How to Correct Drooping Corners of the Mouth: Corner Lift and Bullhorn

Childlike “upturned” lips are associated with innocence, while drooping corners of the mouth give their owner a grumpy, capricious appearance, creating a sad, dissatisfied expression and visually adding years to the face. However, corners of the mouth may droop not only due to age-related changes. In some cases, even young women seek help with this problem, which has persisted since childhood.

This is related to the individual structure of the face, and the situation can only be corrected with surgical intervention on the corners of the mouth.

Surgical Correction Methods

When cosmetic procedures prove ineffective, yet you still want attractive lips, surgical correction methods come to the rescue. The goal is to create lips that look natural and harmonious. This means results should match the patient’s overall facial features and individual characteristics.

Surgical correction of the corners of the mouth is divided into indirect methods, where improvement occurs without direct manipulation of the lips, and direct ones, which target the lips themselves. The first group includes endoscopic midface lifting and resection of the depressor anguli oris muscle (m. DAO).

During endoscopic midface lifting, surgeons primarily work on the tissues of the cheekbone area, and by elevating them, the corners of the mouth are lifted as a result.

Another indirect method to elevate the corners of the mouth is resection of the depressor anguli oris muscle (m. DAO).

When this muscle contracts, the mouth corners are pulled downward. Over time, the muscle becomes rigid and tense, ceasing to relax. The face takes on a sad expression, regardless of actual mood.

In patients over 40–45 years old, botulinum toxin is usually ineffective on this muscle, so resection is performed instead.

This procedure was first described in 2006 by French plastic surgeon Claude LeLouarn. The incision is made on the inside, through the mucosa.

Corner Lift

The operation that directly affects the corners of the mouth is called a corner lift — a type of lip surgery used to elevate mouth corners, correct asymmetry, or restore deficient lateral parts of the upper lip.

A corner lift is the aesthetic correction that can rejuvenate the face, emphasize the lips, make them more expressive, and, most importantly — lift them upwards.

This procedure is often the only way to restore youthful attractiveness to the face for a long period. It can positively influence first impressions, self-esteem, and overall quality of life.

It is important to understand that a corner lift is rarely performed in isolation. It is usually combined with other procedures such as VY plasty, bullhorn lip lift, endoscopic midface lift, or SMAS-lift of the lower third of the face and neck. Performing it alone in the presence of age-related changes may worsen marionette lines or highlight other signs of tissue ptosis.

Indications for Corner Lift:

• Drooping corners of the mouth
• Asymmetry of the corners of the mouth
• Deficiency of the lateral parts of the upper lip

Contraindications:

• Tendency to hypertrophic or keloid scarring
• Frequent herpes outbreaks
• Pronounced marionette folds

Corner Lift Techniques

Diamond-shaped incision

Used in cases of severe drooping, when elevation of more than 7–8 mm is required. The excised skin area is diamond-shaped, with markings made along the contour of the upper lip, extending to the corner of the mouth and then upward.

Triangular incision

Applied in cases of moderate drooping and/or asymmetry. A triangular marking is made partially above the corners of the lips and slightly beyond them. After suturing, part of the scar runs along the vermilion border of the upper lip, while another part extends 4–5 mm onto the skin. After healing, the scar is nearly invisible. This requires precise surgical technique and extensive experience.

Combined technique

Used when it is necessary not only to lift the corners of the mouth but also to slightly widen the oral commissure and minimize visible scarring. The incision marking is triangular above the mouth corner and additionally follows the contour of the lower lip angle. As a result, the scar extends onto the skin by only 1–3 mm.

Postoperative Period

As with any other facial plastic surgery, the scar matures over several months, gradually becoming less visible and blending with surrounding tissue. During the first weeks, the scar lightens and fades. It is important to follow all postoperative care instructions provided by the surgeon to speed up healing and minimize scarring.