Upper lip defects and deformities due to congenital cleft lip and palate are not rare. Although such patients have frequently undergone multiple repairs during their childhood, the expansion and development of the facial skeleton and scar tightening derived from prior surgeries lead to gradual deformities of the lip, with unpredictable results. The typical upper lip appearance of cleft lip lacks the central lip bead (procheilon) and presents a chevron-shaped defect. The philtrum usually deviates to the repaired side due to surgical scar contraction, and the affected upper lip shows unevenness and is thinner than the normal side due to skin deficiency and scar stretching. Severe cases result in difficulty in closing the mouth or articulation, so before lip reconstruction, consideration should be given to ascertain whether the relevant structures of cleft lip and palate are corrected prior to repair for the ultimate appearance.
Cleft lip reconstruction is aimed to restore the relatively normal upper lip appearance of patients, so the design and method of the surgery are flexible to adjust in light of the severity of the deformity and defect of patients. Generally, there are two main aspects to be noted. One is the reconstruction of the central procheilon, which utilizes the hypertrophic skin at both sides of the upper lip for V-Y flap transposition (local rotation flap) to sculpt the central lip bead. The other is balancing the symmetry of both sides of the upper lip, which involves the regional resection or reduction of the relatively thick lip flesh and, if necessary, grafting the excised skin to the affected side lip defect to achieve balanced lips at both sides. Moreover, if the upper lip deformity is caused by the stretching of the scar at the philtrum or inside the lips, Z-plasty scar revision should be performed in conjunction with lip reconstruction to attain complete correction and prevent probable secondary deformities.