Whenever we think of cleft lip, we always think of the little baby with an obvious cleft in the lip. As I had mentioned before, the lip is the most obvious, but the cleft affects others things too, including the nose. It may not be obvious, since we are so distracted by looking at the lip, but the nose is almost always asymmetric and I feel, like a lot of the cleft surgeons out there, that this is also just as important in the initial repair. But as much as we would like to hit a home run, the unpredictability of growth will most likely require a revision later in life. Rhinoplasty is a perfect example of this. Those cute kids eventually, and inevitably grow up to be teenagers, and a lot of times they want their nose done.
It isn’t all about looks though. Nasal obstruction is very common since the septum and turbinates are usually obstructing a clear nasal passage with a cleft lip. Many times my patients are more happy with being able to breathe through their nose than they are with the visual changes.
Rhinoplasty, aka nose jobs, are integral to cleft care. Traditionally we have waited until 14 to 16 years old, but I think now with cleft care being more aggressive, 10 to 12 years old is reasonable depending on the child’s maturity and wants and wishes.
Below are some examples of the subtle, and not so subtle changes possible with cleft rhinoplasty.