Modified flap design for symmetric reconstruction of the apical triangle of the upper lip

The apical triangle is the superior portion of the cutaneous upper lip lying between the medial cheek and alar margin. Defects involving this subunit are often repaired without taking into consideration the aesthetic implications of its potential loss or reduction. We present a simple option for repair of apical triangle defects to address this concern.

We collected a series of 69 patients with apical triangle defects treated from 2002 to 2008 with Mohs micrographic surgery. Their defects were reconstructed using various flaps (advancement, rotation, island pedicle, or M-plasty). A subset of 27 patients was identified who had undergone a standard cheek advancement flap or a modified flap. The modified design introduces an incision extending from the alar crease onto the nasal sill along the cutaneous upper lip, creating a second sliding flap to assist in recreating the apical triangle.

A modified flap design introduced the ability to transfer adjacent tissue of the cutaneous upper lip to reconstruct the apical triangle subunit.

This flap modification is a simple and efficient method of repairing peri-alar defects that restores the apical subunit, preserving facial symmetry.