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?
Doctor Answers 10
Adults needing cleft lip or nose revision: seek experienced cleft and rhinoplasty surgeon.
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.
Cleft lip and nasal deformity
Revision Surgery for Adults with Cleft Lip
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.
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Adult Cleft Lip and Palate Reconstruction
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.
Adults with cleft lip
Cleft lip and palate can cause a series of problems for patients as they grow and mature even after the initial repair. Kids with cleft lip and palate as the grow can have more issues with recurrent ear infections than most other kids and often require ear tubes throughout their childhood. The development of adult teeth can be disrupted requiring tooth extractions, bone grafting and dental implants.
As kids reach adolescence , they may notice changes in the shape of their nose that bother them both in appearance and their ability to breathe through their nose. In the typical unilateral cleft lip, the septum is often deviated to the non cleft side, and the nasal tip is not well supported so it can tend to droop. Also the nostril on the cleft side may appear widened, and collapsed because the insertion point of the nostril is further back and down than the other side. Commonly in kids born with cleft lip who have had a repair of the lip as a baby, they may require a septorhinoplasty to correct these issues. Because of inadequate cartilage to support the tip of the nose, many times these surgery can be more complex than the average rhinoplasty requiring cartilage grafts from the rib or ear to help reconstruct the nose.
Lip asymmetries and scarring can become bothersome as well which may be the result of the severity of the original cleft deformity, the original reconstruction surgery, or the patient's body's healing and scarring. Scar revision of cleft lip repair is not uncommon as well and can be done at the same time as a cleft rhinoplasty.
Make sure you consult with a trained and certified facial plastic surgeon or plastic surgeon who you feel comfortable with and is able to explain to you their plans and recommendations.
Adult Cleft Surgery question
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.
Cleft Related Surgeries performed in Adults as well as Children
Most cleft plastic surgeons operate not just on babies and children but also on adults as well.
Adult cleft surgery
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 repair.
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.