Patients with cleft lip with or without cleft palate undergo reconstructive surgery early in life—but a majority will need further surgery to address the resultant functional and aesthetic deformity of the nose that becomes evident over time.
Cleft rhinoplasty can address these issues, resulting in a more symmetric, aesthetically balanced nose with improved breathing. Cleft rhinoplasty is similar to a traditional rhinoplasty in that it can improve the form and function of the nose. However, this is a much more complicated procedure due to the altered anatomy and scarring from prior interventions, which is why it is important to find a surgeon with the right experience.
Christopher R. Razavi, MD. Call 212-241-9410 or click here to make an appointment.
Christopher R. Razavi, MD, Assistant Professor, Division of Facial Plastic and Reconstructive Surgery, Otolaryngology – Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, explains what you should know before undergoing this complex surgery.
What is cleft rhinoplasty?
Cleft rhinoplasty is a nasal reshaping surgery that essentially addresses form and function issues with the nose resulting from a cleft lip—a congenital defect that occurs in approximately one out of every 1,000 births. This defect most commonly presents unilaterally (on one side of the nose), but it can also be bilateral.
When do patients typically undergo this surgery?
Patients with cleft lip with or without cleft palate generally undergo several surgical repairs during infancy, which start approximately 10 weeks after birth. Cleft rhinoplasty is typically the final procedure in the series of repairs, and it is typically performed between the ages of 15 and 17.
In what cases might someone decide not to get cleft rhinoplasty?
There are cases where the primary rhinoplasty—performed at the initial time of cleft lip repair—results in a nose that looks good enough and works well enough that patients decide not to undergo the definitive cleft rhinoplasty because they are happy with how things are.
How can cleft rhinoplasty help me?
Cleft rhinoplasty can address a wide range of issues related to a cleft lip with or without cleft palate, resulting in:
- A more symmetrical nose
- A more even, slim, and better defined nasal tip
- Increased nasal tip projection
- Increased nose length
- A smoother, better shaped nose
- Enhanced ability to breathe through the nose
Am I a candidate for cleft rhinoplasty?
An evaluation with an expert in facial plastic surgery is a good way to determine if you are a suitable candidate for cleft rhinoplasty. We typically look at physical, functional, and psychologic factors to assess the situation and determine how best to proceed.
There are some patients who have undergone multiple prior rhinoplasties that might make the procedure more challenging. But generally, the contraindications are the same as those for a conventional rhinoplasty, such as a medical comorbidity or instances where the patient’s goals are not realistic.
What happens during the cleft rhinoplasty?
You will undergo general anesthesia, so you will be fully asleep throughout the procedure. While there are several techniques than can lead to favorable outcomes, my team takes a specialized approach that involves using scarred skin from the prior cleft lip repair to enhance the shape and function of the nose. We reposition this scarred skin into the nose, which helps address the relative lack of internal nasal lining on the cleft lip side, and also allows us to revise the cleft lip scar. In this way, we simultaneously improve the appearance of both the nose and the lip scar, while also reducing the need to harvest as much grafting material from other areas of the body. That said, additional grafting material from the rib is typically needed in these cases. This results in an additional incision on the chest.
Why is cleft rhinoplasty challenging?
The degree of scarring from the previous surgeries and the original congenital abnormality often lead to significant asymmetry in the nose. One of the biggest challenges of performing a cleft rhinoplasty is achieving perfect symmetry, particularly when viewing the nose from the base view, or looking up from below the nose. Although we are able to achieve a more natural and symmetrical look for patients using this unique approach, we also take care to set your expectations for outcomes.
Our goal is for improvement, not perfection, but these are things that are applicable to rhinoplasty in general. Ultimately, as much as our focus is on achieving the best possible outcomes for form, we also need to make sure the nose is functional and that the patient’s nasal breathing is optimized.
What should I expect following surgery?
Patients who have undergone cleft rhinoplasty are typically discharged the same day as surgery and advised to take a week off from work or school. To ensure the repair is protected and heals well, we use both external and internal nasal splints to support healing and aid in recovery. We will see you one week post-surgery to remove the splints and assess how well your nose is healing and functioning. Though most patients can return to regular activities two weeks post-surgery and contact sports after six weeks, we advise you to avoid activities that put your nose at risk.
How long will it take to heal?
It can take up to one year for swelling around the nose to completely subside, meaning that the overall improvements to the appearance of the nose may take time to fully appreciate. Despite that, patients who undergo cleft rhinoplasty from an experienced surgeon will likely be satisfied with the outcomes. Whether you want to breathe better, look better, or both, we are here to help make that happen for you.