Traditional free flap reconstruction of complex head and neck defects has tended to emphasize function over form. However, there are several options to improve appearance in head and neck reconstruction. To reduce morbidity and preserve aesthetics, we have adopted a more technically demanding visor technique obviating an incision through the lower lip through which the resection and reconstruction are performed. Three dimensional (3D) surgical planning with medical modeling can improve efficiency and post-operative appearance. Finally, the use of lipofilling, much as in the breast, can improve contour after complex reconstruction.
For the lip preservation study, a retrospective review was performed of patients who underwent free flap reconstruction of intraoral defects over seven years by a single plastic surgeon. Wound complications, margins of resection, and functional outcomes were assessed. Two standardized questionnaires (DAS24 & QLQ-H&N35) were employed to assess psychological distress and dysfunction from disfigurement, speech quality, and oral function. Pre- and post-operative patient photos were evaluated.
The visor technique for intraoral cancer resection and free flap reconstruction was found to be a safe technique that may improve aesthetic and functional outcomes. Additionally, 3D medical modeling for planning of maxillary and mandibular free flap reconstruction can help better preserve pre-operative appearance, while fat grafting can be a useful adjunct. Representative cases will be discussed.

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