Your Questions
Your Questions
Q: Dr. Eppley, Would I be able to have any improvement on my cleft lip with a lip enhancement surgery (cleft lip revision) to make my lip more even?
A: Almost all cleft lip repairs, no matter how beautifully done as an infant, will end up needing some additional revisions to optimize the repair appearance. The one area of the the lip that almost always need adjustment is that of the vermilion. (pink part of the lip) It is frequently volume deficient on the cleft side and makes a major contribution to lip asymmetry.
I think there are several aspects of your cleft lip that can be improved and all of your cleft lip issues are common. There is a lack of vermilion fullness down at the lip line which needs to be augmented by a small dermal-fat graft. The cupid’s bow area is indented, again due to lack of volume which also needs to be grafted. The outer aspect of the cleft lip side along the vermilion-skin border is shorter in height than than the non-cleft side and that can could be improved by a lip advancement on that side. The actual philtral skin scar looks pretty good and I don’t think that scar could be improved with the exception of adding a few hair transplants into and along the scar line.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My son is 16 years old was born with a cleft lip It is now closed , but the scar is clear and the lip is not filled propwely. A fat transfer was done last December but the results are not satisfactory. Please advise if anything further could be done.
A: Without seeing pictures, it is would be impossible to make an accurate comment about any further potential improvements…although I have yet to see a cleft lip repair that could not stand some further efforts. I would not think that fat injections had any chance to offer improvement as the issue is one of proper alignment of the muscle, skin and vermilion not just a volume issue even though it may visually seem so.
Please send me some pictures of your son’s lip at your convenience.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, my daughter is turning 13 next month. She had cleft lip (not palate) and had it repaired when she was 4 months old. She is very self conscious about her appearance. There is a visible scar between the upper lip and nose and a lopsided nose. I want to know about the possibilites to remove the scar and correct her nose asymmetry. Please let me know about the procedure. Thank you very much.
A: Isolated cleft lip always affects more than just the lip. The cleft defect extends to involve the nose in a very classic pattern of lower alar cartilage slumping resulting in an asymmetric tip of the nose with a widened nostril. Even in a well done cleft lip repair, the nose deformity becomes evident as the child grows manifesting itself fully by the teenage years. This always leaves two areas of potential improvement as a young adolescent, the repaired lip scar and the unrepaired nose.
Your daughter would undoubtably benefit by a cleft rhinoplasty and lip repair. Without seeing pictures of her I can not say whether she needs a complete septorhinoplasty or an isolated tip rhinoplasty procedure. Most commonly the fuller version of the rhinoplasty is needed with cartilage grafts. As for the lip, it is better to think of further scar reduction and not scar removal. Completely eliminating the cleft lip scar is virtually impossible. Please send me some pictures of her for a more analysis to determine her exact surgical needs.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have decided that I would like to have my cleft lip scar and nose asymmetry repaired. Besides the surgeries for primary repair as a child, I have never considered surgery, so I have no experience in what to look for, how to choose the right surgeon, etc. I was very impressed by your website and the way it explains things. I am very serious about having this procedure done, I just need to figure out the logistics with scheduling, recovery time, costs involved, etc. Please let me know what my next steps should be. Thank you very much.
A: Even with the best primary cleft lip and nose repair as an infant, growth and ongoing facial development of the scarred area will result in lip and nose asymmetries. Most of these secondary deformities are quite classic and include vermilion notching, a vermilion-cutaneous mismatch, wide philtral scarring of the lip and tip asymmetry with nostril slumping and widening of the nose. As an adult, the best nose repair comes from a complete septorhinoplasty with cartilage grafting and a cleft lip revision. These usually can be done during the same surgery. Recovery largely revolves around the nose and includes the wearing of a nasal splint for a week after surgery. You should be back to work within 10 days after surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was born with cleft lip and palate and am now 28 years of age. I would like to have more symmetry of my profile, which could be improved by either a bigger upper lip or smaller lower lip. I just feel as though I could look better than I do now now.
A: Thank you for sending your pictures. I do believe you are correct in that there is room for further facial improvement and symmetry. You have all of the typical lip and nose manifestations that I have seen in just about every adult patient affected by a cleft. By your pictures, you had a unilateral cleft lip and palate on the right side. The one thing that you don’t want to do is to make the lower lip smaller. That is the normal lip and it is better to focus on making the upper lip (the abnormal one) larger and more aligned to match better to the lower lip. In paired facial structures, it is rarely a good idea in the pursuit of symmetry to try and make the normal half look like the abnormal half. While I don’t have a good frontal view of your face, I suspect that the upper lip needs to be taken apart along the scar lines and reassembled with emphasis on achieving a better vermilion roll and pout. (cleft lip revision) There may even be some benefit to adding some upper lip volume through a dermal-fat graft or allogeneic dermis at the same time. It would also be possible to do a complete septorhinoplasty during the same procedure to treat the nasal component of the cleft as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 37 years old and I was born with a cleft lip and palate. It has been repaired when I was a baby and child and I have had two operations, none past the age of three. I am wondering if anything further can be done to improve my appearance. I understand that due to the deformity, repair options are limited, as well as my age being a factor, causing healing times to be greater and results limiting. If possible I’d like to send pictures for a consult.
A: It is important to understand that age is not a factor in making healing times longer or in limiting the results from revisional facial cleft surgery. There is just as much that can be done for a 37 year-old as there is for a 7 year-old. The limiting factors, like in all cleft patients, is the magnitude of the original deformity and the quality and scarring of the lip, nasal, alveolar and palatal tissues. Since you have had but two surgeries that would suggest to me that there is room for improvement without even seeing your pictures yet. The influence of growth on the face makes for a lot of distorting changes around the orofacial cleft site. Even in the best of primary repairs as an infant, revisional surgery is almost always beneficial and desired in the teen years. It is very likely that there is room for visible improvement in the appearance of your external nose and lip through septorhinoplasty and a cleft lip revision.
Dr. Barry Eppley
Indianapolis, Indiana