37 Yr Old, Would Like Continuing Nostril and Upper Cleft Lip Repair, Is This a Possibility?

Born with bilateral cleft lip and palette,10 surgeries since birth including 3 bone graft attempts. Last graft was semi-successful with bone taken from skull. Also had cartilage taken from ears to revise nose and create more of a tip (very flat before) Q: gaping holes of the nostrils due to having no nostril sill, can this be fixed/created/manufactured in some way or from some other part of me? Also the flatness of upperlip. Can ANYTHING be done about either of these? PS Scared of abbe flap

Doctor Answers 1

Possible, yes...but difficult.

Secondary surgery for cleft lip and nostril deformity tends to become more difficult with each attempt at correction. Scarring can warp the delicate cartilages of the nose and make subsequent revision surgery much more risky. In my practice, initial rhinoplasty for a cleft deformity (unilateral or bilateral) is performed when the patient has reached skeletal maturity (ie, 16-18 years of age). At this point, the risk of a bad result is much less. In some instances, when children have "bad noses", I do perform the surgery much earlier in order to avoid devastating social problems. However, these children will often need revisional work later in life. In your situation, I highly recommend consulting a plastic surgeon in your area who frequently performs all stages of reconstruction of cleft lip/palate deformities, especially since multiple attempts have already been made. As for flatness of the upper lip, this is common with bilateral clefts. Adjunct procedures such as Juvederm, Restylane, or fat injections are necessary to give bulk centrally to the upper lip vermillion area. Unfortunately, insurance companies may not cover much of the secondary procedures which can improve appearance, although nasal reconstruction should be covered.

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