Are There Plastic Surgeons Who Work with Adults with Cleft Lip?

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 rhinoplasty is a challenging operation. I often will revise the lip at the same time as the scar can be advanced to make the nostrils more symmetric. I recommend seeing a surgeon who both performs a high volume of rhinoplasty and cleft surgeries. 

Absolutely! From your photo, there are a variety of options to treat your concerns. It would be prudent to see a board certified plastic surgeon with a fellowship in Craniofacial surgery to address your concerns. The options may include cartilage graft from the ribs and revision of your cleft lip with possible fat grafting as well. Good luck!

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. 

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. 

Most cleft plastic surgeons operate not just on babies and children but also on adults as well.

 

yes I do
Need to see full face in all views
cleft lip and nose revisions are part of skilled plastic surgeons who deal with the pediatric , adolescent into adult population

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.

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.

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!