Importance of primary repair of cleft lip based on secondary revision of the upper lip

Primary surgery on a cleft lip is exclusively responsible for the final shape of the upper lip. There have been numerous modifications of some established operative methods in the repair of cleft lip, with none of them being perfect. In our opinion, what is important for the final outcome is not the design of the white lip incision, but the three dimensional restructure of the lip. One should at least be careful not to make a lip impossible to repair. Our modification of the Millard method is presented. The most important element is to raise the affected alar base, incise the piriform margin high, and insert as high as possible a cleft margin flap to line the nostril floor.