In short. What a second operation on the lip can and cannot improve, why the nose is affected by a cleft, and how revision and nasal correction are planned around growth.
Key points
- Operating on a lip or nose while the face is still growing usually produces a result that further growth then undoes.
- For that reason revision is normally deferred until the face has substantially matured, often the mid-teens, and sometimes later for nasal work.
- In the meantime function comes first: speech, hearing, dental and orthodontic care all continue, and in some cases are prerequisites for a good revision.
Many children with a repaired cleft lip eventually ask about a second operation. The reason is usually one of two things: the lip scar or the height of the lip is not as good as the family hoped, or the nose on the cleft side is flatter, wider or more asymmetric than the other side. Both are common and both are treatable. A revision is an improvement, not an erasure.
Why the nose is affected
A cleft lip is not only a gap in the skin. The cleft runs through the muscle of the lip and the base of the nose, and the cartilage and bone that shape the nostril are distorted by it. The nostril on the cleft side often sits flatter and lower, the tip is pulled to one side, and the base of the nose is wider. Repairing the lip repositions the base of the nose, but it does not reconstruct the cartilage.
What revision can improve
Revision surgery on the lip can narrow or reposition a widened scar, restore height and fullness to the lip, improve the shape of the cupid's bow, and adjust the relationship between lip and nose. Nasal surgery can lift and reshape the nostril on the cleft side, reposition the tip, and improve symmetry. For many patients these improvements are substantial.
When it is done
Growth has to finish first
Operating on a lip or nose while the face is still growing usually produces a result that further growth then undoes. For that reason revision is normally deferred until the face has substantially matured, often the mid-teens, and sometimes later for nasal work. In the meantime function comes first: speech, hearing, dental and orthodontic care all continue, and in some cases are prerequisites for a good revision.
What revision cannot achieve
It cannot remove the scar. It cannot make the two sides identical, because every face is asymmetric, and the corrected side will still differ in ways a careful observer could find. It cannot guarantee that the nose will stay as it is through growth or ageing, and a minority of patients need more than one revision.
Practicalities and honest limits
Revision is performed under general anaesthesia, usually takes a few hours, and involves a short hospital stay. Swelling is significant at first and settles over weeks, and the scar matures over a year or more. The goal is a lip and nose that look and work normally at conversational distance. A perfect result is not achievable, and the operation carries the ordinary risks of any surgery: bleeding, infection, healing problems, altered sensation, and asymmetry.
Seek review if
- A lip repair comes apart, or the repair site becomes red, swollen or discharging after revision.
- The nose or lip becomes increasingly crooked over months, or breathing through one side becomes difficult.
- You have been offered revision surgery before growth has finished and the reason for the timing has not been explained.
Frequently asked questions
Why does a cleft affect the shape of the nose?
A cleft lip is not only a gap in the skin. It runs through the muscle of the lip and the base of the nose, and distorts the cartilage and bone that shape the nostril. On the cleft side the nostril sits flatter and lower, the tip is pulled across, and the base of the nose is wider.
When can cleft lip and nose revision be done?
Operating while the face is still growing usually produces a result that further growth then undoes, so revision is normally deferred until the face has substantially matured, often the mid-teens and sometimes later for nasal work. In the meantime function comes first: speech, hearing, dental and orthodontic care all continue.
Can revision make the two sides identical?
No. It cannot remove the scar, and it cannot make the two sides identical, because every face is asymmetric. It also cannot guarantee that the nose will stay as it is through growth or ageing, and a minority of patients need more than one revision. The goal is a lip and nose that look and work normally at conversational distance.
Risks & Limitations
- Cleft care spans years and usually several operations. A single procedure does not finish it, and the plan may change as a child grows.
- Scars from lip and nasal repair are permanent. They fade and soften, but they never disappear.
- Speech may still need therapy, or further surgery for velopharyngeal insufficiency, after palate repair.
- Hearing problems and repeated ear infections are common, and may need ventilation tubes and long-term ear review.
- Feeding difficulties before and after repair, including slow feeds and poor weight gain.
- Dental and orthodontic problems: missing, misplaced or crowded teeth, and a bite that needs years of treatment.
- Growth disturbance of the upper jaw, which may require later revision or corrective jaw surgery.
- No outcome is guaranteed. Perfection is not achievable and is not the goal.
When to Seek Care
- A baby who cannot feed, coughs or chokes during feeds, or is losing weight or not gaining it.
- Difficulty breathing, noisy breathing, or pauses in breathing, especially after palate repair.
- Fever with a repair site that is red, hot, swollen or discharging.
- Bleeding from a lip or palate repair that does not stop with gentle pressure.
- Fluid or discharge from the ear with pain or fever, or any suspected change in hearing.
References & Further Reading
- American Cleft Palate-Craniofacial Association (ACPA) — parameters and team care guidance
- World Health Organization (WHO) — congenital anomaly and child health resources
- Cochrane Library — systematic reviews in cleft lip and palate care
- Chinese Medical Association, Plastic Surgery Branch — clinical guidance
This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.