Upper Lip Reconstruction Utilizing a Two-Stage Approach with Nanofat Grafting After Hemangioma Treatment

Importance: Lip deformities that occur after treatment of vascular anomalies treatment are often followed by serious local cicatricial adhesion and mucosa atrophy that can complicate reconstruction methods involving simple fat grafting or local flap transfer. Objective: To develop a novel technique that combines flap transfer with nanofat grafting that can be used to reconstruct the upper lip after treatment of vascular anomalies. Design, Setting, and Participants: A retrospective study of a consecutive series of 24 patients with upper lip deformities (13 female and 11 male) aged between 7 and 24 years old was conducted. Of these, 15 patients were treated with nanofat grafting alone and 9 cases were treated with nanofat grafting combined with flap transfer (6 inferior- and 3 superior-based flaps). Main Outcomes and Measures: The appearance, symmetry, and smooth of upper lips with deformities before and after surgery were compared as the main outcome. Results: Among the patients examined, 15 achieved satisfactory results after undergoing multiple nanofat grafting treatments. The remaining nine patients who had serious deformities of the upper lip were treated using a combination of nanofat grafting and flap transfer. For these nine patients, postoperative results showed that the final appearance of the lips was generally symmetrical and smooth. Functional problems such as whistling defects were effectively corrected and no significant complications occurred. The aesthetic symmetry was higher for inferior flaps than for superior flaps and the incision scar for superior flaps was more obvious than for inferior flaps. Conclusion and Relevance: The technique combining nanofat autografting with local flap transfer for upper lip reconstruction was demonstrated to be effective, safe, and simple to perform. These findings suggest that this combined technique can be easily performed to achieve good results with only mild undercorrection.