After mouth corner surgery left you with "Joker lips"… consider "outer philtrum reduction"
A growing number of people complain that, after undergoing mouth corner (corner lip) surgery, their mouth instead looks horizontally torn — the so-called "Joker lips." Many had wanted a natural smile line but, finding the result different from what they hoped for, consider revision surgery; not a few others worry, ahead of their own mouth corner surgery, that they too might end up with Joker lips.
Experts say the cause of this problem should be sought not in the mouth corners themselves but in the "outer philtrum." The outer philtrum is the area of tissue running from outside the philtral columns (the two ridges raised at the center of the philtrum) to the corners of the mouth. When this area has excess tissue or is long, the outer part of the upper lip cannot spread out and instead becomes curled inward.
When only the mouth corners are lifted while the upper lip is curled inward like this, a steep slope forms between the curled upper lip and the raised corners. Like a ski jump, the line bends abruptly and looks unnatural — like Joker lips. Put simply, the long, sagging skin of the outer philtrum presses down on the lip from above; if you then try to forcibly lift only the corners at its end, the shape inevitably becomes distorted. Outer philtrum reduction is the work of drawing this sagging skin taut and lifting it away, and when performed together with mouth corner surgery it can complete a natural line.
Dr. Seungwan Tak, Director of Dr.Tak Plastic Surgery Clinic, explained, "In most patients who come to us troubled by 'Joker lips' after mouth corner surgery, the problem arose because the outer philtrum was not corrected at the same time," adding, "When planning mouth corner surgery, if the outer part of the upper lip has a structure that curls inward, outer philtrum reduction should be considered together in order to achieve a natural result."
He continued, "Even when 'Joker lips' have already developed after mouth corner surgery, improvement is possible with outer philtrum reduction," adding, "However, because this is revision surgery, it is important to carefully assess the state of the tissue deformed by the previous operation and to plan the surgery accordingly."
That said, not everyone needs to undergo both surgeries at once. If the outer philtrum is not long and has good elasticity, mouth corner surgery alone can deliver a sufficient effect. If you are about to undergo mouth corner surgery, or the result afterward looks unnatural, it is worth reviewing the structural causes — including the outer philtrum — together with a board-certified plastic surgeon.