Median Scars and Upper Lip Defects

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In cases where the central portion of the upper lip is retracted upward due to scarring after a cleft repair, burn, or the irradiation of a hemangioma, the lip can be reconstructed using a method first described by Celsus (ca. 25 A.D.). A two-layer, crescent-shaped excision is made lateral to the alar groove on each side and extended along the nasal base. A portion of the scar can be excised (Fig. 6.8a). Both upper lip stumps are then rotated and carefully sutured together to bring down the retracted vermilion (Fig. 6.8b). The muscle stumps are carefully approximated with 4-0 or 5-0 absorbable suture material. After the vermilion scar has been divided and excised, a Z-plasty can be incorporated to add fullness to the upper lip and lower the vermilion (Fig. 6.9). With greater upward retraction of the upper lip, the incision along the nasal base and alar groove can be extended at an approximate right angle along the nasolabial fold. The flaps are then rotated toward the midline to restore a natural-appearing upper lip (Fig. 6.10). The lip muscles are reapproximated separately in this type of operation.

Nasolabial Flap Take Down

Fig. 6.8 Correction of upper lip contracture following a cleft repair.

a Crescent-shaped excisions are made lateral to the alar groove, and the scar is excised. The lip is mobilized and brought down to a normal position. b All defects are closed.

Fig. 6.8 Correction of upper lip contracture following a cleft repair.

a Crescent-shaped excisions are made lateral to the alar groove, and the scar is excised. The lip is mobilized and brought down to a normal position. b All defects are closed.

Cleft Lip Repair Plasty
Fig. 6.9 A Z-plasty can be added to adjust the position of the vermilion (see Fig. 6.8).
Plasty For Vermilion Border
Fig. 6.10 Distortion of the vermilion due to scar contracture. a The scar is excised, and releasing incisions are made in the nasolabial folds. b The vermilion is brought downward, and the defects are closed (see also Fig. 6.28)
Upper Lip Defects

Fig. 6.11 Tumor or scar in the upper lip.

a, c The tumor is excised, and the Z-plasty incision is made.

b, d The scar is dispersed. The lip defect is closed.

Fig. 6.11 Tumor or scar in the upper lip.

a, c The tumor is excised, and the Z-plasty incision is made.

b, d The scar is dispersed. The lip defect is closed.

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