Corner lip lift

What it is

• Downturned mouth corners come with aging or are present from birth (PMID 35373812). With the marionette lines and a longer, flatter upper lip, they are among the main signs of an aging mouth (PMID 33845492).
• The corner is pulled down by the depressor muscle of the mouth corner, the platysma and the cheek muscle, acting on the skin through a network of collagen, elastic fibers and muscle that deepens the fold with age (PMID 39806136).
• A downturned corner is often the one sign of aging left after an otherwise successful facelift, and the area patients say they wished the facelift had corrected (PMID 18005887).
• The operation removes a crescent or triangle of skin just above the corner along the edge of the red lip, so the corner sits higher (PMID 20124851, PMID 33238352).

Where it came from

• In 1992 Austin described the face as rings: facelift, eyelid and brow surgery treat the outer ring, and lip lifts and corner lifts the middle ring around the mouth (PMID 1576793).
• Weston and colleagues have removed skin directly around the lips since 1980, with a lip lift for the center of the upper lip and a corner lift for its outer part. They describe the scar as barely visible from inches away, and few needed revision (PMID 19371836).
• In 1994 a single strip of skin was removed from one mouth corner to the other along the base of the nose (PMID 8124567).
• In 2010 the "frowning mouth" was divided into two types: corners alone, and corners with marionette folds, which need a longer excision (PMID 20124851).
• Recent designs release or suspend the muscles at the corner, adjust the cut for scar-prone skin, and map the incision to the skin's natural lines (PMID 32595087, PMID 33238352, PMID 40541231).

Who it suits

• Mouth corners that turn down at rest, with or without marionette folds (PMID 20124851).
• People who accept a small scar at the corner in exchange for more lift than injections give (PMID 35373812).
• People having a lip lift under the nose: most corner lifts are done together with other lip surgery (PMID 32309096), and a design guide helps decide when to add one (PMID 35583637).
• Scar-prone skin, including many East Asian patients, with a modified triangular design and muscle release to lower tension (PMID 33238352).
• Younger patients who want to avoid surgery may choose injections, with a shorter effect (PMID 32097307, PMID 41644821).

How it is done

• The surgeon marks a small crescent or triangle of skin above each corner and removes it; for marionette folds the excision is extended down into the fold (PMID 20124851).
• Some surgeons also free and suspend the corner muscles or weaken the muscle that pulls the corner down (PMID 32595087, PMID 23107845).
• The operation takes about an hour (PMID 32595087).
• Corner lift types are chosen by the shape of the lip and done alone or with a lip lift under the nose (PMID 40541231).

Results and how long they last

• The corner angle changed from turned down to turned up in a series followed for about two years (PMID 34318343).
• Most patients were satisfied: in one large series the result was clearly effective in about 4 in 5 and ineffective in under 1 in 10 (PMID 32595087). Scar and undercorrection were the main reasons for revision in another (PMID 32309096).
• A systematic review found that surgery lifted the corners more than injections, with weak objective evidence and no severe complications (PMID 35373812).
• Injections wear off: muscle-relaxing toxin improved the corners at four weeks and was back to baseline by 12 weeks, and the most severe droop responded poorly (PMID 41644821). After filler, fewer than half still saw improvement at six months (PMID 15841626).

Risks and how surgeons lower them

• A scar is certain (PMID 35373812). Visible scarring, uneven corners and undercorrection each affected a few patients in a series followed two years (PMID 34318343).
• Early redness and thickening of the scar affected about 1 in 5 patients after excision into the marionette fold, and all scars improved with time (PMID 20124851).
• Thick scars, uneven corners, lasting swelling and undercorrection were the reasons for revision in a large series (PMID 32309096).
• Surgeons lower scar risk by placing the cut along the edge of the red lip and the skin's natural lines and by releasing the muscle to reduce tension (PMID 33238352, PMID 40541231).
• With toxin, the corner muscle overlaps the lower lip muscle and sits beside the smile muscles (PMID 25347627), so a misplaced injection can make the smile uneven (PMID 36808109). In about 1 in 3 people the muscle is absent from the upper part of the fold (PMID 38377399).

Recovery

• Swelling and bruising settle within one to two weeks (PMID 32309096); in one series swelling took about nine days, natural expression returned in about eight weeks, and scar redness faded in about four months (PMID 32595087).
• One protocol removes stitches on days 3 and 5 and treats the scars with a gentle CO2 laser at 6 and 12 weeks (PMID 40541231).

With a facelift

• The corner lift changed the corner angle by the same amount with or without a facelift at the same operation (PMID 34318343).
• A lift of the midface under the bone lining, with release of the muscles that pull the corner down, raised the corner more than a standard facelift (PMID 10654759).
• In a randomized trial, an extended deep-plane facelift improved marionette lines more than a standard deep-plane facelift (PMID 41348089).
• The "joker line" running from the mouth corner toward the ear after some facelifts is usually present in some form before surgery and is treated with volume (PMID 18971739).

Questions to ask a surgeon

• Where will the scar sit, and how visible will it be? (PMID 35373812)
• Should a lip lift be done at the same time? (PMID 35583637)
• Will you release or suspend the corner muscles? (PMID 32595087)
• Would injections give me enough lift, and for how long? (PMID 41644821)
• How often do your patients need a revision? (PMID 32309096)

Open questions

• Evidence quality: the objective data are weak (PMID 35373812); O'Daniel published a commentary on that review (PMID 35532374).
• Surgery or toxin and filler in young patients (PMID 32097307, PMID 33238352).
• Toxin site and dose (PMID 42554701, PMID 41644821).
• New anatomy of the corner: a ligament of the modiolus and the fold network (PMID 39900721, PMID 39806136).
• How much a deeper facelift corrects the lower mouth area (PMID 41348089).
• Selection systems for corner lift types and mouth corner shapes (PMID 40541231, PMID 32309070).

Terms

• Oral commissure / cheilion: the corner point of the mouth (PMID 32595087).
• Commissure angle: the tilt of the mouth corner; negative values mean a downturn (PMID 34318343).
• Modiolus: the point beside the mouth corner where several facial muscles meet (PMID 25347627).
• Depressor anguli oris (DAO): the muscle that pulls the mouth corner down (PMID 38377399).
• Labiomandibular fold / marionette line: the fold running down from the mouth corner (PMID 39806136).
• Frowning mouth deformity: sagging corners with or without marionette folds (PMID 20124851).
• Vermilion flap: a flap of red lip moved to reshape the corner (PMID 33238352).
• Joker line: a cross-cheek depression from the mouth corner seen after some facelifts (PMID 18971739).

Papers