KEYWORDSanterolateral thigh flap; lower lip reconstruction; sialorrhea; tensor fasciae latae Summary Reconstruction for a large lower lip defect is a challenge to reconstructive surgeons. The most challenging problem is to maintain oral competence and prevent sialorrhea. We present three cases of such a defect reconstructed with composite anterolateral thightensor fascia lata free flaps in one stage. The patients reported in this communication had advanced squamous cell carcinoma in the lower lip. A large lower lip defect (>90%) resulted in each case from wide excision of the tumor. A composite anterolateral thigh-tensor fasciae latae free flap was used to reconstruct the defect and to restore the dynamic oral competence in one stage. A tensor fasciae latae sling was attached by two strips sutured together to the upper orbicularis oris muscle in the first case. The four-strip method, a modification of the method described by Serkan, 1 was adopted in the second case. The upper two strips bilaterally sutured to the orbicularis oris muscles in a mode somewhat different from Serkan's method. The tensor fasciae latae sling was attached by two strips sutured to the periosteum of both zygomatic eminences in the third case. The tensor fasciae latae sling of Case 1 failed with persistent sialorrhea. The second case had good oral competence and comprehensible speech ability without sialorrhea. The third case had an acceptable result before he was lost to follow-up. A composite anterolateral thigh-tensor fasciae latae free flap is a good choice for a large lower lip defect to achieve oral competence reconstruction in one stage. Simultaneous dynamic and static suspensions are suggested to maintain oral competence and prevent sialorrhea.