Through cancer ablation, radiation, or secondary congenital cleft lip deformities, a relative side-to-side tightness of a lip often occurs. There also may be deficiency in the free border vermilion. One lip may be tight and thin, with only a minimum of vermilion visible. The opposite lip may be loose, with voluminous vermilion in view (Fig. 160.1). In such circumstances, the lip fleur-de-lis flap has been found to be effective in two planes (1).