Precision Dermal Fat Grafting for Vermillion Deficiencies in Patients With Unilateral and Bilateral Cleft Lip

Jackson, Oksana A.; Lee, Alfred; Nikovina, Elena; Kaye, Alison E.

doi:10.1177/1055665619864221

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…Because of these concerns, we prefer to use DFG. At our center, it was proven to be more predictable in increasing the volume and projection of the upper lip (Patel & Hall, 2004; Tabrizi et al, 2015; Jackson et al, 2020; Sasson et al, 2020).…”

Section: Discussionmentioning

confidence: 89%

“…There is a growing interest in the use of minimally invasive procedures. The most common less invasive procedures for secondary lip repair in the cleft population are the local tissue rearrangement procedures (Jackson et al, 2020) or free fat grafting (Baum et al, 2017) or combination of both. Further, there is a report of the use of hyaluronic acid (HA) fillers for the correction of residual lip asymmetry in a patient after cleft lip surgery with favorable results (Schweiger et al, 2008; Stolic et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

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Aesthetic Enhancement of the Vermilion Using Dermofat Graft in Patients With Cleft Lip Deformity

Chung

deLeeuw

Lin

et al. 2021

The Cleft Palate-Craniofacial Journal

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Background: There is an increasing patient expectation for better esthetics, manifesting through anatomical harmony, projection, and volume of the upper lip relative to the lower lip, in patients with cleft deformity. The aim of this study is to investigate the outcome of vermilion augmentation using autologous dermofat graft (DFG) to enhance the lip using both quantitative and qualitative assessment. Methods: Patients with secondary cleft lip deformity who received the surgical treatment in our institution from 2015 to 2018 were recruited. Panel assessment was performed on standardized preoperative and postoperative digital photographs. A patient questionnaire was used for the reported outcome. Image processing and analyses were applied to measure the lip change. Statistical analyses were performed. Results: A total of 91 patients were included. The mean age at operation was 22.7 years, and postoperative follow-up was 3.6 years. There were no complications in the study group. The panel assessment showed significant improvement ( P < .00001) on upper lip vermilion in both frontal and lateral profile views. Ninety-five percent of patients reported improvement of the upper lip projection and volume. Quantitative image analysis showed an increase in the upper lip vermilion ratio in 97% of the cases in frontal views and improvement of the vermilion projection in 87% of the cases in the superimposed lateral views. Conclusions: The use of DFG is an effective and reproducible method for vermilion augmentation and aesthetic enhancement in patients presenting with upper lip insufficiency relative to the lower lip.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Aesthetic Enhancement of the Vermilion Using Dermofat Graft in Patients With Cleft Lip Deformity

Chung

deLeeuw

Lin

et al. 2021

The Cleft Palate-Craniofacial Journal

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“…The strengths of this technique include fully and permanently addressing the overall volume deficiency. 6 – 8 However, this method does not address the deficiency of the mucosal lining as our method does. Dermal fat grafting also requires harvesting from other parts of the body and has the potential to be associated with donor site morbidity.…”

Section: Discussionmentioning

confidence: 97%

Modifications to the WHISTLE Flap Procedure for Correction of Secondary Cleft Lip Deformities

Collar Yagas,

Bautista,

Chen

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: The whistle deformity, a deficiency of tissue in the central upper lip, is a consequential outcome of primary cleft lip repair. Among multiple described reconstructive options, the wide-hinged island swing transposition labial enhancement (WHISTLE) flap procedure by Grewal et al has been shown to be a reliable technique that restores the continuity of the orbicularis oris muscle and creates a more natural appearing tubercle and central lip element. This article aims to refine the WHISTLE flap procedure with the addition of tailored mucomuscular flaps and an upper lip-lengthening mucosal Z-plasty. Methods: A total of 11 patients with a whistle deformity were examined. All underwent the WHISTLE flap procedure with tailored mucomuscular flaps and a mucosal Z-plasty. The patients were followed for a period of from 6 to 51.5 months. Pre- and postoperative photographs were used for objective outcome comparison. Results: From 2018 to 2023, a total of 11 patients with a whistle deformity were included in the final cohort, comprised four bilateral and seven unilateral cleft lips. Ten cases (90.1%) resulted in satisfactory postoperative cosmetic appearance and did not require further interventions. A single patient with a significant preoperative discrepancy between the upper and lower lip volumes had a postoperative residual deformity. None of the patients demonstrated any functional deficits associated with the procedure. Conclusions: The WHISTLE flap procedure with the proposed individual tailoring of the mucomuscular flap and Z-plasty for mucosal scar lengthening has excellent cosmetic outcomes and can be considered as the primary treatment modality in most patients with a whistle deformity.

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“…Other methods to address a volume deficiency which report more predictability in the longer term result include dermal fat grafting 18 and the use of pedicled de-epithelialized scar tissue. 19 However, all surgical techniques carry greater risk of complications and there will always be an element of unpredictability due to the adverse effects of scarring.…”

Section: Discussionmentioning

confidence: 99%

Use of Hyaluronic Acid Filler in Patients with Secondary Cleft Lip Deformity

Rivers

Skimming

Chong

et al. 2023

The Cleft Palate Craniofacial Journal

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When considering the management of asymmetry, volume deficiency, scarring and vermillion notching following cleft lip repair, surgical techniques are commonly applied. However, surgery may not be suitable for all patients. Hyaluronic acid (HA) is a common, non-permanent filler widely used in non-surgical aesthetic practice. We present our unit's two-year experience of the regular use of HA filler in a dedicated Adult Cleft Facial Augmentation Clinic. Methods Retrospective case note review was undertaken of all patients treated in the clinic over a two-year period. Results 20 patients underwent HA filler injections to the upper lip 26 times. Most were female (F:M = 3:1) and patients were aged 18-58 years. Most patients had a unilateral cleft lip +/− palate (n = 13, 65%). The most common indication was to address upper lip volume (n = 13, 65%). Other indications included vermillion notch (n = 5, 25%), cupid bow peak height asymmetry (n = 4, 20%), scar asymmetry (n = 1, 5%) and nasal sill flattening (n = 1, 5%). Small volumes of filler were used with an average of 0.34 ml (range 0.05-1.2 ml). There were no complications and one patient reported pruritis post procedure. Conclusions HA filler is a safe and reliable treatment for certain aspects of asymmetry following cleft lip repair. It can be used to address volume deficiency and asymmetry, cupid bow peak height discrepancies and a vermillion notch for patients who do not want surgery. Injection of HA to the lips can be performed easily, with appropriate training, in the outpatient setting.

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Precision Dermal Fat Grafting for Vermillion Deficiencies in Patients With Unilateral and Bilateral Cleft Lip

Cited by 5 publications

References 30 publications

Aesthetic Enhancement of the Vermilion Using Dermofat Graft in Patients With Cleft Lip Deformity

Aesthetic Enhancement of the Vermilion Using Dermofat Graft in Patients With Cleft Lip Deformity

Modifications to the WHISTLE Flap Procedure for Correction of Secondary Cleft Lip Deformities

Use of Hyaluronic Acid Filler in Patients with Secondary Cleft Lip Deformity

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