Perioral Mound in Cincinnati, Ohio

Perioral Mounds: What are They and Why are They So Difficult to Treat?

Perioral rejuvenation – or plastic surgery of and around the mouth – is a popular topic in Cincinnati, Ohio. The perioral area includes not only the lips but also the skin and other soft tissue immediately surrounding the lips. The perioral mounds are a subunit of this anatomy that are relevant to facelift surgery. The characteristics and location of the perioral mounds make them very difficult to treat. It is recommended to seek a consultation with a fellowship-trained facial plastic surgeon if you have concerns about your face or neck.

Perioral Mounds are Adjacent to, but Distinct From, the Jowls

The perioral mounds (see image above) have been described as an area that sits between the lower edge of the cheek fat compartments and the fat compartments that form the jowls. The perioral mounds can become fuller and droopier with age (1, 2).

Perioral mounds are confused by many with the jowls, which themselves are confused with buccal fat. Jowls are the fat and other soft tissue of the superficial lower cheek that hangs over the bony jawline with aging. Stuzin et al describe jowl fat as “fluffy, thick fat” which is “situated between the masseter ligaments and the mandibular ligaments overlying the facial portion of the platysma” muscle (3). In contrast, the fat located in the perioral mound is very thin with poorly defined borders.

Perioral mounds are a distinct anatomic feature of the face. The fat in perioral mounds overlies soft tissue called the SMAS layer, which is superior to and continuous with the platysma muscle (1, 2). The SMAS and platysma muscle are treated during deep plane facelift surgery, which is why this approach to facelift surgery can be so effective in treating the jowls in a long-lasting and natural appearing way. However, facelift procedures of any kind do not effectively treat age-related changes at the perioral mounds (1, 2). This may be because multiple muscles that move the mouth meet at the perioral mounds. As a result, dissection does not proceed that close to the mouth. In addition, the area around the perioral mounds contracts actively with speech and emotive facial expressions, creating a crease that is often confused with the perioral rhytids/wrinkles that are typically best treated with a resurfacing procedure such as a laser, chemical peel, or dermabrasion. Such resurfacing procedures are also poorly effective at treating the skin at the perioral mounds.

There are Two Treatment Options That Have Been Discussed for Perioral Mounds

There is little research published on the treatment of the perioral mounds.

Two studies describe the use of a small cannula to perform a limited liposuction of the site manually (1, 2). The problem with this approach is the fact that the fat in this location is very thin and close to the surface of the skin. As a result, Gu et al report “overaggressive liposuction of the perioral mound region may result in skin hyperpigmentation, unnatural facial expressions, depression, and even skin necrosis” (2). Depression or unevenness of the area from liposuction is one of the most concerning and logical risks of this technique. Also, while liposuction can reduce fat, it does not improve loose or hanging soft tissue, including the SMAS layer, which may develop with age.

A second treatment described is the use of energy-based devices to melt fat and tighten skin at this site. The energy-based devices include, but are not limited to, devices that utilize radiofrequency energy to heat the tissue deep to the skin. A search of the medical literature found no article describing this technique and demonstrating its effectiveness.

One should be extremely cautious at this time when pursuing treatment of the perioral mounds due to the potential risks of liposuction and the lack of published effectiveness research for energy-based devices. More safe and effective treatment options may become available in the future, however, as newer techniques and technologies become available.

Trust Your Face to a Facial Plastic Surgeon

It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck.

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Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati, Ohio. Visit our clinic. You will learn more about Dr. Harmon’s credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching “plastic surgery near me.” Get in touch with us to learn more.

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This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.