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The Corner of Lip Lift Technique: Ross A. Clevens, MD, FACS, Renata Khelemsky, MD, and Navdeep R. Sayal, DO
The Corner of Lip Lift Technique: Ross A. Clevens, MD, FACS, Renata Khelemsky, MD, and Navdeep R. Sayal, DO
addressed, other facial rejuvenating surgeries, such as a angle (usually 15–20 mm). The desired amount of verti-
facelift, have a modest effect on this region. Patients de- cal elevation of the oral commissure is measured with
sire full lips that are natural, balanced with the rest of calipers and marked along the tangent line on both
the face, and lack a downturned corner. Nonsurgical ap- sides (usually two-thirds of the distance from the oral
proaches to treating descended mouth corners often com- commissure to the nasolabial fold). This is the second
bine the use of botulinum toxin for weakening of the limb of the triangle. The third limb of the triangle is
platysma and depressor anguli oris muscles, as well as then completed on each side with a gentle curving arch
placement of soft tissue fillers for camouflage of deep between the two previously marked lines.
marionette folds.1,2 Local anesthetic solution containing a vasoconstrictor
Given the complex muscular attachments of the labial is infiltrated. The authors additionally prefer to use tra-
commissure, surgical approaches aimed at direct manip- nexamic acid 100 mg/mL in a 1:10 volumetric dilution
ulation of the levator and depressor anguli muscles have for added hemostasis. After sterile preparation of the pa-
been proposed.3,4 More common methods for treating tient, a no. 15 scalpel blade is used to incise along the
depressed oral commissures are various cutaneous exci- markings while maintaining sharp perpendicular contact
sional techniques designed along the lateral vermilion– of the blade to the skin surface. The intervening triangu-
cutaneous border.5,6 Corner of lip lift (CLL) is a procedure lar skin is removed sharply in the subcutaneous tissue
that corrects the ‘‘sad mouth’’ appearance, creating a plane. Hemostasis is achieved using a monopolar or bipo-
more refreshing look (Fig. 1). In patients with elongated lar fine tip cautery. A conservative amount of skin under-
upper lips and insufficient upper incisal show, CLL may mining is completed superiorly to allow for adequate
be combined with subnasal lifting or extended medially eversion upon placement of deep suture. No undermining
into a direct lip lift for the restoration of a more youthful is performed along the submucosal plane of the upper lip.
upper lip and mouth corners.6 This is often the case in the The deep layer closure is performed with resorbable
advanced aging population of patients in our practice, monofilament suture of 5-0 PDS, using the halving prin-
who seek complementary procedures to address key as- ciple of wound closure to prevent formation of standing
pects of perioral aging in conjunction with the traditional cutaneous deformities. A meticulous closure is then per-
face and neck lift. formed along the vermilion–cutaneous border using 6-0
absorbable or nonabsorbable monofilament suture in an
Surgical Technique everting manner.
Preoperative markings for a planned CLL require a fine
tip marking pen and surgical calipers. The vermilion– Discussion
cutaneous border including the corner of the mouth is Despite the recent shift towards minimally invasive pro-
marked before the administration of local anesthesia cedures, nonsurgical measures using neurotoxin and fill-
(Supplementary Video S1). The nasolabial folds are pre- ers to correct downturned corners of the lips prove to be
cisely marked. A tangential line is then drawn from the temporary and insufficient for more severe cases of oral
oral commissure to the ipsilateral superior helix using a commissure ptosis. Our experience indicates that the
straight ruler. With the aid of preoperative photographs CLL surgery effectively elevates downturned or
Facial Plastic and Reconstructive Surgery, Clevens Face and Body Specialists, Melbourne, Florida.
*Address correspondence to: Ross A. Clevens, MD, FACS, Facial Plastic and Reconstructive Surgery, Clevens Face and Body Specialists, 707 West Eau Gallie Boulevard, Melbourne,
FL 32935, E-mail: drclevens@drclevens.com
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2 CLEVENS ET AL.