Korean smile lift for corners that turn down at rest: when the cause sits lower in the face

I'm Im Young Min, chief director of VG Plastic Surgery in Gangnam and a board-certified plastic surgeon. A dedicated corner-of-mouth lift isn't on our published procedure list. The facelift (Crystal, SMAS and mini) and fat grafting are, and our facelift planning starts by checking which layer of the face has actually descended before choosing the direction of the pull.

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Im Young Min

Chief Director · Board-certified in Plastic Surgery

• — Ph.D. in Medicine
• — Internship and residency, Seoul St. Mary's Hospital
• — Board-certified plastic surgeon, Seoul St. Mary's Hospital

Search the phrase while planning a trip to Korea and several unrelated procedures come up. This is what each term means:

If you can't tell which row you belong in, that's normal, because the mirror rarely shows it. Send two photos on WhatsApp: your face relaxed from the front, and the same at a 45-degree angle, mouth closed and still.

Why does a mouth turn down at rest?

Three things usually pull the corners down, often at the same time. A small muscle under each corner, the depressor anguli oris, drags the corner downward, and in some faces it's active even at rest. The cheek fat and skin above the jawline slide down over the years and form jowls, which deepens the crease running from the corner toward the chin, the marionette line. And some people simply have corners set low from their twenties, with no sagging at all.

Which one dominates decides what can help. A corner excision deals with the third and partly with the first. It does nothing for the second, and a corner pointed upward above a heavy jowl tends to look out of place.

You can do a rough check at home. Face a mirror with your face relaxed, then use your fingertips to gently push the skin in front of your ears upward and back. If the corners rise and the line toward the chin softens, part of the downturn comes from lower-face descent. If the corners don't move, the corner itself or the muscle beneath it is the bigger factor.

A surgeon asks the same question by hand during an exam, with more precision, before deciding whether a korean smile lift makes any sense.

What can go wrong with a corner-of-mouth lift, and what scar does it leave?

A corner-of-mouth lift can change your resting expression. It also always leaves a scar at the corner of the mouth, a spot that moves every time you talk or eat and that other people look at constantly.

The broadest look at the evidence so far is a 2022 systematic review in Aesthetic Surgery Journal by van der Sluis and colleagues. It pooled 11 studies with 962 patients and found that surgical techniques seem to lift the corners more than non-surgical ones, while noting that the objective evidence is weak. On the downside they were blunt: a scar is inevitable.

No severe adverse events were reported for either approach.

Two caveats sit inside those figures. Most of the studies were uncontrolled, and how long the lift lasts is poorly documented, so nobody can tell you with confidence how the corners will look in ten years. A scar that a study counts as acceptable can still bother you every time you look closely in a mirror.

Scar tendency matters for East Asian skin in particular. A 2020 report in Archives of Plastic Surgery by Min and colleagues described a modified technique used in 312 patients and designed for people prone to scarring, naming young Asian women as susceptible to hypertrophic (thick, raised) scars. The authors also noted that many people hesitate to have the operation because of scarring. That paper didn't grade scars formally, so it tells you more about the technique than about how often scars thicken.

What can go wrong with the operation usually meant by a korean smile lift:

• A visible line at each corner, which can stay red, thicken or widen over the first months.
• The two corners healing at slightly different heights, since they rarely start level.
• An expression that feels set when you talk or laugh, if the corner is placed too high for your lip shape.
• Skin that has been cut out can't be put back. A revision can move or refine the scar, but it can't remove it.

When I would not plan a korean smile lift

There are four situations where I'd advise against a corner lift, or at least put it after something else.

The jowls are doing the pulling. If the hand test above lifts your corners, the descent is lower in the face. Treating the corner first leaves the main cause in place.

You form thick or raised scars. Earlier surgical scars, ear piercings that healed lumpy, acne marks that stayed raised: tell the surgeon about all of them. The corner of the mouth stretches with every word and meal, which is hard on a healing scar.

You want to look like you're smiling at rest. A sensible aim is a neutral or slightly lifted corner. A corner set to look smiling when your face is still can look odd as soon as you speak.

The trip is too short. In the Min series, stitches came out on day 5. The scar keeps changing for months after that, and most of those months happen after you're home.

Is a lower facelift the better fit when jowls drag the corners?

When the downturn comes from the jowls and the marionette area, a lower facelift treats the cause. It repositions the tissue that has slid instead of trimming skin at the mouth. The trade-off is scale: incisions around the ear, anesthesia, more swelling and a longer stay in Seoul.

We list three facelift types: Crystal, SMAS and mini. Our Korean facelift guide explains how they differ. If the jowl change is small, the mini facelift page covers who it suits and where the incision goes. If you've been reading about deep-plane techniques, this piece on comparing facelift layers explains why the layer being moved matters.

A facelift has risks of its own, and they're bigger than a corner excision's. The American Society of Plastic Surgeons lists bleeding under the skin (hematoma), infection, poor wound healing, facial nerve injury, hair loss near the incisions, prolonged swelling and unfavorable scarring among them. Our clinic has eight full-time specialists across plastic surgery, ENT and anesthesiology, and the anesthesiologist on staff doesn't operate, so the person watching your breathing and blood pressure isn't also holding the instruments.

A facelift won't reshape a lip corner that sits low purely because of its shape. That's where a corner procedure still has a role, and it's why the cause has to be identified before anyone picks a method.

Fat grafting for the hollow beside the mouth

Fat grafting can soften the hollow along the marionette line by moving your own fat there. It adds volume and doesn't lift, and some of the transferred fat doesn't survive.

Our fat grafting page sums up the point: what counts is how much of the fat stayed. Part of the grafted fat is reabsorbed during the first months, which is why the amount placed and the final result differ, and why a second session sometimes comes up. Lumps, uneven absorption and soreness where the fat was taken from are the usual trade-offs. Fat grafting can be considered alongside a lower facelift when a face has both sagged and hollowed.

On its own it won't turn a corner upward, and a korean smile lift won't fill a hollow.

How many days in Seoul, and who checks the scar at home?

For the stitches alone, the corner-lift series described above removed them on day 5. The harder part is the months afterwards, when the scar and swelling keep changing while you're back home.

The U.S. CDC's guidance on medical tourism suggests three things: get copies of your medical records before you leave, arrange follow-up care at home in advance, and remember that flying soon after surgery raises the risk of blood clots. For surgery around the mouth, that means:

• Find your local doctor before you fly out. Choose a dermatologist or plastic surgeon at home who agrees to look at the scar a few weeks after you return. That's often when a scar that's going to thicken starts to.
• Take your own scar photos. Use the same light and angle every week. These help the doctor in Seoul and the doctor at home talk about the same thing.
• Carry the paperwork. Bring the operation name, the stitch material if you're told it, and your medication list.
• Plan around video calls. A corner scar is usually pink for a while and shows on camera at close range.

The clinic is at 635 Nonhyeon-ro, Gangnam-gu, so book accommodation close enough that a follow-up visit doesn't take half a day.

If your dates are already fixed, send them on WhatsApp along with the two resting-face photos.

What should you send so the doctor can weigh the risks before you book?

Send a front photo and a 45-degree photo with your face relaxed, plus one line on what bothers you: the corners, the line toward the chin, or heaviness along the jaw. If you've had surgery or injections around the mouth before, say what and roughly when. Send these on WhatsApp.

Related pages:

• Facelift surgery at VG Plastic Surgery