Intraoral Rhomboid-Designed Philtral Dimpleplasty Combined With the Muscle-Roll Flap Technique: A Clinical Study

Objective: To evaluate the surgical technique, efficacy, and complications of intraoral rhombus-designed philtral dimple plasty with muscle-roll flap for cosmetic philtral dimple reconstruction. Methods: A retrospective study included 47 women with congenital philtral dimple flattening and hypoplastic philtral ridges. Surgery was performed through a small midline upper labial vestibular incision. Dissection extended to the deep reticular dermis. The superficial orbicularis oris was selectively resected, while part of the deep layer was preserved as a mechanical anchor. After rhombus-shaped aesthetic planning, redundant superficial muscle was rolled bilaterally to reconstruct the philtral ridges. Deep dermis was anchored at multiple points into the deep orbicularis oris, and mucosa was closed in layers. Postoperative static and dynamic lip morphology and complications were recorded; patient satisfaction was assessed on a 4-point scale. Results: All patients completed long-term follow-up. Stable philtral dimples and natural-looking philtral ridges were achieved in 42 patients (89.4%), with improved upper-lip projection, vermilion eversion, and no dynamic distortion. Mild dimple shallowing occurred in 5 patients (10.6%) without loss of philtral architecture. Two cases had delayed mucosal healing, resolving with local oral care. No cases of severe infection, salivary cyst formation, or persistent lip numbness were observed. Patient satisfaction: 35 patients reported being “very satisfied,” 9 “satisfied,” and 3 “fair.” Conclusions: This new technique simultaneously reconstructs the philtral dimple and ridges. The key to success lies in precise identification of the muscular layer, preservation of the deep orbicularis oris anchoring structures, and meticulous handling of the submucosal labial glands. Level of Evidence: Level IV—therapeutic study.