Cheek Advancement Flap for Upper Lip Reconstruction While Preserving Aesthetic Units: Experience With 7 Pediatric Cases

INTRODUCTION: Reconstruction of the upper lip in pediatric patients is challenging due to the need to restore function, symmetry, and aesthetic harmony within facial subunits. Descriptions of techniques that respect the aesthetic units of the face are limited. This study evaluates the outcomes of a cheek advancement flap designed according to facial aesthetic subunits for reconstruction of the lateral cutaneous upper lip in pediatric patients. MATERIAL AND METHODS: A retrospective analysis was conducted on 7 pediatric patients who underwent reconstruction of isolated lateral upper lip skin defects using a cheek advancement flap between 2005 and 2025. Demographic variables, etiology, laterality, follow-up, and complications were recorded. Postoperative aesthetic outcomes were objectively assessed by 4 independent plastic surgeons using the Strasser Scale. RESULTS: Three females and 4 males were included. The most common etiology was congenital nevus (57%). Six patients underwent unilateral flap advancement and one required bilateral reconstruction. The mean follow-up was 3.5 years (range: 6 months-10 years). No intraoperative or postoperative complications were observed. Aesthetic evaluation demonstrated excellent results in 5 patients, good results in one patient, and a mediocre result in one patient who presented with extensive sequelae from upper lip necrosis secondary to mucormycosis. DISCUSSION: The perialar semilunar cheek advancement flap is a safe and reproducible technique that provides reliable aesthetic outcomes for reconstruction of the lateral upper lip. By adhering to facial aesthetic subunit principles, this approach achieves harmonious results, discreet scars, and avoids secondary deformities, making it an excellent option for localized upper lip skin defects.