Lips are an essential aspect of the human face, a vital component of symmetry and aesthetics. They play a critical role in facial expressions, phonation, eating, physical attraction, and intimacy [1]. Since the beginning of recorded history, individuals across cultures have search for various treatments and procedures like injectable fillers, implants, and laser to achieved “beautiful” lips [1],[2],[3]. According to the 2022 American Society of Plastic Surgeons Procedural Statistics more than one million people got lip fillers in the last year. And if the lips are considered a vital component to young women, why would not they be to all women across ages? It is crucial to keep, and not withdrawn the lip’s aesthetic in older women. People worldwide are living longer and research into ageing issues in the Plastic Surgery field must be a priority [4]. As concern to skin cancer, older individuals with sun-damaged skin are prone to develop cutaneous malignancy, such as squamous cell carcinoma, and this is the most prevalent reason for lower lip reconstruction [5],[6].

Lower lip reconstruction is challenging due to multifunctional and high aesthetic requirements that must be achieved for a successful outcome [5],[6],[7],[8]. The reconstruction is done according to dimension, location of the defect and the patient’s appearance [4].

Although many methods of lower lip reconstruction have been reported, when a large defect of the lower lip is presented, the choice of reconstruction method is often difficult [7]. For older patients, considerations like nutritional status, medication, and overall health status are crucial in the planning process [8].

Surgery always gave priority to oncological cure and only after pursued aesthetic and functional correction [7],[8],[9], but nowadays a good outcome in surgical oncology must guarantee both. Due to longevity, the quality of aesthetic reconstruction is increasingly important in deal to social relationships. So, it is important to adjust the surgical plan to address individual issues like self-esteem and lifestyle [4],[10],[11]. Self-esteem is understood as how one sees and feels oneself and is linked directly to quality of life [1]. Therefore, planning and discussing surgical outcomes with the patient is crucial because, opposite to common misconception, body image is meaningful to self-esteem in older adults [4],[11].

A 90-year-old female was referred to the Plastic Surgery Department of our hospital for evaluation of a large tumor of the lower lip. The lesion has gradually enlarged in size in recent months. The clinical examination revealed a 35×20 mm tumor, firm and friable, but not painful on palpation (Figure 1A).

There was no evidence of submandibular or submental lymph node on palpation, abnormalities on intraoral examination, nor suspicious lesions/lymph nodes on computed tomography (CT) scan. Provisional clinical diagnosis of squamous cell carcinoma of the lip was given. Surgical excision of the lesion was performed under local anesthesia. After tumor resection, the defect was evaluated according to the size encompassing over roughly 2/3 of the lower lip. The reconstruction was initiated by W-plasty in the lower-lip, in traditional way (Figure 1B).

The remaining defect was measured, and the second part of the reconstruction began by designing the Abbé flap, slightly larger, to achieve greater tissue recruitment (Figure 1C and Figure 1D). After two weeks, the pedicle of Abbé flap was divided under local anesthesia.

Adequate oral competence and satisfactory symmetry were achieved. The patient did not report problems with the use of denture prostheses (Figure 2A,Figure 2B, Figure 2C).

What is invisible in the photos is the patient’s satisfaction and happiness with her appearance and the recovery of her normal life, which gave her great comfort and security, since the cancer stigma was washed off. This patient, who lives in a rural region, after the two procedures, went back to her house and resumed her normal routine including traditional diet, which excludes soft or liquid diets. For the surgeon contemplating his work, the result is “for them” a very moving serenity [1].

Plastic Surgery is not only about big and challenging procedures, note that certain surgical procedures, such as free flaps, are not appropriate for some elderly patients, due to morbidity and not acceptable aesthetics [6],[7]. In these cases, simple small improvements given by old techniques have a major impact on oneself freedom and quality of life.

Our technique of combining W-plasty with Abbé flap provided functional reconstruction in two stages, both amenable under local anesthesia. Although separately, both techniques have been described and are well established in literature, the effective combination of the two procedures has not been described and can be a valuable option.

New complex techniques like microsurgery focus on reconstruction with less aesthetic concerns and, sometimes, with more donor site morbidity. It is time to restore the beauty in oncological treatment, especially for elderly patients with lip cancer, whose oncological needs are already being addressed. To achieve this, we must revisit old surgical techniques, developed by surgeons who faced similar challenges without the aid of modern technology. These methods are simpler, less traumatic, and prioritize both function and aesthetics. That is the art of Plastic Surgery: tailoring procedures to heal, and restore the beauty and function, allowing patients to maintain their quality of life.