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Fig.60


Fig.61

It is true that Millard's early diagrams showed the tip of C-flap being placed across the nostril sill and sutured to the tip of the nasal alar base5. Since 1964, however, he has repeatedly written about the proper use of C-flap to lengthen the columella2, 10, 11, 12. In spite of this, one still sees lips in which C-flap has been placed as originally drawn.

Fig. 60 and Fig. 61 demonstrate the kinds of deformities that result from such behavior: a short columella on the cleft side, an abnormal nostril sill, asymmetric alar bases, an obvious scar along the lower (and sometimes the upper) border of the flap. Lips repaired in this manner have no hope of achieving the true potential of a rotation-advancement repair.