Submental Hair-Bearing Skin Flap to Upper Lip

EDITORIAL COMMENT

The finesse of this procedure is that it produces a hair-bearing upper lip that has normal-looking hair in the proper direction, as opposed to an island temporal hair-bearing scalp flap that more closely resembles a Groucho Marx moustache. This procedure could be applied to female patients in a similar manner if a hairless resurfacing of the upper lip is required, but it should be limited to severe cases.

Donor sites for hair-bearing skin flaps used in the reconstruction of the upper lip are the scalp (bitemporal flaps), the cheeks (advancement flaps), and the cervical and submental regions (unilateral or bilateral pedicle flaps) (1). The submental flap is preferable for defects of the upper lip and adjacent cheeks in which at least part of the labial mucosa is preserved.

INDICATIONS

In reconstructing the upper lip, the aims are (a) to provide the upper lip with sufficient skin and subcutaneous tissue to cover defects after incision or elevation of scarred and retracted lip tissue; (b) to replace hairless, ugly scars with hair-bearing skin in males; and (c) to lengthen the columella if necessary.

In patients with a cleft lip/nose deformity, the submental hair-bearing skin flap can correct the nasal malformation and improve respiratory function as well as allow active movement of the upper lip. Other indications are large scars and deformities after injuries of the lip and adjoining cheek and defects after tumor resection.

The skin of the submental region is quite similar to that of the lip. As a substitute, it is aesthetically well accepted, even in women. In men, the new moustache is an additional excellent camouflage. Most of our male patients, unable to hide the deformity preoperatively, proudly presented with a moustache postoperatively.

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