Objective. To determine the indications for combination of cheiloplasty techniques in various clinical conditions for harmonious aesthetic results; to develop an algorithm for cheiloplasty according to clinical conditions; to assess proportions of the lower third of the face after combination of cheiloplasty techniques.

Material and methods. We analyzed cheiloplasty outcomes in 817 patients between 2013 and 2022. Bullhorn alone (corner lift or V-Y repair) was performed in 472 (57.8%) patients, and 345 (42.2%) ones underwent a combination of techniques: bullhorn + corner lift in 82 (23.8%) patients; bullhorn + V-Y repair of the upper and/or lower lip in 184 (53.3%) patients; corner lift + V-Y upper lip repair in 43 (12.5%) patients; bullhorn + corner lift + V-Y upper lip repair in 36 (10.4%) patients. The follow-up period ranged from 4 months to 9 years.

Results. We established the indications for each cheiloplasty option. Any specific surgical intervention alone eliminates only one aesthetic defect of the lip. Several aesthetic defects and/or deformities require a combination of cheiloplasty techniques. An algorithm for lip and perioral correction has been developed and implemented in clinical practice depending on baseline parameters and morphology of lips.

Conclusion. Combinations of cheiloplasty techniques can restore ideal proportions of the lower third of the face. Proper assessment of baseline lip deformation allows you to select the correct cheiloplasty technique and, if necessary, perform several surgical interventions to recreate the ideal proportions of the face.

Keywords. bullhorn, corner lift, cheiloplasty, V-Y repair, lip lift, facial plastic surgery, perioral rejuvenation, lip surgery