An Anatomical Evaluation and Surgical Approach to the Perioral Mound in Facial Rejuvenation

Background: Premature aging of the perioral soft tissues of the face is a common complaint of patients seeking facial rejuvenation, although its cause is unclear. The subcutaneous fat compartments of the face may be differentially affected by facial aging. Despite efforts to study and rejuvenate the aging periorbit, midface, and jowls, the effects of aging on the perioral mound have been less studied. Methods: To better understand the cause of age-associated changes in the perioral area, a cadaver dissection study was performed. Eight fresh and fixed cadavers with evidence of perioral fullness were used in anatomical dissection. Anatomical observations and histologic examination were used to describe the age-related changes in this area. After describing the defect, the authors present a surgical approach to rejuvenation of this region, tailored to the findings in this anatomical study. Results: Histologic sections demonstrated a lipomatous area without defined ligamentous attachments or encapsulations. Chambers of adipocytes in the hypodermis were separated by thin fibroseptations: a scaffold in the structural support of this region. Superficial lipodystrophy defines thisfacial region in the cadaver specimens. The end result is a fatty, ptotic perioral mound of tissue that is not well addressed by conventional rhytidectomy. Conclusions: The area of the perioral mound may represent a small, independent fat compartment or a differentially affected extension of the nasolabial compartment described by Pessa. This cadaver study has increased the authors' understanding of the perioral region and allowed them to improve results in its rejuvenation. The senior author's preferred approach is liposculpture with fine-cannula liposuction.