What is Cheiloplasty?

Cheiloplasty is the surgical procedure for the modification of the lips. This procedure restores function and aesthetics of the lips. It is commonly performed to correct congenital or acquired deformities, such as cleft lip, as well as for cosmetic enhancements like lip augmentation or reduction. Generally, cheiloplasty corrects a groove-like defect in the upper lip or separation of the lips. A cleft lip can be unilateral (affecting one side), bilateral (affecting both sides of the nose), complete (extending into the base of the nostril), or incomplete (a partial separation of the lip tissues).¹

Several surgeons have contributed to the evolution of cheiloplasty methods. However, the most accepted technique was introduced by Ralph Millard in 1955. His technique focuses on restoring the maximum labial structures while maintaining both function and aesthetics.²

Preoperative, transoperative, and postoperative views of Millard cheiloplasty for cleft lip repair. — Millard Technique (cheiloplasty). Surgical ﬂaps were made on the side without cleft for inferior rotation of the medial lip element(A); the medial advancement ﬂap – side with cleft (B); and the base ﬂap on the columella (C). I, Preoperative view; II, Transoperative view; III, Postoperative view. Image Courtesy: Across-surface distances after one- and two-stage palatoplasty in children with oral cleft by Ambrosio et al., 2024, https://doi.org/10.1590/1414-431X2024e13805. Available via Researchgate under license CC BY 4.0

Indications for cheiloplasty

The most common indications for cheiloplasty are:

Cleft lip repair – Cheiloplasty surgically corrects an incomplete upper lip, improving both function and appearance. It also helps address difficulties with feeding, breathing, hearing, and speech.
Nasal deformities associated with cleft lip – Since cleft lips affect nasal shape, this procedure can help restore nasal symmetry.
Cosmetic and functional lip reconstruction – Cheiloplasty can reshape the lips, form a cupid’s bow, and optimize the distance between the nose and upper lip.
Facial trauma repair – Reconstructive cheiloplasty restores lip structure and function following injury.

Types of Cheiloplasty

Based on the purpose of the surgery, cheiloplasty is of three types:

Reconstructive Lip Surgery:

This type of cheiloplasty addresses the damage or defects caused by cancer resection, trauma, or other medical conditions. The surgeons apply local flaps or tissue grafts to reconstruct the lips to their former appearance and function.

Lip Augmentation:

This is a type of aesthetic cheiloplasty focused on enhancing lip appearance. It includes fillers or implants to add volume, improve symmetry, and redefine contours. This procedure is more popular among individuals who want to seek fuller and more youthful lips.

Cleft Lip Repair:

Cleft lip repair is the most common type of cheiloplasty, primarily performed on infants born with cleft lips. Orofacial clefts, such as cleft lip and cleft palate, are among the most frequent congenital malformations, affecting functions like breathing, feeding, and speech.³ The global prevalence of cleft lip and palate is estimated at 1 in 700 live births, with variations based on ethnicity, socioeconomic factors, geographic regions, and maternal health during pregnancy. This procedure involves precise repositioning and suturing of the lip tissues to restore normal appearance and function.⁴

How is Cheiloplasty Performed?

Cheiloplasty is performed by a Plastic or Oral and Maxillofacial Surgeon. The procedure varies according to the treatment goals and techniques used. However, a general protocol is as follows:

Pre-operative Steps

Before surgery, a pre-operative consultation with the surgeon is necessary to discuss the treatment plan. The healthcare provider will:

Conduct a physical examination to assess the extent of the deformity or determine the desired cosmetic outcome.
Review medical history, previous treatments, or prior surgeries.
For cleft lip repair, the procedure is typically performed between three and six months of age, depending on the infant’s size and the severity of the cleft. For cleft lip repair, surgeons follow the Rule of 10 to ensure the infant is in optimal condition for surgery. The baby should be at least 10 weeks old, weigh at least 10 pounds (4.5 kg), and have a hemoglobin level of at least 10 g/dL before undergoing the procedure. This guideline helps minimize surgical risks and improves post-operative recovery.⁵

Procedure of Cheiloplasty

The procedure of cheiloplasty varies depending on the specific type of surgery but follows a general approach tailored to the patient’s needs.

To ensure patient comfort and a pain-free procedure, the surgeon administers either local or general anesthesia based on the complexity of the surgery.
The next step involves making precise incisions to minimize visible scarring and optimize functional and aesthetic outcomes. The incision technique depends on the specific type of cheiloplasty being performed:

Cleft Lip Repair

The surgeon carefully repositions the lip tissues and reconstructs the muscle layers to restore normal lip function and appearance. The two most commonly used techniques include Millard’s Rotation-Advancement Flap and Tennison-Randall’s Triangular Flap Technique, both designed to improve symmetry and minimize scar formation. The surgical approach varies based on whether the cleft lip is unilateral or bilateral.

Lip Augmentation

The surgeon enhances lip volume and shape using fillers, implants, or grafts. Options include autografts (fat transfer, dermal grafts), allografts (cadaveric dermis), xenografts (collagen from animal sources), and synthetic fillers (hyaluronic acid, silicone implants). Each method is selected based on the patient’s goals and medical suitability. ⁶

Reconstructive Lip Surgery

If the lips have been damaged due to trauma, cancer resection, or congenital anomalies, the surgeon employs local tissue flaps, such as Abbé flap, Karapandzic flap, or Estlander flap, to reconstruct the lips while preserving function and sensation.

Lip Reduction

In cases where lip hypertrophy or excessive tissue is present, the surgeon removes the excess tissue while maintaining natural contour and proportion. This is often done using wedge excision techniques.

Once the necessary modifications are made, the surgeon closes the incisions with fine sutures (absorbable or non-absorbable, depending on the case). The closure is performed meticulously to ensure proper healing and minimize scarring.

Closeup Image of a man after upper and lower lip reduction surgery.

After the surgery is complete, the patient is transferred to the recovery room, where nursing staff monitor vital signs, including temperature, heart rate, and blood pressure. Parents can hold and feed their baby during this period. Most children are discharged the same day, provided they are able to feed from a bottle and have urinated at least once.
To prevent the child from touching the surgical site, soft arm restraints (No-No’s) may be used. These should generally be worn for about a week but can be removed under close supervision, such as during bathing, to ensure comfort and circulation.

Post-Operative Care

Achieving maximum results depends on proper post-operative care.

Pain management after cheiloplasty is the first post-operative care.
The healthcare provider will recommend appropriate pain relief, usually acetaminophen (Tylenol) or ibuprofen. Stronger medications like codeine are rarely prescribed due to safety concerns in young children. Always follow the pediatrician’s dosage instructions.
You need to supervise your child so that he doesn’t put anything into his mouth that might cause injury.
Watch for redness, swelling, pus, an unusual odor, or fever, which may indicate infection. If any of these signs appear, contact your healthcare provider immediately.
Avoid direct exposure to the sun to minimize scarring and promote good wound healing.
Clean the surgery site on a regular basis and apply antibiotic ointment if required.⁷
Your children may experience dehydration. Observe the following symptoms in your children:
– Dry mouth
– Decreased urination
– Fewer tears when crying
– Sunken eyes or fontanelle (soft spot on the head)
– Unusual sleepiness or irritability
– Reduced interest in feeding
If these symptoms appear, rush to the paediatrician.
Strictly attend the follow-up appointments.

Post-Operative Complications

Bruising and swelling are common complications on the initial days after the surgery. They generally subside within two weeks.
An expert surgeon will leave the patient with minimal after-surgery complications. Cheiloplasty carries the risk of adverse reactions to the anaesthesia used during the surgery, infection, asymmetry, and scarring after the surgery.

Cheiloplasty vs. Palatoplasty

Palatoplasty is also a surgical procedure used to correct or reconstruct the palate in an individual with a cleft palate. It is a challenging and complex procedure.⁸ The comparative description of both techniques is given in the table.

Cheiloplasty	Palatoplasty
It refers to the surgical repair of the cleft lip.	The complications include palatal fistulas and velopharyngeal insufficiency.
It restores the normal appearance and function of the lips.	It aims to close the gap and facilitate normal feeding and speech functions.
Usually performed when a child is three to six months old.	Usually performed when a child is 9 to 12 months old.
This surgical procedure involves realigning the skin and muscles of the lips to create a normal appearance.	The surgical procedure involves closing the palate in multiple layers.
Indicated for children born with cleft lips and for people who want a cosmetic enhancement of the lips. It can also correct the previous surgical defaults.	Indicated for people with cleft palate and restoration of its normal functions.
Require a short hospital stay (one day)	Hospital stay generally lasts from one to three days.
The complications of the procedure include asymmetry, scarring or the need for a revision surgery upon unsatisfactory results.	The complications include palatial fistulas and velopharyngeal insufficiency.

A Quick Review

The lips play a dominant role in the aesthetics of the lower third of the face, significantly shaping overall facial appearance. Cheiloplasty offers a versatile solution for lip modification, whether for reconstructing defects, enhancing appearance, augmenting volume, or restoring a youthful look. As a highly individualized procedure, it is essential for patients to carefully consider their goals and discuss the suitable options with their surgeon to achieve their desired outcomes.

Refrences

1
Haque S, Alam MK. Spectrum of cheiloplasty has detrimental effect on maxillary growth: myth or fact? Bangladesh Journal of Medical Science. 2014;13(4):473.
2
de Siqueira Bringel R, Cruz R, Pereira Lucena Franco J, Bringel D, Bringel G. Primary Cheiloplasty using the Technique of Millard. Int J Dentistry Oral Sci. 2017;4(6):490-3.
3
Ribeiro EM, Moreira ASCG. Update about the multidisciplinary treatment of cleft lip and palate. Revista Brasileira em Promoção da Saúde. 2005;18(1):31.
4
Bringel RJdS, Pita Neto IC, Franco JMPL, Araújo Junior JLd, Ferreira MS, Bringel DN, et al. Cleft lip/palate reconstruction using techniques from Abbé and Von Langenbeck. 2015.
5
Schalet G, Langlie J, Kim M, Thaller S. The Rule of 10s for Cleft Repair: A Historical Review of the Literature. J Craniofac Surg. 2023 May 1;34(3):884-887. doi: 10.1097/SCS.0000000000008994. Epub 2022 Sep 6. PMID: 36731060.
6
Kountakis SE. Encyclopedia of Otolaryngology, Head and Neck Surgery: Springer; 2013.
7
Raghavan U, Vijayadev V, Rao D, Ullas G. Postoperative management of cleft lip and palate surgery. Facial Plastic Surgery. 2018;34(06):605-11.
8
Espel JP, Hohman MH, Winters R. Cleft Palate Repair. StatPearls [Internet]: StatPearls Publishing; 2023.

Cheiloplasty: A Closer Look at Cleft Lip Repair

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