What are the pockets of fat at corners of mouth? Where did they come from? Do I need Perioral Mound Microliposuction? (Photo)

I make a living doing surgery and counselling patients on plastic surgery concerns.  Sometimes, however, the best thing I do for patients is tell them to do nothing.  You don't get rich that way but at the end of the day I am a doctor first and foremost and always put my patients' needs above my own.  In your case although you are not my patient, I would really suggest: do nothing!  You have a beautiful shape to your lips.  There is no one in their right mind that should be critical of how your lips or mouth look.  Give yourself a break and stop worrying about it.  Live life knowing that most women look at your lips with great envy.Dr Rodger ShorttOakville Plastic SurgeonDirector of Cosmetic Surgery Training Program &Assistant Clinical Professor,McMaster University

Don't be so hard on yourself! You have beautiful lips and your concerns are quite subtle. I am sure your friends have told you the same!The corner of the mouth, the nasolabial fold above, and marionette folds below constitute the most common and earliest signs of aging.  The musculo-ligamentous supporting structure of this area stays relatively stable while the surrounding tissues and skin stretch and become noticeable as aging.  You are in the very earliest stage of this inevitable process.i would treat you with non surgical measures including hyluronic acid fillers (Juvederm) to smooth the overall contour and Botox to relax the pulling down effect of the depressor oris muscle.  Later in life, surgical procedures such as face lift can be done.In my opinion, microliposulpture would not give you adequate results and may cause complications such is contour abnormalities. Liposuction works best in larger areas such as under the chin.All my best!  

That one can detect at the corners of the mouth is often the result of redundant skin that is just starting to sag as one enters the middle age. Sometimes, it can be present at a much younger age also. One should be wary of liposuction in this area as there tends not to be significant fat pockets here but muscles and nerves to the lip are present. An exam by your plastic surgeon and a good consultation will be necessary to determine the best course of action. Lifting is usually insufficient for this area but fillers can sometimes help.

Thank you for your question and photograph.  Though nothing replaces an in-person examination, it appears that the pockets of fat in your photograph are actually the result of the aging process and the animation of your face muscles, predominately those used when smiling.  I would not recommend liposuction in this area, but rather dermal fillers to help camouflage the developing lines.  See that attached link below for more information.

this is not fat pockets, this is a combination of natural aging making the muscles more apperant and fat atrophy (drooping).  I suggest fillers to this area to camoflage what is occuring around your mouth.  Liposuction to this area is a bad idea and often leaves people with nerve issues and irregularity.  I am constantly fixing this with fat transfer, bellafill, and sculptra.  Please see an expert for a full facial sculpting consultation.  Best, Dr. Emer.

Hello;The "peri oral bulges" that you are referring to are not fatty pockets such as the "buccal fat pad" or the "jowl fat pad" and therefore liposuctioning would be the wrong treatment.These bulges are actually the soft tissue/ ligamentous structure of your face that are showing early signs of aging through stretching and descent.The ideal treatment would be to tighten and lift these ligaments through a mini lift however if you are not mentally ready for this procedure then you can "blunt away" the prominence of these "bulges" by filling above and below the bulges either with synthetic fillers ( such as hyaluronic acids) or with fat grafting.  Adjunctive treatments such as Radiofrequency would have additive effects to this non surgical modality.I would be able to give you a more detailed treatment plan through a comprehensive clinical evaluation.Please feel free to view some sample photos below.Thank you

Thank you for this interesting question.  In the early days of liposuction, we plastic surgeons attempted to suction almost every part of the face and body.  Some areas, such as the abdomen, upper arms, etc., responded very well to liposuction and got thinner.  The perioral area responded in a very uneven fashion and led to lumpiness even when we used canulas as small as 2.8 and 1.5 mm in internal diameter.  Now it is possible that some unique technique may exist that I haven't heard about, but having done over 500 facelifts in my career and having looked at the corner of the mouth from the inside, I am not quite sure how liposuction can cure the perioral mounds you refer to in a symmetrical and aesthetic fashion.If I am reading your photograph correctly, the lumps you are referring to are the leading edge of your facial soft tissue as it descends during the natural aging process.  Your most prominent perioral mound is the upper edge of what is referred to as the marionette lines.  The reason for the increasing prominence of this lump is due to ligaments in this area stopping the descending soft tissue at this point, and as more and more tissue descends, the perioral lumps you refer to grow.   I would be cautious of  having liposuction of this area as it may lead to more difficulty in doing an aesthetically pleasing facelift in the future. 

It is hard to know from the outside whether these small perioral prominences are fat or not. But most likely fat is a part of them. Using small 1.5mm cannulas 1cc of fat removal can often flatten them out.

HiThanks for the question.  I think your lips look amazing and you shouldn't do anything to them.  I am not exactly sure what you are referring to in terms of the pockets of fat.  If its the buccal fat you are talking about, removal typically leads to a skeletonized look unless your pads are huge.  An in office exam would help to try and figure out what exactly is bothering you and how to fix it.  I would see a plastic surgeon in your area to address these concerns.  Good Luck

Dear frnkiero,

Thank you for your clinical post and
photograph. This is a common clinical
complaint of patients experiencing early facial aging. With the deflation, deterioration, descent,
mid face volume descends, ligamentous laxity allows the soft tissue fullness to
leave the youthful oval descent to the middle part of the face. This provides excess tissue descending
against the ligaments of support at the modiolus. The zygomaticus major and minor muscle then
risorius and the depressor angularis oris all insert in the commissure lateral
corner of the mouth. The soft tissue
overhang that you’re experiencing is normal facial aging. Micro liposuction in this area is, in my
opinion, not the right choice. Repositioning of the mid face through a mid face endoscopic lift or a
mini lift will likely provide repositioning of the soft tissue against the
ligamentous structures that support it.
However, your facial cutaneous envelope appears to be young and you may
not be ready for this type of procedure.
Tightening the skin envelope with radio frequency treatment such as the
Profound or the Forma or Venus Freeze facial applicator, even Althera focused
ultrasound may be helpful in tightening the soft tissue. The simplest solution at this point would be
to use simple sugar gels such as Hyaluronic acid fillers, Juvederm, Restylane,
Perlane or even Tiosol and camouflage above and below the commissure to provide
support. Fat grafting would also be a
more natural autogenous option.

Use of Botox in the depressor
angularis oris will help soften the tugging down effect at the corner of the
mouth and can be used in concert with soft tissue fillers.

As you can see for individuals in
their 30s and 40s non-surgical solutions such as Botox combined with soft
tissue fillers and a radio frequency tightening can correct this problem. As one ages, however, mini lifting and mid
face lifting, even suture suspension and thread lifting becomes the best
option.

I hope this information is of some
assistance and best of luck.

To find out more, please visit the
link below. Also visit the sections on Botox, thread lifting and mini lifting.

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto