What Type of Rhinoplasty Do I Need For My Cleft Nose?
Q: Dr. Eppley, I am interested in a rhinoplasty to help with my congenital nose deformity from cleft lip and palate. I am a healthy 60 year female and my speech is fine. But my nose has never been right and until I read your writings on my problem I did not realize that it is a cartilage memory problem. This seems like it might be a magical solution and I hope you are the magician.
A: Correction of the cleft nose is a particularly challenging rhinoplasty procedure as the anatomy is far from normal. Such a nose appears deviated or twisted from the nasal bones down to the tip. The tip is most noteworthy as it is usually bulbous with thicker skin and deviated towards the non-clefted side. Part of this is due to the twisted septum internally which swings away towards the normal side pulling the tip with it. Trying to correct can be difficult and this where the role of cartilage memory comes into play. But the other major component is the nostril on the cleft side. It is deformed because it has a lack of adequate tissue support. The lower alar cartilage is slumped as it is weak and lacks the amount of cartilage on the other side. In addition the skin is deficient further contributing to the shape distortion. (which also makes it difficult to get a shape like the opposite side)
I will assume you have had some prior rhinoplasty work, perhaps years ago, and substantial efforts were made in the tip area. In my rhinoplasty experience, the cleft tip needs considerable support added including a columellar strut, spreader graft on the cleft side and an alar rim and batten graft above the cleft nostril.
If only improving the nostril shape to correct the amount of nostril retraction/asymmetry, I would just do a composite ear cartilage-skin graft to roll down the retracted nostril edge.
Dr. Barry Eppley