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Page 12 of 14 Sciegienka et al. Plast Aesthet Res 2022;9:1 https://dx.doi.org/10.20517/2347-9264.2021.76

Figure 10. Topographic anatomy of the lips. (1) Philtral groove; (2) Philtral columns; (3) Cupid’s bow; (4) White roll of upper lip; (5)
Tubercle; (6) Oral commissure; and (7) Vermillion.

groove and are often designed as interpolated flaps, necessitating a second procedure to divide the flap
and/or surgically restore the groove.

The melolabial flap should be designed around the melolabial fold and with the recruitment of tissue only
from the cheek and never the lip or nose; recruiting tissue from the lip or nose would distort the symmetry
of these structures, whereas the laxity of the cheek allows for much greater tissue utilization without
cosmetic consequence . When designing the flap, the melolabial flap is first marked. Then a template is
[27]
made of the defect and is used to mark out the amount of tissue necessary for reconstruction. A 4 × 4 gauze
is useful to measure the length of the flaps designed relative to the location of the defect, pivoting around
the base of the flap. The pedicle width should be between 1.5 and 2 cm to maintain perfusion. Incisions are
then made, and the flap is elevated off the cheek. The flap is elevated with gradually increasing thickness
such that the distal end of the flap is thinnest and the base is the thickest. The flap is then secured into
position. Donor site closure is typically uncomplicated due to cheek laxity, but one should ensure that
surrounding structures such as the eyelid or lip are not being distorted as a result of tight closure .
[32]

Lips
The lips are the central point of the face because of their role in expression and communication. They are
both cosmetically sensitive and play a major functional role in speech and eating. The primary objective of
lip reconstruction is the restoration of oral competence followed by maintenance of muscular continuity,
sensation, and oral aperture circumference. Generally, the lip complex should be used to repair defects to
maintain oral competence; if using the lip complex alone would lead to microstomia, adjacent tissues are
included in the reconstruction. Lastly, the cosmetic appearance of the lip and the proportions of the upper
and lower lip should be considered with all lip reconstructions. The multilaminar anatomy and lack of rigid
[33]
underlying structures make the above goals challenging to the reconstructive surgeon .

Oral and perioral defects can be categorized by their size and location. As with other areas of the face, the
lips are comprised of discrete subunits and follow the same subunit principles discussed previously. The
subunits of the lips include the philtrum, Cupid’s bow, white roll of the upper lip, tubercles, commissures,
vermillion, and upper and lower cutaneous lip [Figure 10]. Small lesions on the cutaneous lip far from the
white roll can heal via secondary intension; this method should be avoided if the defect is close to the white