After we've made those points, we move to our cupid's bow. The first point we make on our cupid's bow is the low part of the bow, which is the central point. Obviously, the bow points are made of three, two high points and one low point. The low point is marked first and the high points are marked second. The cupid's bow is a straight component to the bow and we mark second, and the cleft-sided filter height is marked third. We make the mark on the vermilion cutaneous junction, but on the cutaneous part of that junction. Once these points are made, we mark a point above the white roll in what is called the gutter point, which is where we'll eventually make our short filter column back cut to add length to the cleft-side filter column. This point is right above the white roll in the concavity of the lip so as to be as unnoticeable as possible. Here we're measuring the cleft-side filter column and comparing it to the non-cleft-side filter column. The non-cleft-side filter column is 6.5 millimeters and the cleft-side is 3.5 millimeters. A minus B minus 1 equals delta 2 and the minus 1 is the Rose-Thompson effect for a direct back cut. So our delta is 2, which means our advancing flap from the lateral lip element has to be 2. The next marks we make are points in the vermilion mucosal junction or the so-called wet-dry junction points. We make these points correspondent with our bow points. We're looking at the thickness of our vermilion because we want to match that vermilion thickness from the medial lip side to the lateral lip side. This thickness will help us determine where our Nordhoff's point is on the lateral lip element. So if we're looking at our lateral lip element, what we're doing is we're first of all looking at the white roll and then we're looking at the vermilion thickness. We want to make sure that the lateral lip element Nordhoff point or the point where the high points of the bow on the cleft-side come together have the same thickness of white roll as well as the same thickness of vermilion. So looking here, I see that the white roll starts to peter out and the vermilion starts to peter out about the same spot. Therefore, we'll go ahead and make our mark. Like I said before, our Nordhoff's point will be vermilion cutaneous junction. Slightly more on the cutaneous part to make our markings and be consistent. This is a point in the operation where you can slow down and take a minute to make sure you're marking exactly where you want to mark. Then we mark our gutter point right above our Nordhoff's point and we mark our vermilion as well, our vermilion mucosal junction. These are the incisions that we make through the vermilion. And then we will get our caliper out to mark our lateral dart, which we'll make up for the shorter side filth row column. And this is a 2mm dart. And the second caliper that we bring into the screen will be for the length of our short side filth row column. So one is a 2mm dart and the other one is the length of our short side filth row column. And we match those up and we leave enough room so that there's a sill closure point and then there's enough tissue for closure from our sill closure point to the top of our filth row column. So here we are marking the equilateral triangle, which makes up our lateral advancing dart. And this is a 2mm dart. Once we've completed the dart and the rest of the lateral lip markings, we go ahead and mark our mucosal cuts. And these are the markings for a unilateral cleft lip according to the Fisher technique.

cleft lip repair

Fisher technique

cupid's bow marking

Rose-Thompson effect

symmetry adjustments