I am 20 years old and reside in Atlanta, Ga. I was supposed to have a third surgery completed at age 12 but was not able to. I now have an asymmetrical nose and the shape of my top lip is uneven with a small gap in the lip itself.
Are There Plastic Surgeons Who Work with Adults with Cleft Lip?
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2810anon
- Atlanta, GA
- 6 years ago
Doctor Answers 9
The asymmetries that you describe and that your photo demonstrates are unfortunately common. The asymmetry can be related to several things, including the extent of your original cleft, the growth of the nose, lip and mid-face over time, and of course surgical technique. Cleft Rhinoplasty (the formal term for the nasal surgery performed for cleft patients) is delayed until an individual reached skeletal maturity (and stopped growing). Based on your information, you would be an appropriate age for this surgery.
Keep in mind that cleft rhinoplasty commonly requires cartilage grafts that are taken from a patient's rib, and used to straighten out the nose and to normalize additional projection in the nasal tip. These techniques are advanced, and you'll find that experienced rhinoplasty surgeons may not perform cleft rhinoplasty and that experienced cleft surgeons may not perform cleft rhinoplasty. The key is to find a cleft surgeon with significant experience in cleft rhinoplasty.
Cheers.
Keep in mind that cleft rhinoplasty commonly requires cartilage grafts that are taken from a patient's rib, and used to straighten out the nose and to normalize additional projection in the nasal tip. These techniques are advanced, and you'll find that experienced rhinoplasty surgeons may not perform cleft rhinoplasty and that experienced cleft surgeons may not perform cleft rhinoplasty. The key is to find a cleft surgeon with significant experience in cleft rhinoplasty.
Cheers.
Many cleft lip and cleft palate patients require additional surgeries because development problems may occur as the patient grows. It is not uncommon for adult patients to have revision surgery to resolve problems related to the lower third of the face. As a double board certified otolaryngology and plastic and reconstructive surgeon with over 20 years of experience performing both pediatric and adult cleft lip and palate reconstruction, I’ve seen first-hand the advantages of having specialized care for adult reconstruction. When you are searching for a reconstructive surgeon, it is imperative to ensure your surgeon is board certified and well-experienced working with cleft lip and palate patients. Fellowship training in craniofacial surgery is also desirable. Since cleft lip and palate patients often need additional surgeries, you should also discuss treatment plans with whomever you elect to perform your procedure.
Most plastic surgeons, facial plastic surgeons (ENT), and pediatric surgeons are trained to do cleft lip, palate, and nose surgery, but not all continue to do them in their practices. Those that do ultimately gain experience in doing both lip and nose revisions, as their young patients' growth can cause unexpected changes in previously-operated areas. Some of these changes require surgical revision(s).
Now that adult age has been reached, changes are no longer occurring in your lip and/or nose. Prior surgery causes scar tissue, and the more there is, the more difficult the revision. (It may even be lucky that you didn't have a third surgery at age 12!) Hopefully, the initial surgeon(s) preserved as much tissue as possible, and now repositioning and adjustment with skilled technique and fine sutures will yield a better result. Each patient has uniques needs and previous scars, though yours (by looking at your photograph) seem fairly common.
Seek an experienced, board-certified plastic surgeon or facial plastic surgeon who continues to do clefts either in their everyday practice, or who has extensive experience in doing charity cleft surgery overseas. In my opinion, he or she should also have at least a decade of rhinoplasty experience, and continue to do lots of these surgeries in their regular practice. As an adult, you would no longer be a candidate for secondary surgery by a pediatric surgeon.
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Cleft lip deformities all too often lead to the sequela you see. The lip was lined up but the maxillary defect and the vermillion defect are obvious. These would be corrected with a rhinoplasty. Bone graft and cheiloplasty.
I believe you will find a number of plastic surgeons with various backgrounds that are willing and capable of treating residual cleft conditions in adults.
Your limited photo shows the need for maxillary bony support beneath the base of the nose as well as asymmetry of the nasal tip and base at the soft tissue level.
The upper lip needs revision to accurately align the vermillion border. The upper lip mucosal contour could be treated with hyaluronic acid fillers or fat grafts to shape the labial tubercle and to add volume to the R upper lip.
Malar augmentation is often a beneficial adjunct for cleft reconstruction to balance the facial profile.
Your limited photo shows the need for maxillary bony support beneath the base of the nose as well as asymmetry of the nasal tip and base at the soft tissue level.
The upper lip needs revision to accurately align the vermillion border. The upper lip mucosal contour could be treated with hyaluronic acid fillers or fat grafts to shape the labial tubercle and to add volume to the R upper lip.
Malar augmentation is often a beneficial adjunct for cleft reconstruction to balance the facial profile.
Most cleft plastic surgeons operate not just on babies and children but also on adults as well.
Of course there are Plastic Surgeons that work on adults with Clefts! That is a large portion of my practice. What you should look for is a craniofacial trained plastic surgeon (board-certified) that actively operates on patients with facial differences. There are plastic surgeons like this in mostly all metropolitan areas. Good luck!
Cleft lip nose deformity is associated with most cleft lips and they are amenable repair after the nasl cartilages have grown sufficiently during early adolencence. The cleft lip scars may also be revised a that time. The nose repair requires not only the aesthetic aspects in restucturing the alar and columellar distortions needs attention but also shuld correct the severe degree septal deformitis present. A well trained experienced surgeon in cleft lip surgery should be able help you. Good luck in finding one.
It is not uncommon for adults with cleft lip and palate to have revision surgery. These may be simple or complex depending on previous treatments and severity of the deformity. See a board certified Plastic surgeon who has expertise in cleft lip and palate repair and dentofacial deformities. Donald R. Nunn MD, DDS
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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