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.