What Can be Done For A Teenager Who Has A Repaired Cleft Lip and An Asymmetric Nose?

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