Secondary Nasolabial Aesthetic Revision After Cleft Lip Surgery: A Narrative Review of Scar-Related Deformity and Subunit Reconstruction.

Secondary nasolabial aesthetic revision after cleft lip surgery requires coordinated assessment of scar-related contracture, lip subunit distortion, and cleft nasal deformity. Traditionally, these 2 aspects have been managed separately. This narrative review summarizes a focused, revision-oriented framework in which scar management is considered as an adjunct to staged nasolabial subunit reconstruction rather than as an isolated therapeutic goal. Early scar-directed measures, including tension reduction, silicone-based therapy, pulsed-dye laser, and selected pharmacologic interventions, may improve tissue quality and reduce contracture before definitive revision; however, their use should be individualized because evidence and timing remain heterogeneous. For established secondary deformities, definitive revision focuses on the philtrum, Cupid's bow, vermilion, alar base, columella, and nasal tip using local flaps, cartilage grafting, soft-tissue rearrangement, and orbicularis oris reorientation. This approach restores 3-dimensional (3D) symmetry and natural landmarks. Digital technologies such as 3D photogrammetry, finite element analysis (FEA), and artificial intelligence (AI) enable objective scar assessment and personalized surgical planning. However, current limitations remain, including the absence of a cleft lip-specific scar scale, insufficient long-term follow-up data, and unresolved timing of early interventions in infants. Overall, this review reframes scar management as one component of secondary nasolabial revision and emphasizes subunit-based reconstruction, individualized timing, and cautious interpretation of the available evidence.