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

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.

Vermilion Augmentation of Secondary Cleft Lip and Nose Deformity by AlloDerm(R)

Secondary deformities can exist after repair of cleft lip by sophisticated method of primary cheiloplasty and can affect some or all of the previously cleft regions. There may be lip scar, nasal deformity, vermilion deficiency, and maxillary hypoplasia. The correction of secondary cleft deformities is difficult and requires efforts of a multidisciplinary team. There are many operative techniques for correction of the vermilion deficiency, for example double V-Y advancement mucosal flap or double pendulum flap etc. But, these methods are very complex and can remained the scar on vermilion. Twenty six patients of secondary cleft lip and nose deformity with vermilion deficiency were operated in our department from January 1999 to June 2002. The secondary cleft lip and nose deformity was corrected by various operative methods, and the vermilion deficiency corrected by using acellular human dermis(AlloDerm(R), Life Cell Corp., Woodlands, Texas). The three cases suspected for AlloDerm(R) to be absorbed showed that the augmentation of vermilion was poor but another cases showed satisfactory result with good augmentation of vermilion and minimal scar. In conclusion, vermilion augmentation using AlloDerm(R) has the several advantages such as simplicity, shorter operation time, and effectiveness compared with other surgical methods.