I write this to consult surgery on a birth defect. I’m 31-year-old male who was born with a cleft lip and palate, I had two surgeries as an infant to close the upper part of my lip and palate. I also got speech therapy after these surgeries, so I have no problem in speaking. However, my nose is still asymmetrical. I got one surgery done on my nose when I was 21. I’m not satisfied with the shape of my current nose. It’s still asymmetrical. Can you give me some advice? What should I do now?
What Should I Do for my Cleft Nose? (photo)
Doctor Answers 3
Secondary Correction of Cleft Nose
1) what techniques were performed for your surgery at age 21, and
2) what part(s) of your nasal shape bother you.
Cleft lips impact lower 1/3rd of the nose most commonly and to the greatest degree. Accordingly surgical correction of cleft nasal deformities often centralizes and adds projection to the nasal tip, balances the nostrils, and improves the additional skin that is present to the front part of the nasal opening. Occasionally, the middle and upper 1/3rds of the nose benefits from surgical correction, too. Plastic surgeons who emphasize cleft rhinoplasty are fairly rare, so seek out a surgeon with significant experience, and share the details of your past surgery and your present concerns.
Cleft nose revision surgery
Prior to selecting a surgeon, it's best to clearly identify what bothers you. Is it the asymmetry of the nostril rims, for example...or is it the slight cleft seen on the frontal view? Once you can better identify your concern, the solution will become more apparent. For example, the nostril rim height can be adjusted will filler injections. The cleft and projection can be enhanced with a variety of different implant and graft options. Rest assured, your nose can be refined....maybe even without surgery!
Cleft nasal deformity correction
The nasal deformity associated with cleft lips is one of the most difficult problems to correct. I love doing them precisely because of this challenge. With that said, there are characteristic problems that affect the nose when someone has a cleft lip. I would consider your particular nasal appearance rather mild in comparison to the majority of cleft nasal deformities out there. The lower lateral cartilage on the cleft side tends to be displaced laterally, and repositioning of the alar base during lip repair does nothing to address the flattening that occurs along the nostril sill due to warping. The fix is usually made by reshaping this warped piece of cartilage and giving it support in the form of cartilage graft (eg, columellar strut graft +/- batten & tip grafts). An open technique is a must in order to properly shape the cartilage and to address the perceived shortage of mucosal lining that occurs when the cartilage is reshaped. Above all else, seek the advice of a plastic surgeon specializing in cleft nasal deformities in order to maximize your chance of success.