How to Get Rid of Perioral Mounds?

Perioral mounds are pockets of fatty tissue flanking the corners of the mouth that grow more noticeable with age, and getting rid of them usually requires some form of professional treatment. Unlike many age-related facial concerns, these mounds sit in a zone that standard facelifts barely touch, which is why people who have had other work done often find them persistently annoying. The options range from targeted liposuction and intraoral surgery to energy-based devices like radiofrequency and ultrasound, each with its own tradeoffs in downtime, cost, and how dramatic the change will be.

Why Perioral Mounds Form and Why They Are Hard to Treat

The perioral mound sits in the lower face, roughly between the corner of your mouth and the jawline. Cadaver dissections have shown that this area contains a collection of fatty tissue in the hypodermis without well-defined ligament attachments or encapsulation. Instead of being anchored by tight ligaments like some other facial fat, the fat here is held in place by thin fibrous partitions acting as a loose scaffold. The result is a puffy, somewhat ptotic (drooping) pad that tends to bulge forward over time.

1PubMed. An anatomical evaluation and surgical approach to the perioral mound in facial rejuvenation

Aging accelerates the problem from multiple directions at once. The facial skeleton remodels, fat pads in some compartments atrophy while others shift or enlarge, muscle tone changes, and the skin itself thins as collagen production slows down and breakdown speeds up.

2PubMed Central. The Facial Aging Process From the “Inside Out”

In the perioral region specifically, superficial fat tends to reposition or even enlarge, while deeper fat may atrophy. The dermis loses collagen and elastin fibers, so the skin covering the area becomes less able to hold things in place.

3Aesthetic Surgery Journal. The Facial Aging Process From the “Inside Out”

A key reason standard facelifts do not fix perioral mounds is that the mound is essentially a fixed unit of the face. The upper lip and perioral area have an unusually thick dermis tightly tethered to underlying muscle through a dense network of fibrous connections. Pulling the skin laterally or upward during a facelift does not redistribute or remove the fatty tissue sitting in this zone.

4Aesthetic Surgery Journal. An Anatomical Approach to Radiofrequency-Assisted Facial Rejuvenation: Beyond the Treatment Gap

Targeted Liposuction of the Perioral Mound

The most direct approach to reducing a perioral mound is removing the fat that creates it. In a study of 37 patients (74 mound regions), targeted liposuction reduced subcutaneous fat thickness from a median of about 5 mm down to less than 1 mm per side, with a median of roughly 2 mL of fat removed from each mound. All patients in the study were satisfied with their results. Two patients developed mild skin darkening at the treatment site that resolved on its own within three months.

5PubMed. Efficacy and Safety of Perioral Mound Region Liposuction-A Novel Concept to Improve Perioral Mound Fullness

Those numbers deserve some perspective. Two milliliters is a small amount of fat, roughly half a teaspoon per side. But because the perioral mound sits right at the surface and occupies a compact area, even a modest volume reduction translates into a visible contour change. The liposuction is limited to the subcutaneous fat layer, meaning the cannula stays shallow. This is different from deep liposuction elsewhere on the body and demands precision, because there are important nerves running through the lower face that a careless approach could injure.

Comprehensive Intraoral Surgery

Some surgeons have developed more elaborate techniques that address the perioral mound from inside the mouth, avoiding visible external incisions. One approach involves a multi-step intraoral procedure that combines mucosal tissue removal, buccinator muscle stripping, sculpting of the buccal fat pad, and radiofrequency-assisted skin tightening. The rationale is that aging causes superficial fat to atrophy in some spots while the buccal fat pad herniates outward, creating visible compartmentalization and mounding. By sculpting the deeper fat pad and tightening the overlying tissue, the goal is to smooth the entire region rather than just debulking one layer.

6PubMed. Modified Buccal Fat Pad Reduction as a Component of Perioral Mound Rejuvenation “The Mouth Pouch”

This type of procedure is done under local anesthesia and is considerably more involved than simple liposuction. It appeals to patients who have fullness from both superficial fat and deeper buccal fat pseudoherniation, a combination that liposuction alone may not fully address. The added radiofrequency component helps tighten skin that might otherwise sag after the underlying volume is reduced. It is a newer concept, so long-term outcome data is still limited compared to conventional approaches.

Energy-Based Skin Tightening

Not everyone wants surgery, and not every perioral mound is severe enough to warrant it. Energy-based devices that tighten skin by heating deeper tissue layers have become popular alternatives, though their results tend to be subtler than surgical fat removal.

Ultrasound Devices

High-intensity focused ultrasound (HIFU) works by delivering focused energy to specific tissue depths, triggering a wound-healing response that gradually tightens skin. In a study evaluating HIFU across seven facial zones, the jawline, cheek, and perioral areas responded best, and patients reported the highest satisfaction scores for those regions at both three and six months after treatment.

7PubMed Central. High-Intensity Focused Ultrasound for the Treatment of Wrinkles and Skin Laxity in Seven Different Facial Areas

A randomized controlled trial of a newer microfocused ultrasound device found that about 70% of participants showed clinically meaningful facial tightening at three months. The treated side of the lower face lost a small amount of volume on average, while the untreated control side gained volume over the same period.

8PubMed Central. Evaluation of a Novel Microfocused Ultrasound with Three-Dimensional Digital Imaging for Facial Tightening: A Prospective, Randomized, Controlled Trial

The honest assessment of ultrasound devices for perioral mounds is that they can modestly tighten and improve the skin envelope, which may reduce the appearance of mild mounding. They are not going to eliminate a pronounced fatty mound the way liposuction does. They work best for patients whose concern is more about skin laxity than excess fat volume.

Radiofrequency Treatments

Radiofrequency (RF) devices heat tissue to stimulate collagen remodeling and skin contraction. Fractional bipolar RF has been described as a preferred treatment for the upper lip and perioral area in patients who want improvement without the prolonged healing time associated with lasers or dermabrasion.

4Aesthetic Surgery Journal. An Anatomical Approach to Radiofrequency-Assisted Facial Rejuvenation: Beyond the Treatment Gap

Minimally invasive RF devices like AccuTite use a tiny probe inserted under the skin through a needle-sized port. The probe heats the underside of the skin to cause controlled coagulation and tightening. Because the device is small enough to work through a 21-gauge needle port (roughly the size of a standard blood-draw needle), it can be used precisely in tight areas like the perioral zone without requiring sutures at the entry point.

9IntechOpen. BodyTite®: The Science and Art of Radiofrequency Assisted Lipocoagulation (RFAL) in Body Contouring Surgery

Some practitioners combine RF microneedling with biological treatments. One protocol uses low-energy Morpheus8 (a fractional RF microneedling device) followed by injection of nanofat, a processed form of your own fat tissue, into the perioral and other facial areas. The idea is that RF creates micro-injuries that improve collagen production while the nanofat provides stem cells and growth factors to further enhance skin quality.

10PubMed Central. Low-energy Morpheus8 and Nanofat Grafting for Compartment-specific Facial Rejuvenation: Selective Fat Remodeling and Skin Quality Enhancement

Botulinum Toxin for Downturned Mouth Corners

Perioral mounds and downturned mouth corners often show up together and make each other look worse. While botulinum toxin injections do not directly reduce the fatty mound, they can address a related contributor: the depressor anguli oris (DAO) muscle. This thin, fan-shaped muscle pulls the corner of the mouth downward. When it becomes overactive, it contributes to a perpetually tired or unhappy look and exaggerates the visual heaviness of the perioral region.

11PubMed Central. Novel anatomical proposal for botulinum neurotoxin injection targeting depressor anguli oris for treating drooping mouth corner

Injecting small amounts of botulinum toxin into the DAO weakens its downward pull, allowing the muscles that elevate the mouth corner to win the tug-of-war. The result is a subtle lift at the commissure that can visually soften the appearance of adjacent mounding. A three-point injection technique performed in the upper half of the DAO has been described as offering good results while avoiding spread of the toxin to neighboring muscles, which could cause unwanted side effects like asymmetric smiling or difficulty controlling the lower lip.

12PubMed. A Retrospective and Anatomical Study Describing the Injection of Botulinum Neurotoxins in the Depressor Anguli Oris

Getting the injection site right matters a lot. The safest and most effective target zone has been described as a fan-shaped area bounded by specific anatomical landmarks along the jaw.

13Plastic and Reconstructive Surgery. Anatomical Considerations Regarding the Location and Boundary of the Depressor Anguli Oris Muscle with Reference to Botulinum Toxin Injection

If injected too low or too far from the correct zone, the toxin can diffuse into the depressor labii inferioris (which controls the lower lip) and cause temporary difficulty with tasks like drinking from a cup or pronouncing certain sounds. These effects are not permanent, since botulinum toxin wears off in a few months, but they are annoying enough that precise placement matters.

Why Thread Lifts Tend to Disappoint in This Area

Thread lifts are sometimes marketed as a quick-fix alternative to surgery for lower face sagging, and patients occasionally ask whether they can address perioral mounds. The threads are placed in the superficial subcutaneous layer and physically pull tissue upward, creating an immediate lift. The problem is durability. Anatomical analysis of facial tissue planes explains why: threads placed in mobile tissue without releasing the deeper attachments create a tensioned state rather than true tissue redraping. The tissues are pulled upward rather than being freed and resettled into a new position. Experience and research on thread lifts have confirmed that these no-release techniques do not last as long as procedures that actually release and reposition deeper tissue layers.

14PubMed Central. Anatomy of the Facial Glideplanes, Deep Plane Spaces, and Ligaments: Implications for Surgical and Nonsurgical Lifting Procedures

For perioral mounds specifically, the issue is compounded by the fact that the mound’s fullness comes primarily from fat, not from sagging skin alone. Pulling the skin tighter over a fatty pad does not make the pad go away. At best, a thread lift might temporarily camouflage mild mounding by tensioning the overlying skin, but recurrence is the norm rather than the exception.

Safety Concerns in the Lower Face

Any procedure near the mouth and jaw demands awareness of the marginal mandibular branch of the facial nerve. This nerve controls the muscles of the lower lip, and damage to it can cause visible asymmetry when smiling or speaking. Cadaver studies have found that surgical work within about 2 cm of the lower border of the jaw carries a high probability of injuring this nerve branch.

15PubMed Central. Preserving the marginal mandibular branch of the facial nerve during submandibular region surgery: a cadaveric safety study

For perioral mound liposuction and intraoral procedures, the risk is managed by staying in the correct tissue plane and respecting the anatomy. Liposuction limited to the subcutaneous fat layer keeps the cannula well away from the nerve, which runs deeper. But practitioners who are not intimately familiar with the regional anatomy can get into trouble. This is one of the reasons why perioral mound treatment is best handled by surgeons or dermatologists who specialize in facial procedures rather than general cosmetic providers.

Other risks depend on the specific treatment. Liposuction can cause temporary swelling, bruising, and the mild hyperpigmentation noted in the study above. RF and ultrasound devices can cause burns if the operator does not monitor tissue temperature correctly, though modern devices have built-in temperature cutoffs to reduce this risk. Botulinum toxin injections to the DAO carry the specific risk of toxin spread to adjacent muscles, which is temporary but functionally disruptive.

What Skincare and Facial Exercises Can Realistically Do

If you search online for ways to address perioral mounds at home, you will find advice about facial exercises and topical products. There is no clinical evidence that facial exercises reduce the fatty component of a perioral mound. Exercising the muscles around the mouth may improve tone slightly, but muscle tone and subcutaneous fat volume are separate issues. You cannot exercise fat away from a specific spot on your face any more than you can do crunches to spot-reduce belly fat.

Topical skincare ingredients like retinol, peptides, and vitamin C can improve the quality of the skin covering the area. Retinol stimulates collagen production, and antioxidants like vitamin C help protect existing collagen from breakdown. Over months of consistent use, these can make the skin look firmer and healthier. But they cannot reduce the volume of fat beneath it, so their effect on the mound’s overall appearance is modest at best. Think of them as complementary maintenance, useful alongside professional treatment and helpful for slowing further deterioration, but not a standalone fix for an established mound.

Sun protection deserves a mention here too. Chronic UV exposure accelerates collagen and elastin degradation in the skin, and the perioral area is heavily exposed in most people. Consistent sunscreen use and UV avoidance will not reverse an existing mound, but they meaningfully slow the skin laxity component of the problem over time.

Choosing Between Treatments

The right approach depends on what is driving your particular mound. If the main issue is excess fat, liposuction or an intraoral surgical procedure addresses the root cause most directly. If the issue is more about skin laxity with only mild fullness, an energy-based device like HIFU or fractional RF might produce a satisfying result without surgery. Many practitioners combine treatments: liposuction or buccal fat sculpting to reduce volume, followed by RF to tighten the skin envelope, and botulinum toxin to the DAO if the mouth corners are dragging downward.

Age matters, but perhaps not the way you would expect. Younger patients with genetically full perioral regions may only need targeted liposuction and recover quickly because their skin has enough elasticity to retract on its own. Older patients whose skin has lost significant collagen often need a skin-tightening component on top of volume reduction to avoid ending up with loose, wrinkled skin where the fat used to be. A consultation with a qualified facial surgeon or dermatologist is where these decisions actually get made, because the interplay between fat volume, skin quality, muscle activity, and bone structure varies enormously from person to person.

Recovery timelines also vary. Botulinum toxin to the DAO involves essentially no downtime. HIFU and external RF treatments may cause redness and mild swelling for a day or two. Liposuction of the perioral mound typically involves a few days of swelling and bruising, with the final contour becoming apparent over several weeks. The more comprehensive intraoral procedures under local anesthesia have a somewhat longer recovery window due to intraoral healing, though external bruising and swelling are often less conspicuous than with external liposuction approaches.