Christopher Derderian, MD

The phases of cleft care are age dependent. The facial bones are fully grown at about age 16yo for females and 18 yo for males, so your face has been fully developed for some time. From your pictures there appear to be 2-3 issues related to your bite and dentition. The arch of the upper teeth may be narrower than the lower teeth which can affect how the teeth fit together. The upper jaw is behind the lower jaw causing an underbite. The ways to fix this usually requires the upper jaw to be moved forward to fix this. Rarely, the lower jaw may have some overgrowth requiring surgery also. You are missing several of the front teeth. This would require either dental implants to be placed. An alternative would be a dental bridge. The best thing to do would be to see a cleft lip and palate surgeon with experience in these problems to see which if any of the above would be a good treatment option for you. There are several experienced surgeons at the Children's Hospital of Philadelphia who can help you with these issues.

I appreciate your question and understand your concerns. The asymmetry in your left nostril is either due to scar tissue that restricted growth of the cartilage and skin; or is part of the original shape changes in the nose that accompanied the cleft lip that were not addressed with your other surgeries. Much of what you described and what the photos show demonstrate typical changes in the nose that occur with growth following cleft lip repair. The step off of the lip where the pink (vermilion) and white (skin) portions of the lip meet and the uneven bulk in the vermilion can be addressed with lip revision. The hole between the lip, gum and nose is called a nasolabial fistula. This can be addressed at the time of the lip revision. 

I recommend seeking a consultation for rhinoplasty and cleft lip revision from a surgeon with extensive experience in cleft lip repair and cleft rhinoplasty. Cleft rhinoplasty is very different from an average cosmetic rhinoplasty because the surgeons needs to have experience with cleft lip repair techniques and the usual patterns of scarring after cleft lip repair to have a successful result. The same is true for cleft lip revision. Surgeons who are part of an ACPA designated cleft team or have previously been part of a team would likely have the most experience in caring for patients with clefts. The ACPA website lists all of their teams and their locations.

It is common for patients to seek revision of cleft lip repair if they have an unsatisfactory result. Insurance will often cover this type of surgery but calling your insurance company is an important step in planning.

I recommend seeking a consultation for revision of your lip repair from a surgeon with extensive experience in caring for children and adults with cleft lip an palate. Your surgeon needs to have experience with cleft lip repair techniques and the usual patterns of scarring after cleft lip repair to achieve a successful result. Surgeons who are part of an ACPA designated cleft team or have previously been part of a team would likely have the most experience. Best of luck.

The asymmetry in the lip and nose in your photos are common after cleft lip repair. The changes in the nasal shape are primarily caused by scar tissue that restricts growth of the cartilage and skin or areas that were not fully addressed with your early repairs.  With regard to the lip, I believe that some improvements can be made in the symmetry, but there will always be a scar that can be detected if someone looks closely. The goals of you treatment should be to remove the obvious signs that you had a cleft which I hope will relieve any unwanted attention or self consciousness you have regarding the appearance of your lip and nose. 

I recommend seeking a consultation for cleft rhinoplasty and cleft lip revision from a surgeon with extensive experience in caring for children and adults with clefts. Cleft rhinoplasty is very different from an average cosmetic rhinoplasty because the surgeons needs to have experience with cleft lip repair techniques and the usual patterns of scarring after cleft lip repair to have a successful result. Surgeons who are part of a designated cleft team or have previously been part of a team would likely have the most experience. 

The changes in the nasal shape that accompany cleft lip can vary significantly in their severity. Surgeons usually take steps to correct the uneven appearance of the nose at the time of the cleft lip repair and most have good success. As children with repaired cleft lip grow, especially during the rapid growth of the nose accompanying puberty, the nose will assume a similar shape to the original cleft deformity. This asymmetry is primarily caused by scar tissue that restricts growth of the cartilage and skin. Much of what you described and what the photos show demonstrate typical changes that occur with growth following cleft lip repair. 

I recommend seeking a consultation for rhinoplasty from a surgeon with extensive experience in cleft rhinoplasty. Cleft rhinoplasty is very different from an average cosmetic rhinoplasty because the surgeons needs to have experience with cleft lip repair techniques and the usual patterns of scarring after cleft lip repair to have a successful result. Surgeons who are part of an ACPA designated cleft team or have previously been part of a team would likely have the most experience. Best of luck.