Key Clinical MessageLower red lip reconstruction using a mucosal perforator flap is low‐invasive and adheres to the concept of “like with like.” The location of the mucosal perforator can easily be detected using color Doppler ultrasound.AbstractLip reconstructions should provide results of a high degree regarding both functionality and esthetics. We describe a case of lower red lip reconstruction using a mucosal perforator. An 81‐year‐old man complained of repeated bleeding from a submucosal venous malformation on his lower red lip, and surgery was performed under local anesthesia. The venous malformation was completely resected. A 4 cm × 2 cm triangle‐shaped flap containing a mucosal perforator, identified using color Doppler ultrasound preoperatively, was designed in the lower red lip adjacent to the defect. The perforator flap was raised in the submucosal layer, and the defect was covered with the flap in an advancement manner. The flap transfer‐related defect was closed, and at the one‐year follow‐up examination, no recurrence, drooling, or speech impediment was observed. In this case, excellent functional and esthetic results were achieved following the low‐invasive reconstruction using a mucosal perforator flap.