A Hybrid Surgical Technique for Bilateral Cleft Lip Reconstruction

Treatment of bilateral cleft lip is inherently complex because of discontinuity of the orbicularis oris muscle, significant nasal deformities, and the distinctive anatomical characteristics of the prolabium. Several operative techniques exist, including the well-known Millard and Manchester methods. The Manchester technique preserves the vermilion and white roll of the prolabium, joining them with the lateral lip components. In contrast, the Millard technique discards the dry vermilion and white roll of the central prolabium, connecting the 2 lateral lip components at the midline. Advantages and disadvantages exist for both. The Manchester technique often leads to a widened philtrum, while the Millard technique can pose challenges in wider clefts, resulting in a short lip and notching. Surgeons have therefore sought to modify these traditional techniques to improve patient outcomes. In response to the limitations of the traditional approaches, the authors introduce the Low technique-a hybrid technique designed to improve both aesthetic and functional outcomes. This technique aims to minimize the need for secondary corrective procedures by preserving tissue to prevent lip shortening and strategically placing incisions to address philtral widening. In this article, the authors describe the Low technique in detail and outline its advantages.