Loading article content
Why might someone need cleft lip and palate revision surgery?
Patients who opt for cleft lip and palate revision surgery are typically those approaching adulthood who have already undergone cleft palate surgery. Of course, surgical techniques from 18 years ago weren't as advanced as they are today, and as the lip and nose shapes grow over time, the initial 'small scar' from the surgery also enlarges. Additionally, nasal bone growth is relatively slow compared to other facial bone development, and during childhood, only the nasal shape can be adjusted without predicting future nasal structure or head growth. So, some nasal shapes may become increasingly 'turned up' or crooked.
The goal is to correct the lip shape and nasal form that resulted from childhood surgery.
Previous surgeries aimed to align the lip line, minimize scars, and avoid a 'middle' appearance, with some patients having obvious scars that required revision. The purpose of cleft lip and palate revision is to correct scars, and modern techniques emphasize positioning scars at the philtrum for symmetry and aligning the lip shape with the facial midline. Because over 90% of traditional surgeries result in a shift of the lip scar to the affected side.
Adjusting nasal shape is particularly important for Asian faces, mainly because Asian noses are relatively flat compared to Western ones, making it challenging for cleft palate patients with suboptimal nasal and lip shapes. Western cleft palate patients often have high-bridged noses, where scars on the upper lip are less noticeable due to the nasal prominence. However, Asians don't have this advantage.
Typically, patients discuss options with the surgeon beforehand, as individual needs and willingness to invest effort vary.
Generally, scar conditions in children are easier to manage than in adults, who may not comply with scar care post-surgery and can't stay indoors avoiding sunlight like children. Once scars are reopened and re-sutured, scar care and massage are necessary.
Some cleft palate patients have good lip scars (thanks to diligent parental care initially) and don't want to risk reopening the lip. They can consider lip micro-adjustment surgery, such as using 'fat grafting' or 'filler' to create the philtrum while performing rhinoplasty. Of course, without reopening the lip, it's harder to adjust the nasal base shape, but for patients with decent childhood surgery results, it's a simple approach.
Basically, orthodontic surgery is recommended to improve the bite before proceeding with lip and nose revision, much like building a house—without a solid foundation, the structure above won't be stable. Especially for nasal revision, cleft palate patients inherently have issues with crooked nasal base bones, and without correction, the nose will struggle to sit properly.
Of course, unless also revising the lip, the nasal revision method is similar to aesthetic rhinoplasty, or what is currently called Korean-style rhinoplasty. However, cleft lip and palate nasal surgery has evolved over 30 years and differs in some ways from aesthetic rhinoplasty. Mainly in two areas:
Currently, autologous tissue often uses cartilage for nasal revision, similar to some Korean rhinoplasty concepts, as cartilage is strong, abundant, and can create a refined nasal shape for cleft palate patients. Cartilage material is also stable, not easily absorbed, and highly biocompatible, lasting longer. However, cartilage's drawback is warping, so using diced cartilage for nasal framework reconstruction prevents warping.
Generally, since this might be the last surgery for cleft palate patients, surgeons assess for speech issues or the need for speech correction surgery. Some patients have unresolved oral-nasal fistula problems that can be addressed together.
Of course, the most common issue is nasal septal deviation in cleft palate patients, which over time can cause nasal turbinate hypertrophy, breathing difficulties, and chronic nasal congestion. These surgeries can be done concurrently, and they are covered by insurance. Speech correction and oral-nasal fistula closure can use major surgery credentials, saving significant costs.
I've always wanted to share our cleft palate friends' situations, but respecting privacy, I don't ask, especially the beautiful ladies. Unexpectedly, after asking a few who have completed orthodontics and secondary lip-nose revisions, they were very pleased!
(Although they didn't mind, I still covered their eyes to respect privacy.)
Actually, Emma has bright, oversized eyes and is very beautiful herself. She originally had complete left-sided cleft lip and palate, and as an adult, due to asymmetrical bite, she underwent orthodontic surgery at our clinic. The orthodontic surgery was very successful, shaping her face elegantly, and after six months of bone stabilization, Emma was referred to me for secondary lip-nose revision surgery.
It's been nearly two years post-surgery, and her condition is very stable, no need for follow-ups. Let me share:
Secondary lip-nose cosmetic surgery for unilateral cleft lip and palate can be divided into several approaches:
The idea of lip re-revision means 'reopening once more.' Because it's reopening, post-surgery scar care is needed for three months, just like in childhood.