral fat makes my lips look even smaller. What are the least invasive options? (photo)

Question

27F - I’ve always had these ‘perioral mounds’ which make me really dislike my smile. I was thinking of getting hyaluronic acid lip filler but wonder what can be done to reduce the sag/marionette effect.

Anna Chacon, MD, FAAD · Answer

For addressing perioral fat and enhancing the appearance of your lips, there are several minimally invasive options you might consider. Here’s a brief overview:

Hyaluronic Acid Lip Fillers: These can add volume to the lips, potentially balancing the appearance of perioral mounds and enhancing your smile. They are a popular choice due to their natural look and reversibility.

Botulinum Toxin Injections: Small doses of botulinum toxin (such as Botox) can be used around the mouth area to relax muscles, which may help reduce the appearance of marionette lines and create a smoother contour.

Dermal Fillers for Perioral Area: In addition to lip fillers, dermal fillers can be strategically placed in the perioral region to smooth out marionette lines and reduce the prominence of perioral mounds.

Thread Lifting: This minimally invasive procedure uses temporary sutures to lift and tighten the skin, which can help in reducing sagging around the mouth.

Laser Treatments or Radiofrequency Therapy: These non-surgical options can help tighten the skin and improve collagen production, which may reduce sagging and improve overall skin texture.

Microneedling with PRP (Platelet-Rich Plasma): This treatment can stimulate collagen production and improve skin texture, potentially reducing the appearance of lines around the mouth.

It is essential to consult with a dermatologist or a cosmetic surgeon to discuss your concerns and evaluate which option would best suit your needs and aesthetic goals. They can provide a personalized treatment plan based on your specific anatomy and desired outcomes.

Jeffrey H. Spiegel, MD · Answer

Fad pads by the commissures ( corner of the mouth) start to appear when you've lost enough volume in the upper face like the temple or under-eye areas. It usually means it's time for tear trough or temple filler and/or botulinum to the DAO and perhaps filler to the marionette lines. After that it's all about skin tightening.

Nelson Lee Novick, MD · Answer

The problem seen in the photos is a very common one, treated practically daily in any active cosmetic dermatology practice. Quite simply, the choice of an appropriately robust HA Lifting filler properly injected in the space of under ten minutes can lift and straighten the down-turned angles at the corners of the mouth. The results are typically immediate and the treatment usually engenders little to no significant downtime.
You would be wise to make sure to consult with a board certified cosmetic dermatologist filler expert.
Hope this helps and best of luck.

Leonard Grossman, MD · Answer

You do not have any sagging in your face. This is a natural structure of the face which is genetically inherited. Your lips are on the other hand, quite thin, and considering a hyaluronic acid filler would be a great option for you. I hope this helps and good luck from Leonard Grossman MD

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