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Post-vermilionectomy defect closure by a mucosal advancement flap is a well-established method, although moderate morbidity may accompany the procedure, especially in elderly patients. The objective of the present study was to compare a simple primary closure (PC) for reconstruction after complete resection of the vermilion (vermilionectomy) with closure using a mucosal advancement flap (MAF).After margin-controlled vermilionectomy, 18 patients with actinic cheilitis (n=5) or squamous cell carcinoma in situ (n=13) of the lower lip were included in the present study. Patients were randomized into one group receiving PC (n=8) and a second group receiving MAF closure (n=10) for reconstruction of the surgical defect on the lower lip. All complications, esthetic outcomes (EOs), and cut–suture times were documented.In the MAF group, patients' mean EO score on a 10-point scale was 8.4, and the surgeons' mean EO rate was 7.8. In the PC group the patients' mean EO score was 7.5 and the surgeons' mean EO rate was 6.4 for the reconstruction achieved. The rate of side effects was significantly higher in the MAF group than in the PC group (p<.05). The cut–suture times were significantly shorter for PC (29 minutes) than MAF (37.8 minutes; p<.05).MAF is the method of choice and has good functional and cosmetic outcomes, although elderly patients with different comorbidities that need to be protected from unnecessary strain could potentially benefit from PC.The authors have indicated no significant interest with commercial supporters.