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Vermilion Deficiencies After Cleft Lip Repair: Outcomes of Precision Dermal Fat Grafting Technique
Savannah C. Braud
*, Evyn Neumeister, Erona Shurdhiqi, David Low, Jesse A. Taylor, Oksana A. Jackson, Joseph A. Napoli
Division of Plastic, Reconstructive, and Oral Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
Background: In patients with vermilion deficiency after cleft lip (CL) repair, precision dermal fat grafting (PDFG) involves the placement of a dermal fat graft into lateral tunnels created along the vermilion and covered centrally by an anteriorly based V-Y mucosal flap. The fat graft is positioned with the dermis facing the orbicularis and secured. This study aims to evaluate surgical outcomes of this technique. Methods: A retrospective review was conducted of patients who underwent PDFG from 2008-2024 at a single institution. Demographics, cleft type/laterality, repair technique, and revisions were recorded. Pre- and postoperative photographs were analyzed. A horizontal line was drawn between the widest portions of the right and left vermilion. The point of greatest vermilion deficiency along this line was identified, and the vertical distances to the upper vermilion border (A) and from the upper to lower vermilion border (B) were measured (Fig. 1). Assessing vermilion defect, the ratio of the shorter height (B) to the longer height (A) was calculated. Two reviewers performed measurements and interrater reliability was evaluated. Results: The cohort included 33 patients (11 females). Average age at PDFG was 14.7 years (SD 3.2), with a median follow-up of 2.1 years (IQR 4.0). Of the cohort, 17 had bilateral CL and 16 had unilateral CL. Eight patients had prior revisions (debulking, n=6; fat grafting, n=2). Preoperatively, the ratio of B to A was 0.71 (SD 0.1), which increased to 0.93 (SD 0.1) postoperatively (p<.001). Intraclass correlation coefficient was 0.8, indicating good interrater reliability. Cleft type and surgeon (n=4) were not predictive of requiring revision, p=0.58, p=0.24, respectively. Greater vertical height deficiency was correlated with need for revision (p=0.04). Five patients required revision surgery. Conclusion: PDFG following CL repair is effective in correcting vermilion deficiency. With minimal complications and applicability to both unilateral and bilateral CL, PDFG offers a reliable and predictable solution with satisfactory outcomes.
Fig. 1: Vertical measurements of the upper vermilion.
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