Advanced lip reconstruction: functional and aesthetic considerations

The lips have both aesthetic and functional features that serve to provide recognizable individualized beauty, emotional cues, sensual interactions, speech abilities, and oral continence for nutrition. Lip distortion or loss occurring from trauma or neoplasms can have devastating cosmetic and form deficits with resultant psychological, physical, and nutritional detriments. Appropriate reconstruction of the lips requires a balance between form, function, and aesthetics. Conservation of tissue when feasible should be the overall goal followed by exhausting and maximizing on all adjacent local tissue advancements, rotations, and transposition options. Tissue preservation as the first line of lip reconstruction will achieve the highest success in maintaining sphincteric function along with balancing appearance. This goal should be maintained when dealing with simple lacerations with minimal tissue loss to extensive near or total lip defects. We hope to provide an algorithm and review of aesthetic considerations in lip reconstructive techniques for a wide range of lip defects. An anatomic review and historical background followed by aesthetic issues and pearls related to defect size-dependent lip reconstruction techniques will be presented. The emphasis will be on cosmetic issues that arise with lip reconstruction and how to incorporate a detailed preoperative assessment; minimize donor site morbidity; match tissue size, texture, and color; and maintain stomal competence to balance form, function, and beauty.