V-Cheiloplasty, Step-Down Technique, and Primary Rhinoplasty in Bilateral Cleft Lip Repair

This article aims to provide a comprehensive overview of our surgical approach to primary bilateral cleft lip (BCL) repair, with an emphasis on addressing commonly encountered challenges by surgeons. These include lip asymmetry, orbicularis muscle deficiency, superiorly displaced or poorly defined Cupid's bow, a shortened prolabial flap, reduced columellar height, and a blunted nasal tip among other challenges. This article describes a technique that combines 3 key components: the sliding V-cheiloplasty, the step-down technique, and primary rhinoplasty. The sliding V-cheiloplasty is used to create adequate lip length and mobilize the alar base medially by counteracting lateralizing forces of healing. The step-down technique, along with strategic relaxing incisions into the membranous septum, allow lengthening of the prolabial flap, achieve adequate Cupid's bow shape, and enhance nasal tip projection. Primary rhinoplasty is performed concurrently with the lip repair to address nasal deformities early on. Throughout the procedure, minimizing scarring is essential to ensure functional restoration and aesthetically pleasing and lasting results.