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Surgical Pearls
Sept/Oct 2018

Vermilion-Mucosal Advancement Flap: A Scarless Technique of Adynamic Wedge Resection of the Lower Lip in Patients With Facial Palsy

Author Affiliations
  • 1Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, West Sussex, England
JAMA Facial Plast Surg. 2018;20(5):423. doi:10.1001/jamafacial.2018.0639

Adynamic lower lip wedge resections (ALWRs) have long been a staple of surgeons seeking to improve static and dynamic symmetry of the lower lip in patients with facial palsy.1 With respect to dynamic symmetry, ALWRs are typically useful as a second-stage procedure following a lengthening temporalis myoplasty, for example, as a means of redistributing the diagonal smile vector of the transposed temporalis tendon to the lower lip. They also rebalance the ratio of deinnervated, atrophic orbicularis oris to innervated muscle for improved symmetrization following long-term flaccid facial paralysis, such as after cerebrovascular accidents.