A New Method for Creating a Definite Philtrum by the Flipping of an Orbicularis Oris Muscle Flap in a Patient with an Indistinct Philtrum
A 35-year-old female patient presented to our department with the complaint of a flat upper lip. The patient had an ambiguous philtral column and philtral dimple, creating the appearance of an overall flat upper lip (). A faint scar was also observed 20 mm along the white roll of the central upper lip.\nThe patient was born normally at term, denied any history of trauma, and did not disclose any maternal alcohol use. In an attempt to correct the flat philtrum, triamcinolone had been injected in the midline of her upper lip three separate times 10 years earlier. Furthermore, the patient also underwent an operation 5 years earlier to achieve a definite philtrum. However, we were not able to determine the exact surgical procedure used based on observation.\nBased on a previously published anthropometric analysis of the mouths of Koreans, a philtral reconstruction was designed so that the postoperative philtral width would be 12 mm at the peaks of the Cupid's bow and 10 mm at the columellar base []. Under local anesthesia, a 26 gauge needle dipped in gentian violet was used to puncture the area along the designated line, thus marking the orbicularis oris muscle at the area where a philtral column would be created. A linear incision was made. The subcutaneous dissection was done to the columellar base, so that this skin flap could be elevated. After dissection, a vertical incision was made on a superficial layer of the orbicularis oris muscle of the central upper lip, and an orbicularis oris muscle flap about 2 mm thick was elevated to the area marked with gentian violet. Both sides of the elevated muscle flap were then folded to the lateral side. The incisional margin of the muscle flap was sutured using a horizontal mattress stitch onto the lateral portion of the orbicularis oris using an absorbable suture. In the area of the folded orbicularis oris muscle, the upper lip was allowed to thicken, forming a philtral column. A dermal quilting suture was also used in the area of the central upper lip where the muscular flap was elevated to make the philtral dimple more definite (, ). The skin was then sutured using a non-absorbable suture. We tied an external central bolster to the new philtrum with a through-and-through nylon suture to provide additional external pressure and to accentuate the new philtrum formation. Five days later, these materials were removed from the surgical site. The patient was observed for one year postoperatively. Her philtrum deepened by 1.25 mm, with the central angle of her Cupid's bow improving from a preoperative measurement of 146° to 128° postoperatively. Thus, philtral reconstruction, which enabled the patient to naturally move her upper lip, was achieved to her satisfaction ().