Melolabial Flap: Nose, Vula, Advancement, Transposition, Interpolated, Takedown, and Surgical Techniques

Melolabial Flap:

• What is Melolabial Flap?
• Nose
• Vula
• Advancement
• Transposition
• Interpolated
• Takedown
• Surgical Techniques

What is Melolabial Flap?

The melolabial flap is a commonly used local facial flap in reconstructive and plastic surgery, particularly for repairing defects of the nose, upper lip, and adjacent facial structures. It is designed from the melolabial (nasolabial) fold, which allows surgeons to hide scars naturally within existing facial creases. Because the skin in this area closely matches the color, thickness, and texture of nasal skin, the melolabial flap is highly valued for aesthetic reconstruction.

This flap can be performed as a single-stage or multi-stage procedure depending on the size and location of the defect. It is frequently used after skin cancer excision, trauma, or congenital deformity repair. The robust blood supply from branches of the facial artery makes the melolabial flap reliable and versatile. Surgeons may modify the flap into advancement, transposition, or interpolated forms to achieve optimal functional and cosmetic outcomes.

Nose

The melolabial flap is most commonly associated with nasal reconstruction. It is especially useful for defects involving the nasal ala, sidewall, and columella. Because nasal structures demand precise contour and symmetry, the melolabial flap provides excellent tissue match and structural support.

In nasal reconstruction, the flap can restore both external appearance and airway function. Surgeons carefully shape the flap to recreate natural nasal contours while preserving nostril patency. When performed correctly, this technique results in minimal donor-site deformity and a well-camouflaged scar within the melolabial crease.

Vula

In reconstructive contexts, the melolabial flap may be adapted for nearby perioral or vestibular defects, sometimes referred to clinically as involvement near the vula or vestibular region. These areas require flexible, well-vascularized tissue to maintain oral competence and facial expression.

The flap’s proximity to the mouth allows for efficient reconstruction without the need for distant donor sites. Careful planning is required to prevent distortion of the lip or commissure, especially when repairing defects close to oral structures.

Advancement

A melolabial advancement flap involves moving tissue forward in a straight line to cover a nearby defect. This approach is ideal for smaller nasal or facial defects where minimal rotation is required. Advancement flaps preserve blood supply and reduce surgical complexity.

This technique works best when tissue laxity is adequate. Surgeons must carefully design the incision to avoid excessive tension, which could distort facial landmarks or widen scars. Advancement flaps often offer excellent cosmetic outcomes with reduced recovery time.

Transposition

A transposition melolabial flap is rotated over intervening tissue to reach the defect site. This method is particularly useful for lateral nasal or alar defects where direct advancement is not feasible.

Transposition allows greater flexibility in flap positioning but requires careful attention to flap length and arc of rotation. Proper planning helps prevent dog-ear formation and ensures smooth contour integration with surrounding tissues.

Interpolated

The interpolated melolabial flap is a staged procedure used for larger or more complex defects, especially on the nasal tip or ala. In this technique, the flap remains partially attached to its blood supply while healing before final separation.

This approach provides excellent vascular support and allows reconstruction of deeper or structurally complex defects. Although it requires multiple surgeries, interpolated flaps often yield superior long-term aesthetic and functional results.

Takedown

Flap takedown refers to the second stage of interpolated melolabial flap procedures. During this step, the surgeon divides the pedicle and refines the contour of the reconstructed area.

Takedown is typically performed several weeks after initial placement to ensure adequate blood supply. Final shaping, scar refinement, and symmetry adjustments are completed at this stage to optimize the cosmetic outcome.

Surgical Techniques

Successful melolabial flap surgery depends on meticulous planning, precise incision placement, and preservation of vascular supply. Surgeons must consider defect size, depth, and location when selecting the flap type. Layered closure and