The removal of fat from the face by liposuction is historically seen as very limited in what it can accomplish. The large buccal fat pads can be removed by open excision but the remainder of facial fat is largely subcutaneous in location and small in volume over a large surface area. Liposuction of submental and neck fat is commonly done and very effective. Its ease of removal is largely because it is a relatively broad surface and an area that can collect substantial fat in some people. There is also little risk to any facial nerves as long as one stays below the jawline.
But above the jawline, subcutaneous fat removal by liposuction is not as generous. Fat pockets are small and often intertwined with more fibrous tissue. In addition the ability to hide small access incisions for cannula entrance is more limited. But these restrictions aside, there are facial areas where small amounts of fat can be removed. A few ccs of fat removed may not be seem significant but on your face in the right location, its effect can be meaningful to create facial contouring/thinning effects.
One such facial area that can have effective liposuction is the perioral region, specifically the perioral mounds. These small collections of fat beside the mouth and below the buccal pad fats create a puffiness or fullness. They are actually above the jowls although they can merge into them as well. By accessing this facial area through a small incision inside the mouth, the mound fat can be reduced and an outer convexity turned into a concavity if desired. It is important to stay in the subcutaneous space above the buccinator muscle to get the fat reduction effect.
Because this is a small area, it is necessary to use very small cannulas for perioral mound liposuction. Some may call these microcannulas or even nanocannulas depending upon what type of traditional liposuction cannula to which it is being compared. When the cannulas are this small, they will be only one hole located at the tip on one side. Multiple hole cannulas at this small size are difficult to manufacture and are prone to fracture. The area is thus treated by a double pass method, first down on the muscle and then secondly turned over and worked off the underside of the skin. (which is usually the most productive pass) A productive perioral mound liposuction may only pull out 1 to 1.5 ccs of fat at most.
Dr. Barry Eppley