Aesthetic reconstruction of philtrum using de-epidermized scar flap in secondary unilateral cleft lip

Background: The presence of philtrum in the middle area of the upper lip is a pre-eminent feature of facial aesthetics. However, the philtrum is invariably damaged in cleft lips, and the damage persists even after primary surgery. We attempted to use de-epidermized scar tissue flaps, to raise the philtral ridge and dimple, in secondary unilateral cleft lips. Methods: A prospective study was planned to determine the effectiveness of this novel procedure in 11 patients with secondary unilateral cleft lip deformities, from 2011 to 2013. Preand post-operative photographs were taken and postoperative evaluation was performed between 6 and 23 months. Eminence of the philtral ridge was scored on a 5 point grading scale; the dimple was scored on a 3 point grading scale as well as the scars. Scores were recorded both preoperatively and postoperatively. Results: The results demonstrated a significant improvement in both, the philtral ridge and dimple, as indicated by the preoperative and postoperative scores (2.27 vs. 3.91, 1.36 vs. 2.03, respectively, all P<0.05). Five patients had a significant improvement in the appearance of scar, while appearance of the scar was acceptable to the remaining patients. Conclusions: The use of deepidermized scar tissue is an effective and simple method to construct the philtrum, in cases of secondary cleft lip.