Upper lip augmentation with double-row subcutaneous pedicled V-Y flaps in Möbius syndrome

Treatment of open-mouth deformity and augmentation of the upper lip were performed using a combination of double-row V-Y mucosal advancement flaps and a V-Y skin advancement flap in 2 cases with Möbius syndrome. The mucosal V-Y advancement flaps were consisted for 2 rows of flaps. The first row was placed near the labial sulcus, including 3 V-Y advancement flaps. These flaps equally provided 3 directional augmentation for each segment of the upper lip. Second row V-Y mucosal advancement flap was used for the augmentation of the vermilion tubercle. In our cases, V-Y advancement flaps were used as subcutaneous based flaps unlike other distally based V-Y flap techniques for the upper lip. Postoperative complications such as scar formation, sensation problems, severe pain, and edema were decreased because of subcutaneous pedicled V-Y flaps. In addition, the relationship between mucosa and orbicularis oris muscle, which is responsible for the fine balance of the vermilion, was maintained with subcutaneous-based flaps. The skin V-Y advancement flap was used both to lengthen the upper lip and to create philtral columns on the upper lip.