Lip reconstructions should provide results of a high degree regarding both functionality and aesthetics. 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 anaesthesia. The venous malformation was completely resected. A 4 cm × 2 cm triangle-shaped flap containing a mucosal perforator, identified using colour 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 1-year follow-up examination, no recurrence, drooling, or speech impediment was observed. In this case, excellent functional and aesthetic results were achieved following the low-invasive reconstruction using a mucosal perforator flap.