Lip reconstruction after ablative surgery has traditionally relied on primary closure, with free flap transfers emerging as a more recent approach. Cheek skin flaps have often been employed to restore the cutaneous portion of the lower lip. In this study, we describe a combined reconstructive strategy using the Goldstein–Robotti technique to rebuild the vermilion, alongside a buccinator flap to restore the lip’s cutaneous layer and perioral muscles. This double-layer method enables full reconstruction of defects involving more than one-third of one or both lips, including the modiolus, while providing satisfactory functional and cosmetic outcomes. The procedure involves carefully splitting and extending the upper and lower buccinator muscle bundles, performed either individually or together, with blunt dissection to protect facial nerves and vessels and preserve blood supply and partial lip sensation. The technique remains feasible even when facial vessels are ligated during neck dissection by relying on branches of the internal maxillary artery and contralateral facial vessels. We present six cases involving upper and lower lip defects, including commissural involvement, following excision of squamous cell carcinoma or polymorphous adenocarcinoma. All reconstructions demonstrated good aesthetic results, functional recovery, and restoration of tissue symmetry in both static and dynamic states.
