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

Aims and Background: To evaluate the effectiveness of a comprehensive surgical approach addressing perioral mounds— the "mouth pouch"—through modified buccal fat pad sculpting, targeted mucosal and muscle resection, and focal skin tightening for enhanced lower facial contouring. Historical Aspects: Conventional techniques often fall short in resolving contour irregularities in the perioral region due to intricate anatomy and high functional mobility. Anatomy: The perioral area includes a complex interplay of superficial and deep fat compartments, musculature, vasculature, and nerves. Aging-related atrophy of superficial fat and pseudoherniation of buccal fat contribute to soft tissue compartmentalization and visible mounding. Technology: Radiofrequency-assisted dermal tightening is combined with intraoral fat sculpting to promote further definition. Patient Selection: Ideal candidates have distinct perioral mounds, robust buccal fat pads, thickened oral mucosa, and visible lines of parakeratosis. Techniques: A seven-step intraoral technique under local anesthesia includes mucosal resection, buccinator stripping, buccal fat pad sculpting, and radiofrequency treatment. Postoperative Care: Dual compression with intraoral packing and external head wrap minimizes hematoma and infection risk. Current and Future Developments: Combining bony augmentation (e.g., chin implants) with soft tissue contouring yields comprehensive lower face rejuvenation. Conclusions and Clinical Relevance: This technique for treating perioral mounds, in carefully selected patients, provides a reproducible, safe method for lower facial contour enhancement.