Vermilion Deficiencies After Cleft Lip Repair: Outcomes of Precision Dermal Fat Grafting Technique

ObjectiveTo evaluate outcomes of precision dermal fat grafting (PDFG) for vermilion deficiency following cleft lip repair.DesignRetrospective cohort study. SettingTertiary care pediatric hospital. PatientsIndividuals with vermilion deficiency following repaired unilateral or bilateral cleft lip.InterventionsDermal fat grafts were placed at the site of deficiency. Grafts were oriented with dermis-side contacting and secured to the orbicularis oris, then covered with a V-Y mucosal advancement flap.Main Outcome MeasuresUpper lip measurements were obtained from pre- and postoperative photographs. Two vertical heights were measured from the point of greatest deficiency: (1) actual height-from the point of greatest deficiency to the upper vermilion border, and (2) expected height-from the upper to the lower vermilion border. Two reviewers performed measurements; interrater reliability was assessed using the intraclass correlation coefficient (ICC). Associations between patient factors and revision surgery were analyzed.ResultsThe vermilion height ratio improved from 0.72 to 0.94 postoperatively (P < .001), demonstrating increased vermilion volume. ICC was 0.81 (95% CI: 0.72-0.87), indicating excellent interrater reliability. Patients requiring revision had a lower preoperative actual-to-expected vermilion height ratio compared to those not requiring revision (P = .043), suggesting that more severe initial defects may increase the likelihood of revision. Five patients required revision: 4 for excess (treated with excision) and 1 for deficiency (requiring repeat PDFG).ConclusionsPDFG is a safe and reliable technique for correcting vermilion deficiency in unilateral and bilateral cleft lip, offering predictable volume restoration with minimal complications.