LLPs occur in more than 90% of cases of VWS and represent the most important characteristic of this syndrome. If LLPs cause recurrent inflammation by draining secretions or pose a cosmetic problem, the tract of the pits should be completely resected due to the communication with the underlying salivary glands [
6]. Even if LLPs do not result in the above-mentioned problems, chronic secretion of saliva can cause considerable discomfort. The entirety of the tract and its salivary environment must be resected to avoid recurrence and residual mucoceles [
7]. Rizos and Spyropoulos [
4] reported that a sinus tract could extend up to 2.5 cm to the sulcus labialis. Peralta-Mamani et al. [
8] recently published a systematic review of the treatment of LLP in VWS, and found that the use of a vertical wedge excision and inverted-T lip reduction showed better results than simple excision. Simple excision may result in postoperative complications, such as mucocele and pit recurrence [
9]. Other studies have also advocated for the complete excision of LLPs, including the adjacent tissue [
10,
11]. Mutaf et al. [
12] used a split-lip advancement flap to reconstruct the labial tonus and Chen et al. [
13] reported better results in their 34 patients with the inverted -T lip reduction technique. We also advocate for using these techniques and support the proposal made in other studies that fusiform excision alone is sufficient for some patients. However, in some patients with a long sinus tract, the cosmetic results have not been satisfactory when performing simple or wedge excision. VWS is likely to involve a relative deficiency of the midline, which means that
en bloc excision poses the risk of causing a “whistle lip deformity” or another disfigurement in these patients [
4]. We emphasize the need for a tissue-preserving technique to improve aesthetic results in VWS patients, especially those who have long sinus tracts. If surgical resection is performed along a longer sinus tract, there could be a higher possibility of tissue insufficiency. It is difficult to effectively preserve mucosal tissue along the sinus tract using the previously introduced methods. In order to obtain better cosmetic results, the remaining tissue should be manipulated after the sinus tracts are excised with tissue preservation. Therefore, mucosal and muscular tissue surrounding the sinus tract should be carefully dissected in order to minimize the loss of tissue while at the same time performing complete surgical removal of the tract. To ensure total resection of the sinus tract, a marker such as methylene blue or gentian violet solution (as used in this case) can be injected into the orifice to mark the sinus tract [
14]. In conclusion, although LLPs in VWS give the impression that simple excision would suffice, surgeons should keep in mind the possibility of deep extension of the sinus tract. In these cases, injecting dyes and meticulous dissection to minimize the loss of surrounding tissue can produce improved aesthetic results.