Reconstruction of cupid's bow with bilateral vermilion flaps

Application of a Layered Muscle Flap Technique for the Reconstruction of the Cupid's Bow and Vermilion in the Repair of Secondary Cleft Lip Deformities

In the repair of unilateral cleft lip, the Cupid's bow, and vermilion on the affected side are sometimes lowered excessively. Methods involving skin and mucosa flaps have been used to correct this issue, but they pose some risk of scarring. The authors here describe a layered muscle flap technique that was based on the anatomical research of nasal-labial muscles, especially the levator labii superioris alaeque nasi muscle. This technique can be used to suspend the Cupid's bow and vermilion in secondary unilateral cleft lip repair. Forty-five patients with secondary unilateral cleft lip with excessively lowered Cupid's bows and vermilion on the affected side were included in this study, which lasted 3 years. These patients were treated using the layered muscle flap surgical technique. The heights of specific bilateral landmarks were measured on patient photos and used to define the symmetry of bilateral Cupid's bow and vermilion. The comparison between post-operative and pre-operative symmetries was used to evaluate the post-operative results, and most of them were satisfactory. The results were also mostly well retained in follow-up investigations. This layered muscle flap technique could be effective in selected cases.

Elegance in Upper Lip Reconstruction

Restoration of the upper lip provides a reconstructive challenge because of its anatomical and aesthetic requirements. This article provides a "where is it on the lip" approach to reconstruct small to subtotal defects of the upper lip that are feasible to perform in the office setting. Emphasis is placed on adherence to core principles, attention to macroaesthetic and microaesthetic landmarks, and technical refinements of well-established reconstructive techniques. These tenets include algorithms for central and lateral defects, precise use of the Abbe flap, use of local tissue rearrangement and skin grafts, and appropriate management of scars. A strong understanding of the anatomical and aesthetic nuances of the upper lip will allow for enhancement of conventional reconstructive procedures to optimize functional and aesthetic outcomes.