At What Age Can A Cleft Rhinoplasty Be Done For My Teenage Daughter?
Q: Dr. Eppley, I am interested in nose reconstruction (cleft rhinoplasty) for my teenage daughter who was born with a cleft lip. She is fourteen and is looking to have surgery this coming year. I am looking for a plastic surgeon who is experienced with rhinoplasty in clefts and just want her to be comfortable with her appearance.
A: All orofacial clefts (with the exception of isolated cleft palate) has some detrimental effects on the development and appearance of the nose. While the entire nose is almost always affected, the greatest deviations from normal occur in the nasal tip. Because the tip shape is controlled by the underlying septal end and the paired lower alar cartilages, it is particularly susceptible to very noticeable and classic tip shape deformities. Most commonly the lower alar cartilage on the cleft side is weak and misshapen, resulting in it being positioned lower (slumping) and having a widened and oblong nostril. This is exaggerated as the end of the septum is deviated away from the cleft side into the opposite nasal airway. This causes the entire nasal tip to be asymmetric and have the classic slumped appearance. For reasons unknown, the vast majority of cleft noses have a thicker skin cover, an issue that has great relevance in the outcome of rhinoplasty correction efforts.
Most cleft noses need a full septorhinoplasty approach to both optimize correction of the bony cartilaginous framework but also to correct any internal airway obstructions (septum and turbinates) which are almost always present. The relevant question is always the timing of the rhinoplasty surgery given the congenital nature of the nasal problem and the sensitive psychosocial development of children and teenagers. The traditional thinking of doing any rhinoplasty is when facial development is near complete, age 16 or older. However, I have always taken an earlier approach to some rhinoplasty patients particularly the cleft patient and I don’t think age thirteen or fourteen is too young.
Dr. Barry Eppley