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Flores et al. Plast Aesthet Res 2018;5:24 I http://dx.doi.org/10.20517/2347-9264.2018.31 Page 3 of 4

Figure 2. (A) Modified commissuroplasty technique. Incisions performed at the level of the commissures in the shape of a 4-sided polygons;
(B) excision of the scar with preservation of the deep mucosal lining; (C) development of three separate mucosal flaps; (D) resurfacing of the
corner of the mouth, upper and lower lip with individual flaps; (E) final closure with re-establishment of normal lip anatomy

Figure 3. The 6-week postoperative image showing complete healing with a normalized oral opening and esthetically pleasant mouth contour

Microstomia is a challenging condition to treat. Its surgical reconstruction usually involves three steps: re-
establishing the intended location of the commissure, excision of the existing scar and resurfacing of the
resulting defect. While maintaining continuity of the orbicularis oris, the resurfacing can be achieved by
primary closure, split or full thickness skin grafting, or local tissue re-arrangement .
[8,9]
First employed by Dieffenbach in 1831, modified by Converse and later by Friedlander & Millard, the Y-V
advancement technique is a popular choice for treatment of commissural microstomia in burn patients [9,10] .
The procedure described in the present report represents a slight modification of the technique. As the dry
vermilion of the commissures was not affected by the scar tissue, it was not resected in our patient. The three
mucosal flaps used to reconstruct each commissure were used to resurface the wet vermilion only. They were
advanced and sutured to the intact dry vermilion at the level of the red line, replacing only similar tissue.