The lips, like the eyelids, represent a special site; they often have only a modest dermal component, necessitating consideration of alternative repair strategies, and represent a free margin, as they are fixed in place only by muscle. Therefore, any lateral tension across the lips often translates into a long-standing residual pull that does not resolve with time.
Accurate reapproximation of the vermilion border is of critical importance in lip repairs and reconstructions. Similarly, any residual dog ears on the lips, and particularly at the vermilion, do not resolve with time. Therefore, adequately extending linear excisions and performing a wedge resection when needed is of paramount importance.
Appreciating the anatomic subtleties and detail regarding the boundaries of the cosmetic subunits of the lip, while beyond the scope of this book, is a critical prerequisite to approaching any repairs in this cosmetically and functionally sensitive area.
While linear closures are, as always, preferred, the lack of any bony attachments means that residual pull will often not resolve on the lip. Therefore, larger defects may benefit from flap closures, where additional suture techniques, such as the tip stitch, buried tip stitch, vertical mattress tip stitch, or hybrid mattress tip stitch could be useful.