Unilateral cleft lip repair: Standardized key steps for Cupid's bow reconstruction

Cleft lip repair is a complex and technically demanding surgery, performed by skilled surgeons. Improving surgical outcomes in cleft lip repair offers substantial benefits to patients, yet it remains a persistent challenge for surgical teams. To address this challenge, we developed a systematic protocol based on 40 years of refinements in 7400 cases. By deconstructing the procedure into defined steps, this framework aims to reduce procedural variability while preserving flexibility for case-specific adaptations. The stepwise approach was applied to establish a surgical procedure for Cupid's bow reconstruction in unilateral cleft lip repair, providing quantified, predictable, and repeatable steps for both surgeons and surgical teams. Five empirically refined steps were defined: landmarking; descending of Cupid's peak; correction of the Cupid's bow midline; reconstruction of subanatomical structure and the white roll of Cupid's bow; and restore the symmetry and coordination of Cupid's bow. Both immediate and long-term outcomes demonstrated good and stable results in Cupid's bow reconstruction in unilateral cleft lip repair. This protocol synthesizes four decades of surgical expertise into a reproducible framework, emphasizing adaptability to anatomical diversity while reducing reliance on subjective intraoperative decisions.