Soft tissue assessment in midface advancement: the use of regional flaps to enhance facial projection

Classically, soft tissue repair when indicated is done before or after the skeletal mobilization especially in those cases that present midface deficiency with severe midline soft tissue restriction by scars or congenital affectation. The distraction osteogenesis method has contributed to improve substantially this problem elongating bones, muscles, and ligaments, but some situations need specific and more precise reconstruction of the subunits to gain in aesthetics. The labial-columella junction, the tip of the nose, and the more projecting point of the cheeks are one of these exigent anatomic areas, where only sophisticated reconstruction by flaps can improve facial proportions and projections.