ABSTRACT
Context: The bilateral cleft lip and nose deformity frequently requires lip revision surgery
at the time of secondary rhinoplasty. The goal is to achieve an adequate philtrum
with a well-shaped Cupid's bow, white roll alignment and a central vermilion tubercle.
Aims: We have devised a new technique of using prolabial tissue tailored as an island of
skin based on a subcutaneous pedicle for the secondary reconstruction of the philtral
aesthetic unit in patients with bilateral cleft lip nasal deformity. Settings and Design: This technique was used in 21 patients from March 2012 to August 2015. All patients
had undergone primary lip repair at other institutions and required lip revision with
simultaneous rhinoplasty. Subjects and Methods: The objective criteria considered in the post-operative evaluation by the authors
included improvement of philtral ridge projection, symmetry of philtral column and
nasal sill and white roll continuity. The ten individual parameters were given a score
from 1 to 4 (with 1 = lowest and 4 = highest for each individual parameter) and the
total score was rated as 31–40 = excellent, 21–30 = good, 11–20 = fair and 0–10 =
Poor. The patients’ overall satisfaction was assessed at 6 months postoperatively
to record their impression of the aesthetic improvement after our procedure. Results: The follow-up period ranged from 6 months to 3 years. The prolabial flap had no post-operative
complications. The authors’ assessment judged 15 (71.4%) patients as having an excellent
outcome and 6 (28.5%) patients as having a good outcome. All patients expressed subjective
satisfaction with the post-operative appearance of their upper lip and rated their
results as improved and overall satisfaction scoring was high. Conclusions: This technique is a new addition to the repertoire of procedures which already exist
for the correction of bilateral cleft lip nose deformity. It is safe, reliable and
has a good aesthetic outcome with no significant morbidity.
KEYWORDS
Bilateral cleft lip secondary deformity - islanded prolabial flap - philtral aesthetic
unit - simultaneous lip revision and rhinoplasty
