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REPAIR OPTIONS: LATERAL UPPER LIP AND PERIALAR REGION
Preferred option when standard side-to-side closure is not possible
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Repairs in this area must maintain the line of the vermilion border, the white roll and red line as well as maintain symmetry with the opposite perialar region and nasolabial fold area as much as possible.
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Philtral displacement is a primary concern with repairs in this area and needs to be discussed when consulting patients preoperatively. While this is generally unavoidable, it is helpful to avoid undermining beneath the philtral columns. Most of the philtral displacement will resolve with time, as the orbicularis oris muscle is very strong and tends to slowly return distortions of surgery towards normal. However, this process may take up to 6 months and some residual distortion usually remains.
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A small defect at the base of the ala can be converted into a crescentic defect running around the ala and will close side-to-side in a line parallel to the alar groove
Scars on the upper lip are well hidden if they run in, or parallel to, the rhytides
Scars also fade well in the alar groove
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Best for small defects (< 25 to 30% of the upper lip)
A focal depression in vermilion border with lengthening of upper lip may cause asymmetry with suboptimal cosmesis; in such cases, it is best to mark vermilion and remove a small wedge through it2
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Design the excision around the alar groove (see Fig. 10.1) or in the vertical or oblique relaxed skin tension lines on the upper lip (see Figs 10.2 and 10.3).
Excise the standing cones and achieve haemostasis.
Place an absorbable suture to close the middle of the ellipse. Any further absorbable sutures should follow the ‘rule of halves’ principle to close the defect. If including the vermilion, meticulous reapproximation of the vermilion border should be performed initially. Some authors recommend the use of inverting mattress sutures to help accentuate the alar crease.6
Insert the superficial sutures.
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