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Regarding cleft lip procedures, doctors make significant efforts in scar management. Families can also contribute to better scar healing. Any incision in the skin layer will inevitably form a scar. Infants have particularly good skin recovery, and with efforts from doctors and families, the scar condition on babies is generally quite satisfactory.
During surgery, tension is placed in the muscle layer rather than the skin layer, focusing on readjustment and suturing of the lip muscles to avoid suturing the skin layer, preventing scar formation. Botulinum toxin injections during surgery relax lip muscles, effective for about 5 days, allowing prevention of excessive muscle contraction after suture removal.
The skin layer uses ultra-fine lines to avoid damaging the skin, which are absorbable lines that dissolve in about a month. However, it is recommended to remove the lines after a week to prevent scar marks.
Scars form due to excessive tension, so applying "lip tape" to maintain tension on the lip after suture removal is necessary for at least three months.
If there is scar contraction after surgery (shrinkage at the lip peak), scar massage may be required. Scar care after surgery can involve silicone sheets, scar gels, or scar patches to improve scars.
Although infants have excellent wound healing capabilities, any open skin will form a scar. Scar maturation typically takes about six months to a year. Scar color may extend beyond six months, even up to a year.
Scars peak around 2-3 months post-surgery, becoming raised and hard. Active treatment at this time, including scar massage, scar patches, scar injections, etc., can be helpful.
Each baby's constitution differs, and usually, a one-month follow-up can roughly indicate the outcome. Post-surgery lip peaks are generally equal in height, but if shrinkage appears after one month, scar massage is needed. If after 1-2 months the lip peak shows no change and the lip shows no inward shrinkage, with no scar rise, it indicates good constitution without needing massage for a satisfactory result.
Due to improved surgical methods, scars are becoming less noticeable, but if scar contraction occurs, active treatment is still necessary!
The lip is active daily—actions like drinking milk and smiling pull the upper lip wound outward. Although botulinum toxin is injected during surgery to reduce upper lip movement, limiting upper lip activity allows scars to heal finer and less thick.
This is the purpose of "lip tape," limiting upper lip activity for better wound healing. Lip tape is recommended for three months, especially the first to two months are particularly important. "Lip tape" is mainly used during the day, and the evening can be restful, for skin care.
Better quality 3M transparent tape can effectively tighten the lip, but it may cause greater skin damage, with some children experiencing excessive redness. Artificial skin can be applied to the face to prevent transparent tape irritation, or different tapes can be chosen based on the best effect.
Long-term tracking of nose shape shows that because the nasal soft bone on the cleft side is softer, it gradually becomes hard and thick over three years post-surgery. Therefore, during surgery, we overcorrect the nose shape, making it higher and narrower.
"Cleft lip surgery isn't just suturing the lip? Why operate on the nose too?"
In studies of adult patients in different countries, nose shape is the most concerning issue for cleft lip patients.
Although the nasal soft bone is adjusted during surgery, when scars form post-surgery, the nose mold can help establish and maintain nose shape. Because much effort is made during surgery, the nasal septum also needs to be worn for the best results. Nose molds not only support the nose shape but also clear the nasal passages. Typically, after suturing, the nasal passages are narrower. (Below is an image showing how to place the nasal septum)
In recent long-term nose shape studies, overcorrection 20 years ago still achieves the desired goal 20 years later. Parents who cannot wear nose molds regularly need not worry excessively. Although studies show that patients' noses gradually sink over three years post-surgery, in 20-year long-term studies, the nose bridge will eventually become higher and more symmetrical due to bone growth. Therefore, my approach to nose bridge overcorrection is more conservative to avoid excessive damage.
Parents may consider using scar gels or silicone sheets. From a doctor's perspective, as long as they are used consistently, they should be effective.
Silicone sheets or scar gels actually have moisturizing effects, making scars smoother. Silicone gel usage requires special attention; the amount does not need to be too much, and it is effective only when dry. There are many brands, some convenient and some expensive, but all assist in scar care. The focus is still on moisturizing and massage.
Scar patches contain mild steroids. If scars proliferate post-surgery, steroid patches can be used. Steroid patches are changed daily and applied to smooth scars. For infants, the recommended usage is three weeks, 12 hours per day per week, to avoid steroid accumulation side effects. (Please search for Koalass scar patches)
For babies with stable lip scars, the nose mold becomes the most important task.
As mentioned earlier, the nasal soft bone will become increasingly sunken over the next three years, so as long as the baby can adapt, they should wear the nose mold for longer periods.
Thanks to Alex and Emma for the demonstration, how to help baby wear the nose mold.
From 2024 onwards, some foundations provide free cleft baby care kits, containing the following tools and necessary consumables, including nose molds. This allows parents to save time on preparation.
※ Preparation Items
(The above nose mold wearing weeks are recommended weeks, but each baby's nose bridge size differs, so adjust based on individual condition; generally, recommend continuing to wear the next number if the previous number is loose)
Babies may cry during massage; parents need patience, perform on an empty stomach to avoid vomiting, feed after massage, which has a soothing effect.
If there is skin damage on the lip, pause massage, resume when skin recovers.
This is the daytime tightening situation; some babies have narrower nasal passages, so a soft tube will first be used to widen the affected side nose bridge in the first week after suture removal. Immediate lip tightening is required after suture removal (tighten both sides again, the purpose is to limit upper lip activity). Lip tightening continues for 6 months, especially the first 1-2 months are particularly important. The purpose is to make scars heal without thickening.
No lip tightening at night, but still wear nose mold; use silicone sheets for the evening lip scar part, cut to 1x1 cm size and place on the lip scar location, fix with transparent tape.