BACKGROUND. When closing surgical defects, optimal aesthetic results are obtained when cosmetic units are preserved and, whenever possible, when scars are placed in naturally occurring creases and folds. This is particularly challenging in the perialar region, where surgical defects can encompass more than one cosmetic subunit. OBJECTIVE. To examine the reconstructive options and to demonstrate that the crescentic advancement flap for closures of defects in the perialar area is a superior alternative. METHODS. This is a review of surgical approaches, a historical examination of perialar repairs, and an illustrative case. RESULTS. A patient with a perialar defect was reconstructed using the crescentic advancement flap with excellent postoperative results. CONCLUSION. When compared with the other options, whenever feasible, the crescentic advancement flap, which has evolved over the years, remains a superior option for defects in the perialar location.
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