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Simple mistakes in identifying precise anatomic points in the distorted cleft lip play an important role in many unsatisfactory results, no matter what kind of lip repair is used.

Fig. 21 and Fig. 22 demonstrate triangular repairs in which a small portion of cupid's bow was discarded, most likely because the surgeon had not correctly identified the high point of the bow on the cleft side.

Fig. 23 shows two examples of poor R-A repairs also resulting from inaccurate marking of the high point of cupid's bow on the cleft side of the philtrum. In both of these examples, the photos on the right highlight the scars and the location of the remaining high and low points of cupid's bow. In the upper example, the high point had been placed too medially; consequently, almost half of the philtrum had been discarded. The lower example shows the opposite problem: the cleft side high point had been placed too far up into the cleft, thus keeping too much medial lip tissue in the philtrum. Proper marking of cupid's bow does not require calipers or measurements; the most accurate marking is done while accurately observing the complete anatomic unit in situ. This is often difficult if attempted from the vertical perspective of the patient's face. This distorted view of the philtrum often does not allow full appreciation of the complete unit.

Fig. 24, from above, and Fig. 25, from below, shows the before and after markings of the cupid's bow done by a resident, looking straight down on the patient's face. Careful inspection of these examples will show that the cleft side high point is located too low. One might argue that calipers would have improved that position. Perhaps; but what if the non-cleft high point were to be incorrectly identified? One can avoid miscalculating the extent of the cupid's bow by simply marking from the perspective of the malrotated philtral unit.

Fig. 26A shows the perspective of the philtrum; Fig. 26B shows the cupid's bow having been marked correctly by that same resident, without calipers, while looking at the philtral unit from its singular perspective.

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