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.