Hyaluronic acid lip filler in a male patient with unilateral cleft lip: a case report

Abstract

Introduction

Cleft lips are complex congenital malformations that, in addition to morphological changes, can be associated with significant psychosocial repercussions, impacting self-image and social integration. They are usually addressed by multidisciplinary teams and, although early surgical correction can resolve most functional changes, structural asymmetries and residual aesthetic complaints often persist into adulthood. Hyaluronic acid filling has been described as a complementary minimally invasive approach in these cases.

Objective

To report a clinical case of lip filling with hyaluronic acid in a male patient with a history of unilateral left cleft lip who had previously undergone corrective surgery.

Method

Extraoral antisepsis was performed with 0.2% chlorhexidine and intraoral anesthesia with 2% lidocaine associated with 1:100,000 adrenaline. For perioral and lip restructuring, 1 ml of hyaluronic acid (Restylane Kysse®) was used. Two incisions were made at the level of the Cupid's bow bilaterally, followed by subcision of the scarred area of the upper lip with a 22G 50-mm cannula, aiming to release fibrotic adhesions (Serratine & Barbosa, 2022). Filling was performed predominantly with a linear retroinjection technique using a cannula, complemented by a fan technique to support the white lip in the scar tissue region and controlled eversion of the vermilion with a 30G 1⁄2 needle. A larger volume was used on the left side of the lip, corresponding to the previously affected side. Immediately after the procedure, slight edema and small hematomas were observed, with no relevant pain complaints.

Clinical case description

A 27-year-old male patient reported persistent aesthetic dissatisfaction after surgical correction of a unilateral left cleft lip performed in childhood. Clinical examination revealed asymmetry of the lip vermilion, slight sinking in the scar area of the upper lip, and structural unevenness between the hemilips. There was also a reduction in the support of the left alar base, with collapse of the nasal wing and slight narrowing of the ipsilateral nostril.

The scar was linear and slightly hypochromic, with a fibrotic component on palpation and decreased elasticity. The therapeutic plan was designed to improve the volume, contour, and symmetry of the region, preserving characteristics compatible with male lip morphology.

The presence of fibrotic tissue is a technical challenge, as it can interfere with the homogeneous diffusion of the gel and compromise the predictability of the result. Prior subcision favored mechanical

release of adhesions, allowing better integration and distribution of hyaluronic acid in the area affected by the scar.

The procedure proved essential for restoring the balance between the hemilips and improving the lip contour, reinforcing the need for individualized planning that respects the morphological characteristics specific to males.

Limitations include the restricted follow-up period and the possible need for a complementary session to refine the treatment, considering the initial complexity.

Conclusion

The hyaluronic acid treatment improved lip symmetry and upper lip support, with adequate tissue integration after one month of follow-up. In cases with residual post-surgical cleft lip alterations, the intervention should be progressive and judicious, considering the anatomical specificities and the need to maintain proportions compatible with the patient.