Q: I am a 33 year old adult who was born with a cleft lip and palate. I have had two rhinoplasties since the original surgeries I had as an infant. One nose surgery was at the age of 14 and the other one was at the age of 23. My nose is still not straight at all. I know that I do not normal tissue and the cartilage is very stubborn, but I want to know if there is any hope for a more symmetrical nose.
A: One of the most difficult of all rhinoplasties in which to get a good result is that of the cleft nose. As you have pointed out, the tissues on the side of the cleft (if it is unilateral) are not normal. This means that the lower alar cartilages are deficient and there is scar from the lip repair into the base of the nose as well as the scar tissue that you would have from your prior two rhinoplasties. But the most limiting factor, above all of that, is the skin at the tip of the nose and around the nostril. It is not only thicker than normal but it is both deficient and scarred. This is particularly true inside the nostril and in the soft triangle area near the tip. Having done many hundreds of cleft rhinoplasties, I find this issue to be the really problematic one that limits how good a cleft rhinoplasty result can be. To answer your question specifically, please send me some photos of your nose and I can provide a good answer if any further efforts at rhinoplasty are worth it.
Dr. Barry Eppley