Summary Background  Vermilionectomy is an excisional technique for the treatment of lower lip squamous cell carcinoma and actinic cheilitis. The vermilionectomy defect is usually repaired by a labial mucosal advancement flap. Traditionally, the mucosal wound margins are widely undermined but this can be associated with significant postoperative morbidity.

Objectives  We describe our experience with a modified technique whereby lower lip vermilionectomy defects were repaired by direct primary closure without undermining and present the subsequent cosmetic, functional and sensory results.

Methods and materials  This is a retrospective case series of 21 patients who underwent vermilionectomy repair by direct closure without undermining. Combined data regarding the presence of any postoperative sensory, functional or cosmetic disturbance are presented.

Results  Complete data were available for 17 patients. Minimal sensory disturbance was noted in 10·5% of our patients 6 months postoperatively, which is less than previous studies. Similarly, labial scar tension was less frequent in our series; 94% of the patients were satisfied with cosmesis.

Conclusions  Direct closure without undermining is a simple, reproducible technique for repair of lower lip vermilionectomy defects and leads to excellent cosmetic, functional and sensory results in the majority of patients.