Cleft Lip Repair Before & After Photos

Cleft Lip Repair Before & After Case 1

This boy is seen at 4 weeks after repair of his unilateral cleft lip.

Anatomic repair of the muscles in the lip, and of key landmarks on the lip, restore balance and symmetry.

Cleft Lip Repair Before & After Case 2

This boy is seen after repair of his bilateral cleft lip.

The lip from either side of the cleft is repaired in the midline, with attempt made to reconstruct a more normal appearance of the lip.

At the first surgery, some repair is performed on the nose as well to lengthen the columella and improve the appearance and function of the nasal passage.

Cleft Lip Repair Before & After Case 3

This boy is seen after repair of his unilateral cleft lip.

The scar for this repair usually falls along the normal philtral column, making the scar less noticeable in conversation.

Slight asymmetries in the red part of the lip may be touched up as needed, including at the time of other procedures like the cleft palate or cleft rhinoplasty repair.

Cleft Lip Repair Before & After Case 4

This boy is seen after repair of his unilateral cleft lip.

Extreme care is taken to align the vermilion (or red) margin of the lip, as even a stepoff of 1mm is noticeable in conversation.

Cleft Lip Repair Before & After Case 5

This child is seen after repair of his unilateral cleft lip.

Making the Cupid’s bow peaks of the lip even requires reorientation and repair of the orbicularis muscle in the lip.

Cleft Lip Repair Before & After Case 6

This handsome boy is seen after initial repair of his unilateral cleft lip.

The scar is more likely to be thicker and/or darker early on for patients of certain ethnicities (African-American, Hispanic, Asian), but does soften and fade with time and scar care.

The first year often includes:
– Prenatal visits for when the cleft is seen on ultrasound, to talk about expectations and timing. Most children have otherwise very normal childhoods and lives! Almost all clefts we see are random, and not caused by anything that the mother or father did during pregnancy.
– Day 1 working with our speech therapist @monicakemp and the team at the hospital where you deliver, to immediately get on track with feeding and weight gain.
– Cleft lip repair between 3 and 6 months.
– Cleft palate repair between 9 and 12 months. That seems to be the best balance between waiting for the child to grow as much as possible, and before speech begins taking off.

Cleft Lip Repair Before & After Case 7

This delightful girl is seen after repair of her unilteral cleft lip.

She has an infectious smile and magnetic spirit that brightens our day every time she comes to visit.

Cleft Lip Repair Before & After Case 8

This sweet girl is seen soon after her palate repair at 9 months of age.

Her primary lip and nose repair were performed earlier, for most patients usually at 3-6 months of age.

The cleft palate is then repaired usually in a single stage at 9-12 months, as babbling begins and speech development starts taking off.

This timing tries to balance scarring (which can restrict growth of the palate and midface), with optimizing speech development.

Cleft Lip Repair Before & After Case 9

Our cleft cuties always bring a smile to our faces!

Repair of the orbicularis muscle of the lip guides the alveolus (or gum line) to realign and narrow the cleft, even in the absence of nasoalveolar molding (NAM).

Complete treatment of the muscle at the first operation is also key for preventing future problems.

Release of the muscle from the septum helps to reduce the deviation typically seen as patients get older, improving both breathing and appearance.

The lip scar and nasal symmetry will continue to improve over time, especially with optimal scar care and massage.

Thank you for trusting our team with the care of your loved ones!

Cleft Lip Repair Before & After Case 10

This beautiful girl is seen after repair of her bilateral cleft lip and palate.

The orbicularis oris muscle normally completes a ring around the mouth, allowing one to eat without food spilling out, and drinking through and straw.

In bilateral clefts, there is no muscle in the central portion, so the muscle must be brought all the way across from the sides.

This restores function, and helps to bring the premaxilla back in line with the lateral maxillary arches.

Elongation of the columella was also performed in the initial operation to reduce the flat and wide nasal appearance usually seen with bilateral cleft patients.

Cleft Lip Repair Before & After Case 11

This lovely girl is seen at 6 months old after her bilateral cleft lip repair.

The first year for our families with cleft lip and palate are the busiest. This may involve NAM (nasoalveolar molding), cleft lip repair, and cleft palate repair.

The timing of these procedures take into account the normal milestones for growth and speech development, to give children the best chance to reach their potential. At the same time, we also aim to minimize the number of surgeries and exposures to anesthesia as we can.

Nothing makes us happier than seeing our patients thriving!

Cleft Lip Repair Before & After Case 12

This handsome patient was born with a complete bilateral cleft lip and palate.

He underwent repair of his lip at 3 months of age, and his palate repair at 9 months.

Repair of the orbicularis oris muscle early on helps to bring the central part of the palate and gums back in line with the rest of the gums over time.

He did also have some wider, thicker scars early on, and these improved gradually over time with massage and a steroid injection.

He is seen now, about to celebrate his 2 year birthday!

Cleft Lip Repair Before & After Case 13

This sweet girl is one month after her cleft lip repair.

Normally surgery is done between 3 and 6 months of age.

This is a good balance when weighing anesthesia safety, scarring, activity level, and time to heal before the palate surgery.

Afterwards, children may continue breastfeeding or bottlefeeding the same as before surgery.

Most of our cleft lip patients also go home the same day after their lip repair.

After cleft palate surgery, patients usually stay 1 or 2 nights until we are confident the child is feeding well.

She has done beautifully, with a scar that will soften and fade over time.

Cleft Lip Repair Before & After Case 14

One month after cleft lip repair, this girl is thriving.

Cleft lip repair is normally done between 3 and 6 months of age, though for the right patient, it is reasonable to discuss performing surgery at as early as 4 weeks of age.

Factors to consider include:
– prematurity, which increases the risk of apnea after surgery
– weight and feeding, to minimize risks of anesthesia and of postoperative problems
– width of the cleft, as additional nasoalveolar molding may be recommended before going ahead with surgery

Cleft lip surgery can safely be done as a same day surgery, though patients and families sometimes choose to be observed in the hospital overnight.

Cleft Lip Repair Before & After Case 15

An “incomplete” cleft lip, meaning there is still a skin bridge, still requires full separation and dissection of the lip to fully repair the anatomy and minimize long-term asymmetries.

A few things I think about during this repair:

Pic #2 – The white roll (at the border between the skin and dry mucosa) draws attention if there is a break in that light reflex, so creating continuity with good quality white roll is priority number 1 to reduce unwanted attention.

Pic #3 – The muscle fibers not only need to be repaired, they must be reoriented back to their original direction. This is similar to what we have learned from our cleft palate repairs, as the muscle action has a vector that should be returned to normal anatomic direction as possible. Judicious backcuts help to unfurl the muscle and bring the noncleft side down.

Pic #5 – The septal deviation is due to the muscle imbalance, with the noncleft side muscle pulling unopposed. The septum here is straightened without any resetting or unseating of the cartilage; rather, it was achieved by balancing the forces on the septum by releasing the muscle on that side.

Pic #5 – The release of that muscle can be achieved underneath and separately from the skin, so that the scar on the surface stays along the philtral column without adding scar at the base of the columella if one chooses.

Cleft Lip Repair Before & After Case 16

Why does a bilateral cleft lip happen?

Most clefts are due to random chance in the first couple months after conception.

Normally there is nothing that the parents or families could have done any differently to prevent it. (Some things like smoking, alcohol, or other drugs, can slightly increase the odds.)

The premaxilla is the central part of the upper jaw. It extends from the forehead and nose, growing down from the frontonasal prominence.

From the sides, the lateral maxillary prominences come towards the middle to join with the frontonasal prominence.

When the lip doesn’t fuse on one side, a unilateral cleft lip is seen.

When both sides don’t fuse, a bilateral cleft lip occurs.

When the maxillary prominences don’t meet on the inside of the mouth, that is when a cleft palate occurs. (Specifically, of the secondary palate, the part posterior to the premaxilla.)

This sweet child is seen at 1 month after lip repair, eating well and thriving!