Lip Scar Research Articles

What Matters to Patients With Cleft Lip and/or Palate: An International Qualitative Study Informing the Development of the CLEFT-Q.

The goal of treatment for individuals with cleft lip and/or palate (CL/P) is to improve physical, psychological, and social health. Outcomes of treatment are rarely measured from the patient's perspective. The aim of the study was to develop a conceptual framework for a patient-reported outcome (PRO) instrument for individuals with clefts (CLEFT-Q) by developing an in-depth understanding of issues that individuals consider to be important. The qualitative methodology of interpretive description was used. Setting, Participants, and Intervention: We performed 136 individual in-depth interviews with participants with clefts of any age, presenting for cleft care, across 6 countries. Parents were involved if the child was more comfortable. Interviews were audio-recorded, transcribed verbatim, and coded using constant comparison. The data were used to develop a refined conceptual framework. Participants described concepts of interest in 3 top-level domains, each of which included subdomains: appearance (face, nose, nostrils, teeth, lips, jaw, cleft lip scar), health-related quality of life (psychological, social, school, speech-related distress), and facial function (speech, eating/drinking). Participants were able to describe changes over time with regard to the 3 domains. A conceptual framework of concepts of interest to individuals with CL/P formed the basis of the scales in the CLEFT-Q. Each subdomain represents an independently functioning scale. Understanding what matters to patients is essential in guiding PRO measurement.

Abstract: Comparison of Efficiency of Z Plasty and Diamond Shape Excision for Correction of Secondary Deformities in Unilateral Cleft Lip Patients

INTRODUCTION: Many different methods have been described for the revision of cleft lip scars in patients with unilateral cleft lip. The aim of this study is to compare Z plasty and diamond shape excision that commonly used techniques to correct secondary lip deformities. METHODS: 10 patients and 8 patients were operated diamond shape excision and Z plasty respectively in 2013–2016. Patients photos after lip revision were studied with facial symmetry program and by having the symmetry of the non-cleft side; a normal lip appearance without cleft was obtained. In the late period after surgery, VAS (visual analogue scale) was performed to determine the satisfaction rates of operation. When looking at the scale, patients were given 10 points for their photographs without cleft lip and the pre-revision photographs are considered 0 point. By the surgeon, the non-clefted lips and post-revision lips were overlaid in the 2015 version of Adobe Reader Photoshop CC program, and the asymmetry of the vermillion and the filtral colon distances were determined. The surgical outcome was evaluated by the surgeon. The result is excellent if there is a difference less than 0.5 mm, good result if difference between 0.5 and 1 mm, bad result is if the difference is more than 1 mm. Whether there is a statistically difference in patient and surgeon satisfaction between the two surgical techniques was evaluated by using the PearsonÂ’s squared test in the scale data in the SPSS 15 analysis. RESULTS: There was no statistical significance between the patients and surgeon satisfaction rates and two surgical procedures. CONCLUSION: Z plasty and diamond shape excision are the most commonly used methods for correcting the secondary cleft lip deformity. These methods, which have no difference in terms of surgeon and patient satisfaction, can be used according to shape of the deformity.

Repair of upper lip scar by expanded submental flap

Objective To discuss the repairing methods of the wound after upper lip lesion excision. Methods The wound after upper lip lesion excision was repaired by expanded pedicled submental flap. The 3 cm-long incision was located in 1 cm to sub-mandible. The 100 ml expander was placed beneath the platysma, and the aqueducts and spigots of the expanders were laid out of the skin. After complete expansion, the spastic scars of the upper lip and nasal bottom were resolved, the nasal columella and upper lip were put back to the normal position. The pedicled submental flap was transferred to the wound after upperlip excision according to the size of the wound. The pedicle was severed after 3 weeks. Results There were 5 cases of the expanded pedicled submental flap to repair the wound after upper lip excision. The flap survived without complications. The appearances were satisfied by the patients. Conclusions The method of the expanded submental flap is suitable for the wound after upper lip excision. Key words: Submental flap; Tissue expansion technique; Upper lips; Cicatrix

Orthodontic-orthognathic management with secondary lip and nose revision of unilateral cleft lip and palate individual

BackgroundThis case report describes orthodontic, orthognathic, and secondary lip and rhinoplasty treatment of a patient with a unilateral complete lip and palate. Multidisciplinary treatment approach is used for the correction of severe crossbite, hypoplastic maxilla, large mandible, and collapsed arch along with a lip scar and deformed nose. MethodsEmphasis is placed on a phased treatment approach with orthodontic treatment, orthognathic surgery, and adjunct surgical procedures carried out at phased intervals, accentuating the achievement of objectives with each phase. ResultsThe treatment via the multidisciplinary approach brought good results and showed good retention at 3 years post-treatment. ConclusionA multidisciplinary treatment approach is the treatment of choice for cleft lip and palate case to achieve a realistic outcome.

CIRPLAST: Cleft Lip and Palate Missions in Peru.

The author presents a 20-year experience leading cleft lip and palate surgical volunteer missions in Peru for CIRPLAST, a nonprofit volunteer plastic surgery goodwill program that has provided free surgery for patients with cleft lip and palate deformities in remote areas of Peru. Surgical procedures were performed by the author, together with a group of experienced plastic surgeons, under the auspices of the Peruvian Plastic Surgery Society, and local health authorities. CIRPLAST missions are scheduled annually in different locations around Peru. Selected patients for surgery after adequate screening are photographed, and their cleft deformity is recorded. Scheduled patients or their parents, when they are minors, sign an informed consent form. Patients operated on in any given day are examined and photographed 1 day after surgery, before discharge. Between 30 and 35 patients are operated on at each mission site. About 2 weeks after the mission, patients are checked and photographed, and the outcome of surgery is recorded. Complications that may occur are recorded and treated by the CIRPLAST team as soon as possible. Almost all operations are performed under general endotracheal anesthesia coupled by local anesthesia containing a vasoconstrictor, to reduce bleeding and facilitate tissue dissection. All wounds of the lip and palate are closed with absorbable sutures, to avoid the need for suture removal. After cleft lip surgery, patients go to the recovery room for monitoring by nurses until they recover completely. A total of 6108 cleft lip and palate repairs, primary and secondary, were performed by CIRPLAST in 141 missions, between May 12, 1994, and October 15, 2014. The medical records of the 5162 patients (84.5%) who returned for follow-up (ranging from 12 days to 9 years) were reviewed retrospectively. Between 45% and 70% of the patients operated on a mission have returned for early follow-up and some the following year. There were 3176 males (51.9%) and 2932 females (48.1%). The incidence of isolated lip clefts was 1546 patients (25.3%); of isolated palate clefts, 2223 patients (36.4%); and combined defects, 2339 patients (38.3%). Of the 5162 patients who returned for follow-up, 377 patients (7.3%) had complications. Lip wound dehiscence was present in 58 patients (15.4). Palate fistula formation in 33 patients (8.8%): 24 (6.4%) after primary palate closure, and 9 (2.4%) after previous fistula closure. Infection occurred in 37 cleft lip patients (9.8%). Hypertrophic lip scars were seen in 56 patients (14.9%). Bleeding occurred in the recovery room after palatoplasty in 48 patients (12.7%), and in most cases, it was contained by applying pressure. No blood transfusions were used. Residual deformities of varying degree of the nose and/or lip occurred in 145 patients (38.5%). All required reoperation for correction. There were no intraoperative deaths in this series. During the past 20 years, the CIRPLAST team has offered free surgery with good outcomes and few complications, to more than 6000 cleft lip and/or palate patients in remote areas of Peru.

Curvilinear transformation of z-shaped upper lip scar by diamond-shaped excision in secondary cleft lip deformities: a photogrammetric evaluation.

Purpose : The visible Z-shaped upper lip scar that occurs after the Tennison and Randall triangular flap technique remains a cleft stigma. Herein, we present our curvilinear transformation technique for the Z-shaped upper lip scar by diamond-shaped excision and evaluate the results using photogrammetric analyses. Patients and Methods : From 1997 to 2006, 23 patients with secondary cleft lip deformity with the visible Z-shaped upper lip scar underwent correction with the technique. The scar was excised in the diamond shape above the muscle. After curvilinear closure, the elongated length of the upper lip was excised just below the nostril sill, as the measured Cupid's bow height discrepancy. The result was assessed by the authors' standardized photogrammetry technique. Results : There was a statistically significant decrease between the preoperative central limb of the Z-shaped scar and the width of the postoperative curvilinear upper lip scar. The pre- and postoperative Cupid's bow height differences were not statistically significant. Conclusions : The curvilinear transformation of the Z-shaped scar is an efficient procedure that provides (1) a significant decrease in the width of an upper lip scar to make it less conspicuous, (2) incorporation of the scar into the philtral column, (3) a biconcave natural philtral column shape in frontal view, and (4) formation of the natural concave philtral contour in profile view.

Botulinum toxin to improve results in cleft lip repair: a double-blinded, randomized, vehicle-controlled clinical trial.

BackgroundMost patients with facial scarring would value even a slight improvement in scar quality. Botulinum toxin A is widely used to alleviate facial dynamic rhytides but is also believed to improve scar quality by reducing wound tension during healing. The main objective was to assess the effect of Botulinum toxin on scars resultant from standardized upper lip wounds.MethodsIn this double-blinded, randomized, vehicle-controlled, prospective clinical trial, 60 consecutive consenting adults undergoing cleft lip scar revision (CLSR) surgery between July 2010 and March 2012 were randomized to receive botulinum toxin A (n = 30) or vehicle (normal saline; n = 30) injections into the subjacent orbicularis oris muscle immediately after wound closure. Scars were independently assessed at 6-months follow-up in blinded fashion using: Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS) and photographic plus ultrasound measurements of scar widths.Results58 patients completed the trial. All scar assessment modalities revealed statistically significantly better scars in the experimental than the vehicle-control group.ConclusionQuality of surgical upper lip scars, which are oriented perpendicular to the direction of pull of the underlying orbicularis oris muscle, is significantly improved by its temporary paralysis during wound healing.Trial RegistrationClinicalTrials.gov NCT01429402

A simple innovation for improving the donor site scar of the Abbe flap

The Abbe flap is commonly used for the correction of secondary deformities of cleft lip. The midline lower lip scar of the donor site can lead to a bridging contracture when it crosses the labiomental crease. By addition of a small Z-plasty we can ensure that the concavity of the crease is maintained with a superior aesthetic result.

Secondary bilateral cleft lip-nose deformity correction by rhinoplasty with simultaneous Abbe flap.

Aim:The purpose of this article is to review modification and outcome of secondary rhinoplasty along with Abbé flap for correction of secondary bilateral cleft lip deformity.Materials and Methods:A total of thirteen patients of secondary bilateral cleft lip-nose deformity having tight upper lip, lack of acceptable philtral column, Cupid's bow definition, irregular lip scars, and associated nasal deformity were selected. All the patients received Abbé flap and simultaneous nasal correction. All cases were treated during a period of three years. Mean patient age at the time of the operation was 21 years, and ranged from 16 to 27 years. The average follow-up period was three years.Results:Assessment of results was based on comparing preoperative and postoperative clinical photographs done by surgeon and patient relatives and patient satisfaction questionnaires. The columellar lengthening and upper lip vermillion correction achieved was satisfactory. There were no perioperative complications such as airway obstruction, bleeding, infection, wound disruption, or flap necrosis.

Reconstruction of Central Upper Lip Defects With the Subcutaneous Pedicled Nasolabial Island Flap

Defects in the central upper lip are difficult to close because of the unique anatomy and limited reconstructive options. Therefore, for every individual patient, reconstructive goals must be prioritized. Reconstructive priorities for an old patient with a large full-thickness oncologic defect are clearly different than those of a teenager with a residual deficiency after cleft repair. Authors aim to share their experience of 2 cases in which large central upper lip oncologic defects have been reconstructed in a single stage using subcutaneous pedicled nasolabial island flap, which provides a single-stage reconstruction by recruiting tissue from the cheek. It obsoletes the need for a lip adhesion. Lip adhesion-related feeding problems are eliminated, oral aperture circumference is maintained, and oral function is preserved. For the elderly male, a full beard is an advantage because it hides both the cheek and the lip scars.

Cleft lip and palate surgery: 30 years follow-up

Ten cleft lip and palate patients with complete unilateral (five patients) and bilateral (five patients) clefts were treated by a multidisciplinary team integrated by psychologists, surgeons, orthodontists, prosthodontists, pediatric dentists, and speech pathologists, to obtain ideal soft tissue and hard tissue continuity, facial symmetry, functional and esthetic dentitions, excellent nasal architecture, subtle, and hidden lip scars. No hypernasality and adequate social adaptation were found in the 30 years follow-up (20-30 years follow-up with an average of 25.5 years). The patients were treated in a pro-active fashion avoiding complications and related problems, executing the ideal surgical, dental, and speech therapy plan, based on a close follow-up over the entire period. Those patients treated at the right time required less surgeries and less salvaging maneuvers and presented complete dentitions with less dental prosthesis or dental implants and stable occlusions, than those who missed the ideal dental and surgical treatment opportunities. The focus of this article is the need of a close long-term follow-up to ensure an ideal patient's quality of life.

Temporización inmediata de implantes unitarios en la maxila posterior

PurposeThis article is a prospective study of implant success rates and of mechanical and biological complications in the assisted-implant rehabilitation treatment of the posterior maxilla by immediate temporization. Material and MethodsThe clinical study observed 21 partially edentulous subjects with lip scar and antagonistic natural teeth in the posterior maxilla for a period of 6 months in which conical threaded internal implant connections were inserted with a surface treatment and timed immediately after being inserted into the jawbone by producing an acrylic resin crown on a temporary titanium abutment screwed directly into the implant and left without tooth contacts during the Maximal Intercuspal (MIC) and mandibular eccentric movements. All restorations were observed over a period of 6 months evaluating implant success rate and biological and mechanical complications. Results25 implants were inserted into 21 patients yielding an average surgical insertion torque of 45.6 Nt. During the clinical observation there was 100% success of implant survival. No biological complications were detected, but there were mechanical complications - a buccal cusp fracture of an acrylic provisional restoration and two screws loosening. ConclusionsThe unit temporization by temporary screwing is a predictable and reliable protocol that allows osseointegration and the coexistence in the health of peri-implant tissue and its prosthetic system.

Post-burn philtrum restoration

One of the consequences of face burn is upper lip deformation with philtrum injury. The philtrum's absence poses severe cosmetic defects. A literature review shows no effective developed technique which allows the surgeon to restore the upper lip and the philtrum in a single-stage procedure. The article presents a new method for burn-damaged philtrum restoration. Two scar stripes are deliberately left in place above the upper lip where the normal philtral ridges should be. The width of these two stripes (ridges) should be around 4 mm. The upper lip scars, lateral both ridges and between them, are excised forming the philtral dimple. The wound is covered with a split thickness skin graft. Two U-shaped sutures are led through the skin graft, both scar stripes and deeper through the underlying tissues between stripes. A bolster is plunged between the ridges in order to fill the dimple and is fixed by the tie-over dressing with tension. The skin transplant lying laterally to the ridges is covered with a separate tie-over dressing. The bolster is being kept in place for the duration of 7 days. As a result, the scar ridges preserve their height and the dimple keeps its depth. Good long-time follow-up results (up to 7 years) were observed in all 18 patients. In most cases the dimple can be slightly smoothed with time. The suggested method of philtrum restoration is an important component of the burned upper lip reconstruction as part of the post-burn facial resurfacing.

Microform or Incomplete Median Cleft Lip: Strategy and Management

Sir: Median cleft of the upper lip is a congenital midline vertical cleft because of the absence of the prolabium. Long-term data and a treatment algorithm for the minor form of median cleft deformity and its associated problem (e.g., frenula anomalies and upper incisor diastema) are lacking. This retrospective review includes five patients between 1982 to 1994, two male and three female patients. The follow-up ranged from 10 to 20 years. The patients exhibited microform median cleft of the upper lip and survived like other normal infants. The straight-line lip repair was performed at 3 months of age (Fig. 1) and followed by orthodontic treatment. The skin lining was excised and the mucosa, orbicularis oris muscle, and skin were repaired without Z-plasty or other lengthening techniques. Alveolar bone grafting was also performed at the age of 5 years, before eruption of the permanent maxillary incisors.1 The results were evaluated by using the classification published by Abyholm et al.2 and evaluated by occlusal radiographs 1 week, 6 months, and 1 year after surgery.Fig. 1.: One midline notch on the upper lip and extending halfway up the philtrum. A median dysgenesis remnant was localized in the central part of the philtrum.An aesthetic and symmetrical philtrum column and upper lip were achieved. The length of the philtrum column was adequate (Fig. 2). All patients achieved type I results of alveolar bone grafting, and the dental radiographs showed new bone reaching alveolar ridges. Long-term dental occlusion proved stable results of diastema correction.Fig. 2.: Good symmetry of vermilion and Cupid's bow, minimized scar formation, and adequate length of the upper lip were achieved.Pathologic findings of the remnant in the first case demonstrated cutaneous tissue with a partial cartilaginous component that was different from the pure cutaneous component in other articles. In this series, the straight-line technique was chosen instead of the forked flap procedure described by Millard to correct the upper lip notch at 3 months of age.3 The midline ridge was excised, narrowed, and lengthened by advancement of the forked flap in his series. The straight-line mark along the bilateral philtrum column margin was designed. Simple excision helps narrow the column, maintain the concavity, and avoid altering the Cupid's bow and tubercle. The adequate length and nondisfigured philtrum and symmetric upper lip indicate that it was not necessary to use specific techniques to camouflage the upper lip scar. A median cleft associated with alveolus cleft and diastema has been described.4 Diastema caused by midline bony clefts tends to relapse earlier and was resistant to conventional treatment.5 The relationship between notching on the upper lip and relapse of maxillary diastema was also reported. A V-shaped bony cleft between two central incisors typically occurs in these patients. The bony cleft interrupts the formation of transeptal fibers and fails to proliferate across the midline cleft. In brief, restoration of bony support should precede the orthodontic correction in incisor diastema. Early secondary bone grafting was performed between 4 and 7 years of age. We recommend bone grafting at the age of 5 years, before permanent incisor eruption. Successful bone grafting provides better support when new teeth erupt and helps maintain subsequent orthodontic results. In our series, diastema larger than 4 mm may be aesthetically and functionally restored by early bone grafting. Erh-Kang Chou, M.D. Department of Plastic Surgery China Medical University Hospital Taichung, and School of Medicine China Medical University Taichung, Taiwan Ellen Wen-Ching Ko, D.D.S., M.S. Department of Dentistry Philip Kuo-Ting Chen, M.D. Department of Plastic Surgery Chang Gung Memorial Hospital Chang Gung University College of Medicine Taoyuan, Taiwan Jack Chung-Kai Yu, M.D., D.M.D. Section of Plastic and Reconstructive Surgery Medical College of Georgia Augusta, Ga. Sophia Chia-Ning Chang, M.D., Ph.D. Department of Plastic Surgery China Medical University Hospital Taichung, and School of Medicine China Medical University Taichung, Taiwan

Minor-Form, Microform, and Mini-Microform Cleft Lip: Anatomical Features, Operative Techniques, and Revisions

Whatever method of closure, a cleft lip scar extends along the full labial height. A smaller scar is possible in repair of limited forms of incomplete cleft lip. This retrospective study was undertaken to define the subgroups of lesser-form cleft lip, describe technical alternatives, and review results of repair. The senior author's (J.B.M.) registry was searched for patients with lesser-form cleft lip, defined by the extent of vermilion-cutaneous dysjunction as either minor-form, microform, or mini-microform. Techniques for repair of these three anatomical variants were examined and the revisions were analyzed. Of 393 patients with unilateral incomplete cleft lip, 59 lesser-form variants were identified. Minor-form clefts (n = 20), defined as a defect extending 3 mm or more above the normal Cupid's bow peak, were repaired by rotation-advancement. Microform clefts (n = 28), defined as a vermilion-cutaneous notch less than 3 mm above the normal peak, were corrected by double unilimb Z-plasty. Mini-microform clefts (n = 11), defined as a disrupted vermilion-cutaneous junction without elevation of the bow peak, were repaired by vertical lenticular excision. Primary nasal correction was necessary in all minor-form and microform types and in some mini-microform types. In all three lesser-forms, the rate of nasolabial revision was relatively low in comparison with that for unilateral complete cleft lip. The extent of disruption at the vermilion-cutaneous junction defines minor-form, microform, and mini-microform cleft lip. These anatomical designations determine the method of nasolabial repair and correlate with types and frequency of revision.

Two-Stage Unilateral Cleft Lip Repair

Reconstruction of the unilateral cleft lip deformity remains a challenge. The Millard repair is the most commonly employed technique of lip closure. Wide clefts with malaligned alveolar arches and very short cleft-side philtral ridges are particularly difficult to reconstruct well. These cases frequently require some degree of cleft-side alotomy with attendant scarring and potential growth disturbance. Additionally, the lip scar tends to cross the philtrum at an aesthetically unsatisfactory low level. Nasoalveolar molding is one method to address these problems, but is not always available or practical. Alternatively, a two-stage lip repair serves as a reasonable means of managing these problems as well. The first stage, performed at approximately 4 to 6 weeks of age, is a full-thickness straight-line repair with tip rhinoplasty. The second stage is a modified Millard repair done at approximately 6 months of age. An alotomy is never needed. The lip scar does not cross the philtrum until the nasolabial crease. The alveolar segments are passively brought closer together by the early lip repair facilitating anterior palate closure. This technique has been used for more than 10 years with satisfying aesthetic and functional results.

A long term subjective and objective assessment of the scar in unilateral cleft lip repairs using the Millard technique without revisional surgery

The aim of unilateral cleft lip repair is to achieve a functional and aesthetically acceptable upper lip scar. Many techniques have been described but do not fulfil the basic aesthetic criteria. This series assessed the long term results from a subjective and objective point of view in a group of 20 patients who only had the initial repair, as described by Millard, without further revisional surgery. Surgery was undertaken at approximately 3 months of age and no secondary procedures were performed thereafter. The analysis related essentially to the residual scar. Patients were assessed subjectively and objectively by means of questionnaires. A control group (n = 20) of normal patients, of similar age, male to female ratio and of similar racial distribution was selected for comparison of the Cupid's bow. No patients were unhappy with the middle part of the scar, however, the upper and lower thirds created more concern. The complaints in the upper part of the scar were related to an unattractive scar crossing the base of the columella. The complaints relating to the lower part of the scar were related to peaking of the vermilion skin junction and notching of the lip margin. The most striking features that were noted from the objective evaluation were: 1. Virtually all patients had scar transgression of normal anatomical boundaries in the upper part of the lip. 2. There was a very high incidence of peaking (65%) and notching (45%) in this study group. 3. Cupid's bow to horizontal lip length ratio was greater in most patients as compared to normal. The study shows that the upper part of the scar close to the nose is problematic both from a subjective and objective point of view. In addition, the ratio of Cupid's bow to the overall lip length seems to be large.

Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair

Objectives To evaluate our patients who were treated with ventral buccal mucosa onlay grafts for open urethral stricture repair with a follow-up exceeding 5 years. Buccal mucosa onlay is widely used for urethral reconstruction; however, the long-term outcome of these patients remains unclear. Methods During the past 10 years, 67 patients underwent ventral buccal mucosa onlay graft surgery for urethral stricture repair. Of these, 32 were followed up for longer than 5 years (mean 6.9 years) for the occurrence and timing of any postoperative complications. All patients had undergone prior internal urethrotomy (mean 2.9 procedures), and the average length of the stricture was 4.3 cm (range 3 to 17). Results The overall complication rate was 25% (8 of 32). We observed one fistula, one graft infection/necrosis, two lower lip scars with transient impairment of lip motility, and four recurrent strictures (at the proximal anastomosis), all of which were treated successfully with internal urethrotomy. All but one recurrent stricture occurred during the first 12 postoperative months. Conclusions Ventral buccal mucosa onlay grafting for urethral stricture repair provides stable long-term results with complications occurring primarily during the first 12 postoperative months.

Simultaneous reconstruction of the secondary bilateral cleft lip and nasal deformity: Abbé flap revisited.

The purpose of this retrospective study was to review the method of using the Abbé flap for correction of secondary bilateral cleft lip deformity in selected patients with tight upper lip, short prolabium, lack of acceptable philtral column and Cupid's bow definition, central vermilion deficiency, irregular lip scars, and associated nasal deformity. A total of 39 patients with the bilateral cleft lip nasal deformity received Abbé flap and simultaneous nasal reconstruction during a period of 6 years. Mean patient age at the time of the operation was 19.1 years, and ranged from 6.6 to 38.5 years. The average follow-up period was 1.8 years. Fourteen patients had prior orthognathic operations. The Abbé flap was designed 13 to 14 mm in length and 8 to 9 mm in width and contained full-thickness tissue from the central lower lip, with a slightly narrow reverse-V caudal end. The prolabium, including the scars and central vermilion, was excised. Lengthening procedures of the upper lip segments were performed if vertical deficiency existed. Part of the prolabial skin was preserved and mobilized for columellar elongation, if indicated. Open rhinoplasty was carried out with or without cartilage graft for columella and nasal tip reconstruction. Reduction of the alar width and nostrils was achieved by a Z-plasty or excision of scar tissue at the nostril floor. The Abbé flap was then transposed cephalad, insetting into the median defect and sutured in layers. The results demonstrated no flap problems or perioperative complications. Seven patients needed further minor revisions on the nose and/or lip. Laser treatment was used to improve the lip scars in three patients. The patients were satisfied with the final outcome and found the lower lip scars acceptable. In conclusion, the described technique of Abbé flap and simultaneous rhinoplasty is an effective reconstructive method for select patients with bilateral cleft lip and nasal deformity.

Single–Follicular-Unit Hair Transplantation to Correct Cleft Lip Moustache Alopecia

Abstract Objective: To present the case of an 18-year-old boy with a cleft lip scar and an obligatory need for facial hair who underwent single–follicular-unit graft hair transplantation that resulted in significant moustache hair restoration in a single procedure. Setting: The surgery was performed in an outpatient private practice setting using oral sedation and local anesthesia. Results: Advances in instrumentation technology and an increased understanding of the anatomical clustering of hair follicles into so-called “follicular units” containing one to six hairs per unit has resulted in a rapid expansion of hair restoration surgery into new areas including female–pattern alopecia, scarring alopecias, and cosmetic surgery scars. These new techniques can be employed to create natural-looking hair lines in front of artificial hair replacement systems; to improve unnatural looking, old “large-plug” hair transplants; and to correct discontinuity of eyebrows and hairlines in patients with congenital facial ...