Scientific Abstract Presentations: Global Partners Session 1 Saturday, October 11 Sat, Oct 11 10:30 a.m.-12:00 p.m. CDT

Surgical and Non surgical Rhinoplasty, Similarities and Differences Dr. Rezarta Kapaj Dr. Klaudia Ferko Dr. Virxhinia Cuko

Rhinoplasty is one of the most commonly performed operations, ranking second in aesthetic surgery surpassed only by breast augmentation. This is not a new operation, there have been anecdotal reports of rhinoplasties performed as early as the 16'th century, but the most important boost has been after the 80'ies with contributions from Sheen demonstrating the importance of reconstruction of the important structures of the nose, instead of the destructive approach performed formerly. Surgical rhinoplasty, open or closed, consists mainly on reducing the dorsal hump, fixing the tip of the nose in the right angle, which can be 95-105 degrees in females and narrowing the dorsal lines according to the patient's needs. Nonsurgical rhinoplasty, on the other hand, consists on filling strategically the nose to create a better profile, without altering the hump, but concealing it. These two strategies, although may look very different in concept, have the same principle, to create a straight and beautiful nose. Of course the main difference between the two strategies is the correction of the nasal airways and breathing, but that is a difference outside the scope of our report. In this report we will cover the differences and similarities between surgical and nonsurgical rhinoplasties, will discuss the possible complications and will stress the important key points to avoid them. The satisfaction of the patient doesn't depend only on the final results, it also depends on the expectations, the function and the recovery time. With this in mind, perhaps it's not very accurate to compare the satisfaction after surgical and nonsurgical rhinoplasties. Nevertheless what has to be stressed is that these procedures should be performed by professional only and can be very dangerous in the wrong hands.

Introduction

Juvenile gigantomastia is a benign, infrequent disease of unknown etiology, characterised by excessive, diffuse, and rapid growth of the mammary gland during adolescence; it being extremely rare also known as virginal hypertrophy, accounts for 13% of the total cases of macromastia. Henry, also described this pathology in 1910 as gigantomastia, juvenile hypertrophy, or virginal breast hypertrophy.

Objectives

Report on a clinical case to evaluate the treatment of patients with this type of rare pathology. Highlight the complexity of the clinical case, as well as the resolution and follow-up it may require.

MATERIALS AND METHODS

The case of a 19-year-old female patient with no previous medical history is presented; she reports progressive bilateral breast enlargement over approximately one year, accompanied by non-cyclical mastalgia, trophic changes in the skin of both breasts, as well as limitations in standing and walking that have progressively worsened, which is why she sought consultation. Upon physical examination she presented large, ptotic (grade three), asymmetric breasts that exceeded the umbilical scar, trophic changes in all four breast quadrants bilaterally, bilateral collateral venous network with palpable nodules. Both axillae and supraclavicular fossae were free. Breast ultrasound report: right breast multiple masses with well-defined edges. Left breast with masses of well-defined edges. BIRADS 2. Mammogram report: both breast bodies with mild fibroadipose transformation, multiple nodular opacities. BIRADS 0

RESULT

The surgical procedure performed was: reduction mammoplasty with a derma-fat flap and free nipple-areola graft, where 2300 grams of material was obtained from the right breast and 1600 grams from the left breast; the nipple-areola complex was grafted, achieving a good result, with medium-volume breasts, symmetrical, with aesthetically acceptable scars, without suffering of the nipple-areola complex. Improvement in her quality of life regarding all aspects of it, both personal and professional.

CONCLUSIONS

Mammary hypertrophy is a rare benign condition that occurs in women near the beginning of puberty, in the absence of pregnancy, with normal hormone levels; it is generally due to an exaggerated response of the mammary parenchyma to estrogens. It is very important to conduct strict long-term follow-up as recurrences may occur after surgical treatment, for which the patient and her family should be prepared. Postoperative treatment with tamoxifen can reduce recurrences.

Bibliography 1. Sepúlveda, O. a. B. (2016). Hiperplasia virginal mamaria. CES Medicina, 30(1), 122–128. 2. Sperling, R. L., & Gold, J. J. (1973). Use of an anti-estrogen after a reduction mammaplasty to prevent recurrence of virginal hypertrophy of breasts. Case report. PubMed, 52(4), 439–442. 3. Soliman, S. A., Algatheradi, M. A., Aljahwashi, T. A., Alhussan, T. H., Alqahtani, R. S., & Ali, N. I. (2023). Virginal breast hypertrophy: a case report. Cureus. 4. Alviar-Rueda JD. Patología mamaria benigna: diagnóstico y tratamiento. MÉD.UIS. 2018;31(3):61-71. 5. Hisham A, Abd Latib M, Basiron N. Juvenile Breast Hypertrophy: A Successful Breast Reduction of 14.9% Body Weight without Recurrence in a 5-Year Follow-Up. Case Rep Surg. 2017;2017:3491012. doi: 10.1155/2017/3491012. Epub 2017 Jan 31. PMID: 28255494; PMCID: PMC5306971.

Introduction: Abdominoplasty is one of the most commonly performed plastic surgeries worldwide, with Brazil leading in procedure volume. Changes in eating behavior may occur before and after surgery, influencing weight gain. Weight fluctuations are linked to restrictive diets, emotional eating, and compensatory behaviors, contributing to metabolic and psychological disturbances (VITAGLIANO, 2023; ADAN, 2019). While studies show weight gain in women post-abdominoplasty (NAHAS et al., 2011), no research has examined the relationship between eating behavior and postoperative weight gain. Methods: This longitudinal clinical study included 51 women (25–50 years old) undergoing abdominoplasty at the Federal University of São Paulo (UNIFESP). Patients with chronic diseases, smoking habits, prior bariatric surgery, or additional aesthetic procedures were excluded. The Dutch Eating Behavior Questionnaire (DEBQ) and Binge Eating Scale (BES) assessed eating behaviors preoperatively and six months postoperatively (PO6). Nutritional status was evaluated through anthropometric measurements, including BMI adjustments for excess skin and fat removal. Results: The mean excess skin and fat mass (ESFM) removed was 832.90 ± 298.06 g, corresponding to 1.32 ± 0.48% of preoperative weight. Mean baseline weight (BW) was 62.6 ± 6 kg, increasing to 64.6 ± 6 kg at PO6, with a significant weight gain of 2.0 ± 2 kg (p < 0.05). BMI increased from 24.4 ± 1.7 kg/m² (POI) to 25.2 ± 2.1 kg/m² (PO6), with 56.9% of patients classified as pre-obese postoperatively. Significant increases in eating behavior scores were observed: • DEBQ total score: +4.5 ± 2.4 (p < 0.001) • Restrained eating: +0.8 ± 1.0 (p < 0.001) • Emotional eating: +2.2 ± 1.5 (p < 0.001) • External eating: +1.5 ± 1.0 (p < 0.001) The severity of binge eating (BES score) increased from 23.5 ± 7.0 (PRE) to 29.1 ± 3.0 (PO6) (p < 0.001). Women with severe BES scores preoperatively had higher BMI at both PRE and PO6, suggesting a link between binge eating and weight gain post-abdominoplasty. Discussion: Weight regain after body contouring procedures is consistent with findings from HENDERSON et al. (2023), who observed postoperative weight recovery in 11.81% of bariatric patients and 7.56% of non-bariatric patients. SAARINIEMI et al. (2014) reported improved body satisfaction and reduced eating disorder risk post-abdominoplasty, though additional studies were recommended. Psychological factors significantly influence weight outcomes. MCCOMB & MILLS (2021) found that exposure to idealized body images increased body dissatisfaction in perfectionist women, potentially leading to disordered eating. CARANO et al. (2012) emphasized that food intake is regulated by both hypothalamic and emotional mechanisms, with the lipostatic theory (KENNEDY, 1950) suggesting that rapid fat loss may trigger compensatory weight regain. ZIMMER et al. (2022) identified binge eating disorder (BED) in 10.8% of abdominoplasty patients, supporting the link between eating disorders and aesthetic surgery candidates. RAMOS et al. (2019) found 48% of rhinoplasty candidates had body dysmorphic disorder (BDD), emphasizing the need for preoperative psychological screening in plastic surgery patients. Post-bariatric patients undergoing body contouring surgery showed better long-term weight control (DE VRIES et al., 2020), yet nutritional and psychological challenges remain. HERMAN et al. (2015) and KOKOSIS & COON (2018) highlighted postoperative nutritional deficiencies, reinforcing the importance of dietary and behavioral management. Conclusion: Women undergoing abdominoplasty showed reduced control over binge eating and significant weight gain six months postoperatively. The findings highlight the need for nutritional and psychological support in abdominoplasty candidates to optimize postoperative weight maintenance and eating behavior.

Patient HS 27y. attempted suicide by jumping from a height on April 8.2024. Polytraumatized patient. She suffered multiple fractures of the foot, lower leg, upper leg, hip, acetabulum and other parts of the pelvis, sacrum, cervical and lumbar vertebrae, ribs, SDH, heart contusion, pneumothorax and pneumomediastinum. Fractures of the legs, hip and sacrum were treated surgically. Postoperatively, there was infection and dehiscence of the mediosacral wound measuring 9x5cm with exposed bone spongiosis, infection and fibro necrotic tissue. She entered sepsis, which was resolved with i.v. Antibiotics and daily dressing. Considering the psychological status: recurrent depressive disorder, now a severe episode with psychotic symptoms, veganism, not eating, not drinking protein preparations, low protein status (albumin below 20g/l), locally bad findings - no subcutaneous fat tissue, skin directly on the bone - we did not decide on surgery, but started treating the wound with a novel antimicrobial wound dressing impregnated with copper oxide micro particles-MEDCu (1), already after about 10 days the use of MEDCu dressing material resulted in the removal of infection, complete intense granulation of the bottom of the wound and bone coverage, and closure of subcutaneous pockets, epithelialization of the wound edges, which we have not been able to achieve with other dressing materials. She was bandaged like that for 2 months every 2 days, because she was lying down and moving a little (1 hour/daily with the help of a walker and a physiotherapist) and the exudation of the wound was minimal. After 2 months, she was discharged and verticalized and she moves a lot more, the secretion increased and we introduced daily dressing with VACUTEX (2) rapid capillary action dressing-not identical to NPWT but has an autologous mechanism similar to NPWT and patient is free from canister holding device and tubes so she can move freely. Epithelialization progressed further so that after 4 months in total we had a completely epithelialized wound without residual defects and without additional operations. Our results coincide with other published results (1, 2) that wound dressing not only protects against contamination but can also remove wound infection, and most importantly stimulates skin regeneration and wound healing. We believe that this is an important advance in the treatment of complex wounds and patients for whom surgery is not an option, and that the results are of the same quality both functionally and aesthetically as surgery, and it certainly represents a great advance in the technical possibilities of treating complex wounds.

1. Healing of Chronic Wounds by Copper Oxide-Impregnated Wound Dressings-Case Series; Eyal Melamed, Patrick Kiambi, Dancan Okoth, Irena Honigber, Eran Tamir, Gadi Borkow; Medicina (Kaunas) 2021 Mar 22;57(3):296. doi: 10.3390/medicina57030296.

2. VACUTEX capillary action dressing: a multicentre, randomized trial; L Russell, M Deeth, H M Jones, T Reynolds; Br J Nurs. 2001;10(11 Suppl):S66-70. doi: 10.12968/bjon.2001.10.Sup2.12346.

Background: Patients with rheumatoid arthritis have slightly increased risk for developing certain types of cancer, most significantly lymphoma. Furthermore, mostly due to RA treatment, many patients develop non-melanoma skin cancer as basal cell carcinoma and squamous cell carcinoma. Hence, does this increased risk of other cancers translate into an increased risk of melanoma? Objectives: This cohort study aimed to investigate the risk of melanoma in patients with RA compared to an sex- and calendar year-matched controls. Methods: We conducted a nationwide, register-based cohort study using Danish National Health Registers. Patients aged 18 years and older diagnosed with RA between January 1990 and December 2022 were included. All patients with a prior melanoma diagnosis were excluded. The cumulative incidence of melanoma was assessed using Kaplan-Meier survival analysis and Fine and Gray competing risks models. Cox proportional hazards regression models estimated hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for age and sex. Results: We identified 40,194 patients with RA and 200.495 control individuals. The crude incidence rate of melanoma was slightly higher in RA patients than in controls. However, Cox regression analysis showed no clinically significant increased risk of melanoma (HR: 1.15, 95% CI: 1.03–1.29, p = 0.0149). Age was a strong predictor of melanoma (HR: 1.03 per year, 95% CI: 1.02–1.03, p < 0.001), while female sex was associated with a lower risk (HR: 0.73, 95% CI: 0.67–0.80, p < 0.001). Conclusion: This study found no clinically significant difference in melanoma risk between the patients and the control group. Hence, the melanoma incidence remained largely comparable to controls. Further research should explore potential risk modifiers in RA patients to refine melanoma prevention and early detection strategies.

Introduction: The surgical management of the cleft lip is designed to restore its functionality and aesthetics and preserve the normal growth of the area involved. The surgical management of cleft lip may be delayed due to the patient presenting late with a hypoplastic maxilla, deformed dental arch, and severely protruded premaxilla. These consequences may worsen after cleft lip repair as complications with surgical intervention, particularly dehiscence of repair or jumping of protruded premaxilla, especially with bilateral complete cleft lips. The purpose of the presented cases is to represent a few ticks on an anatomical basis to avoid previous surgical complications and help the premaxilla settle back efficiently. Methods: The management protocol aimed to prevent post-operative protrusion of the premaxilla after cleft lip repair. The technique begins with lateral osteotomy of the premaxilla with preservation of the overlying periosteum to preserve the vascularity of the premaxilla and to maintain normal growth. The Millard and Tennison technique was used for cleft lip repair. After the repair of the cleft lip, the cement suture was taken using absorbable sutures from the mucosa of the repaired lip to the mucoperiosteum overlying the premaxilla. The muscles were repaired in three slips to avoid shortening of the repaired lip. The cement suture was placed for one month till the premaxilla was settled back. Results; Three cases of complete bilateral cleft lip with severe protruded premaxilla were presented. The cement sutures were used with satisfactory functional and aesthetic outcomes. One of the cases required further reconstruction of the upper lip with an Abbe flap. Conclusion The sutures were placed to avoid post-operative complications and preserve the expected growth of the involved area. Furthermore reconstruction of tightening repaired upper lip may require intervention late with Abbe flap to achieve patient satisfaction.

Introduction: Total wrist arthroplasty (TWA) has emerged as an alternative to wrist arthrodesis for patients with advanced post-traumatic or degenerative arthritis. While earlier generations of wrist prostheses were associated with high complication rates and were primarily recommended for low-demand patients, fourth-generation implants show promising results in restoring wrist mobility and function. This study evaluates the functional outcomes of MOTEC® wrist prostheses one year post-implantation.

Methods: A single-center study included patients who underwent TWA with a MOTEC® implant between December 2022 and December 2024 due to advanced wrist arthritis. Functional outcomes were assessed based on total range of motion (TROM) for extension/flexion and radial/ulnar deviation, grip strength, and patient-reported outcome measures, including the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Patient-Rated Hand and Wrist Evaluation (PRHWE) score. 53 patients were analyzed, 80% of whom had post-traumatic arthritis. 28.1% had undergone prior carpal salvage procedures.

Results: At the one-year follow-up, patients demonstrated a significant improvement in wrist mobility, with TROM increasing from a preoperative mean of 70° (extension/flexion) to 110° (p < 0.01). Grip strength improved in parallel with a statistically significant reduction in pain and improvement of overall hand function and daily activity performance, as reflected by a decrease in the PRHWE score from 87 preoperatively to 50 postoperatively (p < 0.01). On a scale of 0 = no difficulty to 10 = impossible, functionality in household tasks improved from an average of 6 to 3.5 (p < 0.01), and work-related functionality improved from 8 to 3 (p < 0.001) within one year after prosthesis implantation.

Conclusion: The results suggest that MOTEC® wrist arthroplasty provides a viable alternative to wrist arthrodesis, particularly due to its substantial improvement in wrist mobility and function. This benefit appears to extend even to patients with prior carpal procedures. While short-term outcomes are promising, further long-term studies are needed to assess implant durability and functional preservation over time.

Background: Trunk masculinization in transmen presents unique challenges due to inherent differences in fat distribution between assigned female and male individuals. While standard gender-affirming chest surgery effectively removes breast tissue, achieving a masculine torso requires additional body contouring procedures. This study explores a novel surgical approach integrating subcutaneous mastectomy, liposuction, and high-definition lipoplasty to enhance masculinization outcomes.

Methods: Between January 2023 and February 2025, 13 transmen (mean age: 24 years) underwent a comprehensive trunk masculinization procedure. The surgical approach included either double-incision or keyhole subcutaneous mastectomy, depending on patient anatomy, followed by abdominal and flank liposuction. High-definition lipoplasty was performed to sculpt the abdominal musculature and create a six-pack appearance. Harvested autologous fat was injected intra- and submuscularly into the pectoralis major to enhance chest contouring. Postoperative outcomes, complications, and patient satisfaction were evaluated.

Results: All patients successfully underwent the procedure without major intraoperative complications. Two minor complications were recorded: one case of nipple graft loss and one instance of wound dehiscence. No infections, hematomas, or other significant adverse events occurred. Postoperative follow-up showed satisfactory healing and maintenance of the sculpted masculine torso. Patient satisfaction, assessed via a standardized questionnaire, was universally high, with all participants reporting improved self-image and alignment with their gender identity.

Conclusion: This novel approach to trunk masculinization, combining subcutaneous mastectomy, liposuction, and high-definition lipoplasty, provides an effective and aesthetically superior outcome for transmen. The addition of pectoral fat grafting further enhances chest definition, achieving a natural and masculine contour. High satisfaction rates and minimal complications were observed in this study

Background:

Over 24 million hand injuries occur globally every year and are responsible for chronic pain, functional impairment and psychological distress [1]. This study aimed to investigate the functional and psychosocial impact of hand injuries and their association with injury severity.

Methods:

A prospective, observational study was conducted in a tertiary hand trauma centre. Patient-reported outcome measures were collected at two and six-weeks postoperatively using the Disabilities of the Arm, Shoulder and Hand (DASH) scale, Derriford Appearance Scale-24 (DAS-24), Conor-Davidson Resilience Scale-25 (CD-RISC-25), Post Traumatic Growth Inventory-Short Form (PTGI-SF), Hospital Anxiety and Depression Scale (HADS) and Short Form-36 (SF-36). The hand injury severity score (HISS) and demographic data were obtained from medical records.

Results:

There were 62 participants at baseline and 44 (71%) at follow-up. The mean age was 44 (range 20-72) with a male preponderance (89%). The mean HISS was 38 (range 2-204), with 21% scoring severe injuries. HADS and DASH scores were less favourable than the general population means. HADS, DASH and SF-36 scores significantly improved at follow-up. Scores were not significantly correlated with HISS.

Conclusion:

Our results demonstrate notable psychological distress and functional disability, irrespective of injury severity, highlighting the need for psychological input in hand trauma management.

References:

[1] Crowe CS, Massenburg BB, Morrison SD, et al. Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017. Study Injury Prevention. 2020, 26:i115-i124.

The surgical treatment of tuberous breasts presents several technical difficulties that can be addressed with some simplifications with the proper technique and implant (1). The gradual expansion of the lower pole can be of great help in breast modeling. We present the results of our personal technique developed over the last eight years. Between November 20216 and December 2024, 482 cases of tuberous breast were treated with some personal modifications to the techniques described and with the aid of a smooth-surface implant that allowed a gradual expansion of the lower pole thank to a low tendency to capsular ingrowth. Expansion was measured thanks to a 3D graphic analysis software. Lower pole expansion in the tuberous breast showed a constant and measurable increase during the first six months postoperatively and then stabilized at one year. The mean duration of follow-up was 32 months and expansion remained stable after the first year. The use of a modified technique that allows gland redistribution and expansion together with a specific type of implant and surface that allows a gradual expansion of the lower pole, facilitate the preparation of the breast tissues and represent a great advantage in the outcomes of the treatment of the tuberous breast.

(1) The Surgical Treatment of Tuberous Breast Deformity: A Review Article Daniel El Israwi , Jean Paul Makdessi , Samer Bassilios Habre Ann Plast Surg. 2023 Sep 1;91(3):395-399

Purpose: Lymphaticovenous anastomosis (LVA) is a surgical technique that alleviates lymphedema by creating a bypass between the lymphatic vessels and veins. Patient outcomes are improved by anastomosing the functional lymphatic vessels. However, these vessels are often degenerated in advanced lymphedema stages, making their identification challenging. LymTracer, a fine 0.3-mm wire that can be inserted into lymphatic vessels, is used to identify proximal difficult-to-detect functional vessels. This study aimed to assess the potential of LymTracer to preoperatively identify the difficult-to-detect central lymphatic vessels in patients with advanced lymphedema. Methods: Between December 2022 and July 2024, 18 patients with advanced secondary lower-limb lymphedema underwent LVA at our institution. Preoperative indocyanine green (ICG) lymphangiography revealed ≤2 suitable sites for anastomosis in all patients. A lymphatic wire was inserted into the most proximal lymphatic site identified via ICG lymphangiography. When the wire was advanced centrally by >10 cm under radiographic guidance, an additional incision was made for further anastomosis. Subsequently, patient outcomes of the additional anastomosis and non-additional anastomosis groups were compared. Results: All patients exhibited secondary lower-limb lymphedema, but only nine underwent additional anastomosis. On average, LymTracer was advanced centrally by 12.0 ± 10.8 cm (maximum: 35 cm) from the initial incision. In the additional anastomosis group, lymphatic vessels at the initial and additional incision sites were compared. Vessel diameters were 0.63 ± 0.14 and 0.66 ± 0.18 mm (P = 0.68) and depths were 6.2 ± 2.2 and 12.7 ± 3.3 mm (P = 0.0003) at the initial and additional incision sites, respectively. At 6 months, limb volume reduction was 5.7 ± 7.7% in the additional anastomosis group and 2.4 ± 8.6% in the non- additional anastomosis group (P = 0.24). Bioimpedance analysis revealed a segmental water volume reduction of the affected limb of 13.1 ± 9.6 and 2.8 ± 9.5% (P = 0.05) in the additional anastomosis and non-anastomosis groups, respectively. Discussion: Lymphatic vessels are often degenerated in advanced lymphedema, making their identification difficult. ICG lymphangiography reliably detects the functional vessels, but not the deep vessels or those with dermal backflow, in areas with linear patterns. Here, LymTracer helped to identify the lymphatic vessels in half of the cases, facilitating additional anastomoses at more central sites. Although no significant difference in diameter was observed between the central and peripheral vessels, central lymphatic vessels identified by LymTracer were significantly deeper than those identified via ICG lymphangiography. These findings demonstrate the superiority of LymTracer over ICG lymphangiography in identifying the difficult-to-detect functional lymphatic vessels. Especially, segmental water volume of the affected limb was significantly decreased in the additional anastomosis group. Overall, LymTracer improved the postoperative outcomes of patients with advanced lymphedema by aiding in the identification of suitable vessels for LVA. Conclusion: LymTracer is a valuable tool to identify the functional lymphatic vessels for LVA in patients with severe lymphedema, potentially improving their surgical outcomes.

The lip-nose complex is an important aesthetic subunit of the mid and lower face. This cross sectional descriptive study aims to establish the norms of the lip-nose complex among the main ethnic races in Malaysia, namely the Malaysian Malays, Chinese and Indians, and to compare the variations between them. Seven parameters of the lip-nose complex namely mouth width, cupids bow width, columellar width, nasal width, lip height, columellar height and dome height were measured using standard anthropometric measurement tools. Three hundred sixteen-year-olds were randomly selected from three schools in Kuala Lumpur, with equal gender and ethnic distribution. Results obtained showed that all seven parameters of the lip-nose complex in Malay, Chinese and Indian males were consistently larger than their respective female counterparts. The difference in lip-nose complex measurements for mouth width, nasal width, lip height and dome height were statistically significant between Malays, Chinese and Indians. Mouth width was highest in Malays. Nasal width was widest among Malays. Lip height was highest amongst Indians. Dome height was highest amongst the Chinese. The cupids bow distance, columellar width and height showed minimal difference within the three races (p>0.05). Malays and Chinese differed in all parameters except cupids bow width. Malays and Indians only differed in mouth width and nasal width. Chinese and Indians differed in lip height and dome height. Malays and Chinese show differences in their lip-nose complex profile although both ethnic groups are classified as Mongoloids. Malays and Indians differed in width measures, while the Chinese and Indians differed in height measures. The variation of anthropological measurements among the three ethnic groups reinforces the need to have individualized norms. These findings form a valuable guide to the reconstructive surgeon especially when dealing with unilateral and bilateral cleft lip repairs.