Facial Plastic Surgery & Aesthetic Medicine
Volume X, Number X, 2020
ª American Academy of Facial Plastic and Reconstructive Surgery, Inc.
DOI: 10.1089/fpsam.2020.0072
The Corner of Lip Lift Technique
Ross A. Clevens, MD, FACS,* Renata Khelemsky, MD, and Navdeep R. Sayal, DO
Introduction
The perioral region, specifically the corner of the lip,
attracts a great deal of attention to patients with a
‘‘sad mouth’’ or ‘‘frowned’’ appearance. Unless directly
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addressed, other facial rejuvenating surgeries, such as a
facelift, have a modest effect on this region. Patients de-
sire full lips that are natural, balanced with the rest of
the face, and lack a downturned corner. Nonsurgical ap-
proaches to treating descended mouth corners often com-
bine the use of botulinum toxin for weakening of the
platysma and depressor anguli oris muscles, as well as
placement of soft tissue fillers for camouflage of deep
marionette folds.1,2
Given the complex muscular attachments of the labial
commissure, surgical approaches aimed at direct manip-
ulation of the levator and depressor anguli muscles have
been proposed.3,4 More common methods for treating
depressed oral commissures are various cutaneous exci-
sional techniques designed along the lateral vermilion–
cutaneous border.5,6 Corner of lip lift (CLL) is a procedure
that corrects the ‘‘sad mouth’’ appearance, creating a
more refreshing look (Fig. 1). In patients with elongated
upper lips and insufficient upper incisal show, CLL may
be combined with subnasal lifting or extended medially
into a direct lip lift for the restoration of a more youthful
upper lip and mouth corners.6 This is often the case in the
advanced aging population of patients in our practice,
who seek complementary procedures to address key as-
pects of perioral aging in conjunction with the traditional
face and neck lift.
Surgical Technique
Preoperative markings for a planned CLL require a fine
tip marking pen and surgical calipers. The vermilion–
cutaneous border including the corner of the mouth is
marked before the administration of local anesthesia
(Supplementary Video S1). The nasolabial folds are pre-
cisely marked. A tangential line is then drawn from the
oral commissure to the ipsilateral superior helix using a
straight ruler. With the aid of preoperative photographs
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
1
in the upright position, any patient-specific factors are
considered during the marking. The desired horizontal
length of cutaneous–vermilion border to be incorporated
is also marked and corresponds to the first limb of the tri-
angle (usually 15–20 mm). The desired amount of verti-
cal elevation of the oral commissure is measured with
calipers and marked along the tangent line on both
sides (usually two-thirds of the distance from the oral
commissure to the nasolabial fold). This is the second
limb of the triangle. The third limb of the triangle is
then completed on each side with a gentle curving arch
between the two previously marked lines.
Local anesthetic solution containing a vasoconstrictor
is infiltrated. The authors additionally prefer to use tra-
nexamic acid 100 mg/mL in a 1:10 volumetric dilution
for added hemostasis. After sterile preparation of the pa-
tient, a no. 15 scalpel blade is used to incise along the
markings while maintaining sharp perpendicular contact
of the blade to the skin surface. The intervening triangu-
lar skin is removed sharply in the subcutaneous tissue
plane. Hemostasis is achieved using a monopolar or bipo-
lar fine tip cautery. A conservative amount of skin under-
mining is completed superiorly to allow for adequate
eversion upon placement of deep suture. No undermining
is performed along the submucosal plane of the upper lip.
The deep layer closure is performed with resorbable
monofilament suture of 5-0 PDS, using the halving prin-
ciple of wound closure to prevent formation of standing
cutaneous deformities. A meticulous closure is then per-
formed along the vermilion–cutaneous border using 6-0
absorbable or nonabsorbable monofilament suture in an
everting manner.
Discussion
Despite the recent shift towards minimally invasive pro-
cedures, nonsurgical measures using neurotoxin and fill-
ers to correct downturned corners of the lips prove to be
temporary and insufficient for more severe cases of oral
commissure ptosis. Our experience indicates that the
CLL surgery effectively elevates downturned or
 2 CLEVENS ET AL.
Fig. 1. Preoperative and
postoperative images of
patients who underwent the
corner of lip lift technique.
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descending corners of the mouth. The CLL may be cus-
tomized to produce variable degrees of vertical lifting
to the right and left oral commissures. Similarly, the hor-
izontal length of eversion of the upper lateral vermilion
border can be precisely adjusted and varied to meet the
desired outcome. Careful preoperative assessment for an-
atomic factors relevant to the baseline appearance will
guide the need for asymmetry correction.
Although several configurations of skin excision have
been suggested to decrease scarring lateral to the mouth
corner, such as a limited elliptical excision,6 we have
not encountered the lateral limb of our incision design
to serve as a negative trade off for the predictable lifting
of the corner. The CLL does not address the central third
of the upper lip and as such may be combined with sub-
nasal lip lifting.
Conclusions
The CLL technique achieves a permanent reversal of
clinically downturned corners of the mouth. This has
proven to be an excellent stand-alone or adjunctive pro-
cedure for perioral rejuvenation, allowing for precise
control over position of the mouth corner. Meticulous
double-layered closure is essential to successful healing,
without concern for the short scar lateral to the oral
commissure.
Acknowledgment
We thank the patients for granting permission to publish
this information.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.
Supplementary Material
Supplementary Video S1
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