Why is There So Much Disparity Between Surgeons for a Cleft Lip Revision?

As a 28 y/o woman looking at a cleft lip revision and septorhinoplasty, I have had some different consultations. Undoubtedly each patient's case is different, thus necessitating a different approach. However, in my experience all of the surgeons (all ASPS members) have quite conflicting opinions. I am not sure who to trust anymore! For example, with the notching of the lip, one doc says repairing the superficial muscle is the solution, another a dermal graft, and yet another says to inject fat..

Doctor Answers 4

Matching what the surgeon sees with what you want in Cleft Lip Revision and Rhinoplasty

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Dear KatrinQ

I can see why the different opinions on a rhinoplasty and cleft lip revision can be confusing.  

Most of my consultation is spent talking about what you see and what functional problems are involved (e.g whistling, nose obstruction, nose bleeds, etc)

All of the three things that other surgeons recommended can be very useful procedures for the right situations.  

The kind of revision of the lip  and nose depends on a lot of factors like:

1) your skin type,

2) color of the scarring

3) muscle movement of the lip 

4) assymetry of the nostrils and lip, and

5)  even the underlying structure of your facial bones.

The final decision on what procedures are best are based on your view of yourself,

balanced by what the cleft surgeon observes and matched to the most effective techniques. 

I hope this helps.   Regards Dr. T



Sacramento Facial Plastic Surgeon

Experience counts

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Cleft surgery, especially revisional cleft surgery, presents challenging problems for both the surgeon and the patient.  Plastic surgery is a unique specialty in that there are many different solutions for any given problem.  Conflicting opinions from board-certified plastic surgeons doesn't mean you should lose trust in the surgeons, but illustrates that there are multiple different ways to approach your specific problem.  The "right" answer is one that you and your surgeon decide is the right solution for you given risks, benefits, and potential outcomes.


That said, if you were my sister, I'd want you to see a surgeon who is fellowship trained in craniofacial surgery and has experience dealing with clefts - both initial repair and later revisions. 


Hope that helps,

Dr. Hall

Jason J. Hall, MD, FACS
Knoxville Plastic Surgeon
5.0 out of 5 stars 12 reviews

CLeft Lip Repair Discrepancy

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Discrepancies can arise among clinicians based on their education, school of philosophy and experiences.  DO a lot of consultations and research.  It also depends on what your expectations are.  I am aware of one facial plastic surgeon with a cleft lip repair himself so he would be a good source because he has lived it and obviously had the opportunity to really investigate and do what is best for himself.

Lawrence Singer, DMD
Washington Dentist
5.0 out of 5 stars 4 reviews

No substitute for a cleft surgeon with lots of experience in cleft work

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Many problems will have multiple solutions, none of which are necessarily wrong. This is where your in-person consultation becomes critical. Not all cleft lip/nose problems are equal. There is no one magic bullet. Rhinoplasty for people who have had their cleft lip/palate repaired tends to be one of the most difficult types of noses to correct. There are aesthetic and functional considerations that need to take into account the underlying abnormal anatomy. Failure to do so will result in multiple attempts at revision, each effort becoming more difficult than the last due to excessive scarring. Problems with breathing can also result. Cleft lip revisions follow this type of complexity and challenges faced. I would highly suggest that you look into a consultation with a skilled board-certified plastic surgeon in your area who is part of a craniofacial or cleft center that routinely sees patients such as yourself. These plastic surgeons tend to deal with cleft patients at all stages in life and are familiar with the challenges I have described. All the best...

Andre Panossian, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 4 reviews

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.