‘Symmetrize the Defect’
William Shockley, MD, chief of facial plastic and reconstructive surgery at the University of North Carolina in Chapel Hill, described a case that captured the finesse that can be needed for patients who have had a resection on the face. A 43-year-old woman had a defect from resection of squamous cell carcinoma in the middle of her upper lip. The defect extended into muscle tissue. Dr. Shockley chose to do an Abbe flap, involving the transfer of skin, muscle, and mucosa from the lower to the upper lip.
Explore This IssueMarch 2020
A principle he followed was to “symmetrize the defect,” which in this case meant moving the red part of the native lip more to the middle. This symmetry can help the final result look more natural.
The woman was happy with the result but asked for more of a Cupid’s bow, the classic double-curve shape of the upper lip. He kept this adjustment “really simple and low-risk,” he said, drawing out a new Cupid’s bow, excising skin and just advancing the vermillion of the lip—yielding a striking before and after.
Dr. Shockley said that, in his view, facial and nasal contours, and the position and orientation of special facial structures, are more important than nasal or facial scars. Sometimes, he added, symmetry is not as vital as you might think. It’s far more crucial for the nose, say, than the ear.
“Symmetry is important,” he said. “But it is less important as you move away from the midline.”
Thomas Collins is a freelance medical writer based in Florida.