This is a young baby with a unilateral incomplete cleft lip. In this condition, the cleft partially involves lip. Often the esthetical expectation of the parents is often high and needs to be met. Parents often expect a miraculous and immediate result on table. However, though it appears simple, this condition need to be treated as a complete cleft lip only.
The correction is challenging. The affected side nares are depressed. From the lower lateral cartilage, a suture is placed and the assistant is asked to lift the nares to the most satisfactory position. The entire musculature is adjusted and corrected so that at the end of the surgery, the depressed nares are corrected.
Also, care must be exercised so that no tissue is wasted during the procedure.
To ensure the correction of cleft, from the lateral aspect of the cleft, a C flap incision is placed in a modified way towards the nasal sill. This technique, a Modified Millard’s Technique will have no multiple incisions or scars as seen in regular alar base incision. This would help to prevent the unsightly scars. A Z plasty needs to be performed to ensure minimal or no scar contracture at a later date. Also by this the notching is prevented. The orbicularis oris sling is reconstructed and the labial frenum is not disturbed. The orbicularis oris muscle sling is reconstructed and confirmed. The vermilion stitch along the segment or margins of the orbicularis oris gives a perfect length and appearance. This also prevents the notching of the vermilion border.
At the end of the surgery, the nares are nearly normal, muscle sling is complete and aesthetics is the best.

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