Reconstructing the Lip and Perioral Region: Principles, Techniques, and Subunit Repair

Conclusions

• Lip and perioral reconstruction is most successful when the natural free margins of the mouth are preserved and even small distortions are avoided.
• Scar concealment is a major goal, with best outcomes achieved by placing incisions along cosmetic subunit boundaries and normal facial rhytides.
• Reconstructing each lip subunit separately often produces better cosmetic results than treating the area as a single defect.
• Secondary intention healing can work very well for many vermilion defects, including some that cross the vermilion border, and patient satisfaction is often high.
• The vermilion border is highly visible, so precise landmarking and alignment are critical before and during repair.
• In selected cases, tacking sutures or directed granulation can help recreate the vermilion border during secondary healing.
• Mucosal advancement flaps are useful for larger vermilion defects but can cause a rounder, redder lip, dryness, cracking, and postoperative numbness.
• Wedge repairs are effective for larger full-thickness lip defects and can often avoid microstomia if performed in layers.
• Lower-lip wedge repairs may benefit from added techniques such as z-plasty to reduce fish-mouth deformity.
• For upper cutaneous lip defects, the choice of repair should be driven largely by defect shape and size, especially width versus height.
• Crossing the vermilion border during upper-lip repair may be acceptable when necessary and does not necessarily worsen aesthetics or function.
• Fat-lip deformity is a real risk after primary closure or sliding flaps and usually does not resolve on its own, so prevention is important.
• Avoiding fat-lip deformity requires minimizing bulk, extending repairs when needed, and sometimes removing some orbicularis and subcutaneous tissue.
• Rotation, advancement, and island pedicle flaps can give excellent results when designed with long arcs, careful undermining, and controlled tension vectors.
• When reconstructing the upper lip and nasolabial region, undermining into the cheek and past the nasolabial fold is often necessary to prevent unwanted tension and lip elevation.
• The mental crease is an especially valuable landmark for hiding scars in lower cutaneous lip reconstruction.
• Overall, the best reconstructive outcomes come from meticulous attention to anatomy, tension, and subunit boundaries rather than from simply closing defects as quickly as possible.