title: Small-wave plasty for correction of lip length deficiency: a case report.
abstract: BACKGROUND
  Lip reconstruction may lead to disappointing results due to secondary deformity and visible scars. The Z-plasty in the Tennison technique is an effective method for repairing the upper lip subunits. The main issue is the visible and ungracious scar.
  
  
  METHODS
  A 38-year-old woman was treated for an upper lip deformity secondary to a dog bite injury. At 1 month after a direct suture, a scar contracture with a defect of Cupid's bow and a vermilion height deficiency occurred. A Tennison procedure was chosen to repair the deformity. A small-wave incision procedure also was considered to minimize visibility of the scar. These two techniques were coupled in a small-wave plasty. The small-wave plasty design was performed with a superior flap base (L1) of 7 mm and a circle arc of 10 mm. The superior height (H1) was 3 mm. The middle flap base (L2) was 4 mm, and the circle arc was 6 mm. The middle height (H2) was 2 mm.
  
  
  RESULTS
  The surgery time was 55 min with the patient under general anesthesia. The skin healing was completed in 10 days without scar contracture. The upper lip subunits were reconstructed with a regular Cupid's bow and a symmetric vermilion height. The scars were slightly visible at 1 month postoperatively. The results were stable after a follow-up period of 12 months. No revision was needed.
  
  
  CONCLUSIONS
  The small-wave plasty, which couples a Tennison technique with a small-wave incision procedure, is efficient in reconstructing the subunits of the upper lip after a scar contracture deformity. This method should be used for upper lip reconstruction for minimal scar visibility.                                LEVEL OF EVIDENCE  V:                  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors                      www.springer.com/00266                                        .
authors.affiliation: Department of Plastic and Reconstructive Surgery, Sud Francilien Hospital, University Paris Sud XI, 116, Bd Jean Jaurès, 91100, Corbeil-Essonnes, France. bayestaray@yahoo.fr
authors.forename: Benoit
authors.initials: B
authors.lastname: Ayestaray
authors.forename: Farid
authors.initials: F
authors.lastname: Bekara
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Andreoletti
mesh_terms: D000328:Adult; D000818:Animals; D001733:Bites and Stings / Q000601:surgery*; D004285:Dogs; D005260:Female; D006801:Humans; D008046:Lip / Q000293:injuries* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D013524:Surgical Flaps