Cleft lip nose reconstruction

About the procedure

Patients who are born with a cleft lip often have an associated nose deformity, which is called the cleft lip nasal deformity, or cleft nose. Depending if the cleft lip is a unilateral or bilateral cleft lip, the cleft nose takes on a characteristic shape although the deformity varies in severity. Although patients with cleft nose deformity may undergo multiple nasal surgeries in infancy and childhood, they can still have a residual deformity or breathing difficulty when they get to their high school years or young adulthood.  Because most cleft lip and palate multidisciplinary teams only treat patients until age 21, it is often difficult for patients with residual cleft nose deformities to find surgeons with experience treating adult cleft nose deformity.

Classically, the unilateral cleft lip nose deformity shows asymmetry between the cleft and non-cleft sides, with the cleft side nostril less projecting and wider. The base of the ala may be asymmetric as well, with the cleft side displaced posteriorly and superiorly. The septum is often deviated with an enlarged inferior turbinate, which makes breathing difficult. The columella may be short and constricted.  Finally, the nostril sill, where the opening of the nose meets the upper lip, is usually depressed and flattened.

Similarly, the bilateral cleft lip nose deformity has a characteristic appearance as well. Typically, the left and right sides are not extremely asymmetric but the nostrils may be very deformed in shape and may be abnormally oriented. The nasal tip is often broad, and the columella on the underside of the nose is usually very short.

A cleft lip nasal deformity reconstruction, or cleft nose rhinoplasty is different than a standard rhinoplasty in that the anatomy of the cleft nose is distorted and cartilage structures are not normally shaped.  Additionally, there frequently is scar tissue present within the nose as a result of previous surgeries.  Dr. Hirsch combines the aesthetic principles of cosmetic rhinoplasty with the tenants of nasal reconstruction to restore the shape of the noses of patients with cleft lip nasal deformity. He individualizes treatment to the shape and function of each patient’s nose, and uses a combination of suture and cartilage grafting techniques to achieve the desired result. The goal of each cleft nose rhinoplasty is an improvement in both nasal appearance and function! 
For patients who are under the care of a multidisciplinary cleft team, Dr. Hirsch will work with your team and lend his expertise to the treatment of the cleft lip nasal deformity.

After surgery, depending on what was performed, a nasal splint (on the outside of the nose) or nasal stent (on the inside of the nose) may be used for 3-7 days to help minimize swelling after surgery. Cleft lip nose deformity reconstruction patients may experience swelling of the nose and occasionally bruising around the eyes and cheeks for 1-3 weeks following surgery. Swelling of the nose, especially in revision cleft lip nose deformity reconstruction when extensive reshaping is performed, can take several months to resolve. However, pain is usually mild, and patients are able to resume normal activities 1-2 weeks after surgery.

Frequently asked questions about cleft lip nose deformity reconstruction:

My child is 8 years old and has a cleft lip nose deformity. Can Dr. Hirsch improve his appearance?


Cleft lip nose reconstruction can be performed at any age. In general, rhinoplasties for cleft lip nasal deformity are performed at 3 age groups: in infants (at the time of the cleft lip repair), in school age children, and after growth is complete (16-18). Usually, the rhinoplasties that are performed in infants and in school age children focus on tip work only, and do not involve extensive repair of the nasal septum out of concern that damaging the nasal septum at an early age can interfere with long-term nasal growth. There are benefits to performing rhinoplasty at the younger ages, and there are benefits to waiting to perform a definitive rhinoplasty until your child is full grown. During your consultation with Dr. Hirsch, he will discuss the specific characteristics of your child’s nose and help your formulate a treatment plan that works best for you.

I was born with a cleft lip and I have had multiple nasal procedures and my nose is still asymmetric. Can anything be done about this?


Yes, it is possible to improve the appearance of your nose despite having undergone multiple prior nasal procedures. With each procedure however, there is more scar tissue formation in the nose, and there is a higher risk of damage to the external nasal skin. In order to combat the forces of the scar contracture, Dr. Hirsch will frequently use cartilage grafts to support the nose and hold it in the proper position following rhinoplasty.

Can my breathing and appearance be improved at the same time?


Patients with cleft lip nasal deformity often have severe difficulty breathing through their noses due to warped nasal cartilage in the nasal septum and corresponding hypertrophy of the turbinates. These characteristics are all repairable through surgery, and the cartilage that is blocking airflow can be removed and then replaced to help improve the aesthetic appearance of the nose. Breathing surgery and improving the aesthetic appearance of the nose at the same time is certainly possible!

My child is followed by a multidisciplinary cleft team, and Dr. Hirsch is not a part of that team. Can he still perform my child’s nose surgery?


Even if Dr. Hirsch is not part of your multidisciplinary cleft team, he will be happy to evaluate your child and evaluate if he can improve the appearance of the nose or improve breathing. He will always communicate with your cleft team regarding his plans for surgery. If your child is followed by a multidisciplinary cleft team, please mention this to Dr. Hirsch at the time of your initial consultation.

Additional resources about cleft lip nose deformity reconstruction


Feel free to browse the following links to learn more about cleft lip nose deformity reconstruction:

http://www.rhinoplastyarchive.com/articles/cleft-lip-rhinoplasty

Dr. Elliot Hirsch

Meet Dr. Elliot Hirsch

Los Angeles plastic surgeon Dr. Elliot M. Hirsch has been educated at some of the most prestigious institutions in the country, including Johns Hopkins University, the University of Southern California, and Northwestern University. He is an active researcher and has published over 40 original papers and book chapters, and holds patents for his inventions in plastic surgery. Dr. Hirsch’s specialties include not only aesthetic surgery, but reconstructive surgery with special attention to aesthetic detail to ensure that patients achieve the best possible results.

To read more about Dr. Hirsch, please visit his extended biography page.


Read Dr. Hirsch's Biography