The principles of reconstructing large lower lip defects include: restoring the continuity of the oral sphincter, respecting aesthetic units and using “like tissue” (if possible.) Traditionally this has been done with local musculocutaneous (Karapandzic) flaps. Unfortunately this traditional approach, although accomplishing the goal of reestablishing lip competence and animation, is frequently done at the expense of causing microstomia. Using composite free tissue transfer we have developed a technique that functionally restores lower lip competence and animation without microstomia in very large lower lip defects. The essence of this technique uses an “internal” Karapandzic principle of mobilizing remaining orbicularis oris muscle toward the midline. The orbicularis oris sling is restored by bridging the ends of the muscle with tendon or fascia from the composite tissue transfer. The composite tissue transfer provides aesthetic unit skin replacement as well. Additionally, the lip position is maintained by suspending de-epithelialized portions of the skin to the malar area. Case presentations along with a video demonstrating lip animation will be presented.