Upper Lip Reconstruction
Reconstruction of an aesthetically acceptable and functional upper lip requires a careful consideration of the transverse and vertical soft tissue, muscle, and skin deficiency. This review focuses on the reconstructive aspects of the upper lip. The functional anatomy of the upper lip is considerably complex and includes paired muscles in addition to the orbicularis, elevators of both the upper lip and commissure. The muscular action of facial expression recruits different sets of these paired muscles. Unlike the aesthetic uniform appearance of the lower lip commissure to commissure, the upper lip aesthetics can be divided into a central, philtrum unit, and a lateral upper lip unit. The lateral unit can be further subdivided into medial and lateral elements, with the medial more fixed and less mobile because of attachments superiorly at the alar sill and base. Reconstruction of the philtrum is best accomplished with an Abbe flap. Methods to reconstruct the lateral unit hinge on location, medial versus lateral, and defect size. A conceptual approach to successful reconstruction of upper lip defects entails the use of a classification based on the aesthetic unit, appropriate selection of the reconstructive option for a particular defect driven by location and size, and careful consideration given to a final result in harmony both transversely and vertically with the lower lip and the remainder of the midface.