Cleft rhinoplasty

Patients with a cleft deformity may have medical breathing issues, as well as the superficially apparent cosmetic problems. A cleft rhinoplasty seeks to address both. There are nuances in the way it is performed, depending on the severity of the cleft, its external appearance and whether medical problems have arisen as a result of it.


What does the surgery involve ?

Cleft rhinoplasty is usually performed as an open procedure, which gives the surgeon better access to the nasal tip and allows her to finesse the results more carefully. To complete this, a small incision is made on the outside of the nose, in the collumellar, so that the skin can be lifted from the nasal tip and expose the muscles and tissue below. Often, a cartilage graft is required to build up the fallen side of the nose – which can be taken from the ear, elsewhere in the nose, or occasionally the ribs.

Cleft rhinoplasty can be performed in a number of ways, depending upon the individual circumstances of the patient; their age, lifestyle and the severity of their condition. Below are a few methods of cleft rhinoplasty, but the list is in no way exhaustive – for a specific handle on the bespoke cleft rhinoplasty procedures, you must have at least one consultation with a plastic surgeon.

Different types of rhinoplasty procedures

Primary rhinoplasty  – in which the cleft is repaired at the time of nasal surgery. The lip and nose are addressed at the same time, but are not adjunct in terms of surgical process. Primary rhinoplasty provides better contour and symmetry to the nasal tip by releasing and repositioning the lower cartilages. Adjustments to the nasal bridge can also be made where necessary.

Intermediate rhinoplasty – is normally performed on young children to correct a cleft palette. It achieves a more symmetrical nose shape after surgery and can resolve medical issues associated with a cleft lip, but any required septal surgery should be deferred until after adolescence.

Secondary rhinoplasty – occurs when the face is fully developed (usually between the ages of 14 and 18). Use of a cartilage graft in this procedure allows for improved tip definition and enhanced support, which prevents contracture or collapse in the future.

What should I expect after the procedure?

If you require a splint, this will be applied during the procedure. It must remain there for 7-10 days after your procedure, because it helps to control swelling. If you have had a cartilage graft – which is fairly common in cleft rhinoplasty – you may also require an internal splint, which will remain in place for 5-7 days after surgery.

You may experience some bruising around the eyes and over the upper face, which will begin to fade after around 3 days. Keep your head elevated while you sleep to aid the healing process. You may experience some discomfort, which can be managed by painkillers.

Glasses wearers should take care not to wear them for long periods, and it will not be appropriate for contacts wearers to use lenses while the eyes are still swollen.

You should expect to take 10-14 days off work, and 6 weeks from exercise. Speak to your surgeon about specific time frames for your individual needs.


What are the risks associated with cleft rhinoplasty?

Complications are fortunately rare. Time will generally improve the swelling and hence the appearance of the nose. Occasionally bruising takes longer to disappear especially in darker skinned people. Nose bleeds and infections are all possible complications but extremely rare and easily corrected if early treatment is obtained. Very occasionally, in about one in fifteen cases, a small secondary adjustment will be required. This can often be corrected under local anaesthetic. As swelling of the nose settles following surgery, the nose shape will gradually change over a period of months and minor irregularities should therefore not usually be addressed until most of this swelling has settles which is usually 10-12 months following your initial surgery.

Scarring can occur and in these cases the scar maybe a different colour to the surrounding skin or raised and lumpy. Again scars take time to settle and will usually fade and soften over 6-9 months following surgery.

It is common for the nose – especially the tip – to feel numb following rhinoplasty. This should settle over 4-6 months.

Some nasal asymmetry may still be present following surgery, especially if the nose was deviated before surgery although usually this should be much improved.

Occasionally allergic reactions can occur to sutures, tape, splints and may require treatment.

Wound disruption or delayed healing can occur and rarely some areas of the skin may necrose. This is more likely in patients who either have had multiple procedures on their nose previously, or in smokers and immunosupressed patients e.g. diabetics.

If some cases cartilage grafts need to be placed to support the structure of the nose and this cartilage is usually harvested from the septum inside the nose. Occasionally this can cause a septal perforation which usually does not need further treatment but occasionally can cause discomfort with airflow and breathing and require a secondary procedure to correct.

Differences in breathing maybe apparent following surgery and in the initial healing period nasal airway obstruction is common as the mucosa is more congested and nasal drops may help with this.

There is also a chance that you may develop an allergic reaction to sutures, tape or splints used during your procedure. This will require treatment.

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