Cleft Midface Augmentation

Q: Dr. Eppley, I am a 28 yr old who was born with a unilateral cleft lip and palate and have undergone a diced rib cartilage rhinoplasty within the past 6 months. Although I am very happy with the rhinoplasty, I feel a midface augmentation would very much improve any midface deficiency caused by the cleft. I am also interested in a potential forehead augmentation as my forehead slopes back quite a bit with a prominent browbone. Can this all potentially be done in one visit,? I am looking to have this done within the next couple of years. I would like to schedule a Skype consultation to get a better idea of what can/cannot be done in my case. My main concern lies with potential extrusion of any silicone implants in the midface. I have heard some horror stories of infection and extrusion of non-autologous/man-made material implanted into the face, especially into an area with a lot of muscle movement. I look forward to your response.

A: All facial clefts cause some degree of midface deficiency on the clefted side which may become more apparent with an augmentative rhinoplasty. Building up the deficient paranasal/midface area can be very beneficial in the cleft patient and there are lots of ways to do it using various autologous and alloplastic materials. It is a shame this was not done during your rhinoplasty since you had access to one of the best long-term materials to do such midface augmentation…rib cartilage. Since you still have the chest wall scar from the harvest this probably remains a possibility. But considering other options, a wide variety of implant materials exist to do the job. While synthetic implants have a risk of infection, particularly when placed through the mouth, it is fortunately very low. I have put in thousands of facial implants over the past 30 years and these risks are incredibly low in my experience. However it is important to acknowledge that they are not zero. Only the use of your own tissues poses the lowest risk exposure to infection. (and even that is not zero)

I would need to see some pictures of your face for a more detailed assessment of your midface and forehead for further recommendations.

Dr. Barry Eppley
Indianapolis, Indiana