The lip roll resides at the lip vermilion/cutaneous junction. Although some call it the ‘white roll’, it is not white in dark-skinned individuals; therefore, we prefer the term ‘lip roll’. It is a three-dimensional, hill-like structure with adnexal structures of specialized glands and fat underlying the surrounding tissue that imparts a roll to the lip. One of the most important aspects of obtaining a good result when reconstructing a lip roll is that it heals with a solid three-dimensional hill, bump or roll effect across the scar. If the hill is effaced across the scar, it can be visible across a room to the casual observer. If the three-dimensional roll is maintained across the scar, the lip appears aesthetically pleasing (Video: go towww.pulsus.com).

Obtaining excellent aesthetic results from cleft lip repairs can be challenging. Many inherent anatomical abnormalities, including short lip, cleft nasal deformity, discontinuous vermilion border with an effaced three-dimensional lip roll, deficient vermilion and a whistle deformity, can result in a suboptimal repair (1–3). Two of the most prominent features in a suboptimal cleft lip repair include a short lip and an effaced, flat, discontinuous, non-three-dimensional lip roll (4). These two features can be quite noticeable in patients in social settings. Thevideo describes the technique and some principles of obtaining a continuous vermilion border with a good three-dimensional lip roll.

The technique begins by marking the upper (yellow mark inFigure 1) and lower (green mark inFigure 1) borders of the lip roll and the remainder of the surgical markings according to the surgical cleft lip repair technique of choice. The lip roll is incised (red mark inFigure 1) with a stab incision using a No. 15 scalpel blade the full height of the roll to maintain the integrity of the three-dimensional structure. The lip is dissected around the roll carefully, ensuring that the lip roll is not damaged by forceps, scissors or sutures. The orbicularis oris muscle is released from the skin and approximated so the lip roll borders approximate without tension. This will restore oral muscular continuity and decrease the tension in the skin repair.

When repairing the lip roll, intradermal 5-0 monocryl sutures are used just above the superior border of the lip roll and just below the inferior border of the lip roll. It is important that no buried sutures are placed in the delicate glands and fat of the lip roll itself. This ensures that the medial and lateral lip rolls are aligned to be continuous and noneffaced without damaging the three-dimensional hill-like structure of the lip roll. The remainder of the skin and the nasal deformity is repaired in a standard fashion but is not discussed in thevideo.