A cleft in the lip
On one side or on both sides; from the small notch in the red border to the gap all the way to the nose.
CONDITION / FACE
Cleft lip ("cleft lip").
Cleft upper lip ("hare's lip") is a congenital cleft in the upper lip of a child. It is corrected by surgery in the first months of life, and before that, parents are helped to establish feeding.
CONCEPTUAL VISUALIZATION- What it is
- Congenital cleft in the upper lip - on one or both sides, from a small notch to the cleft up to the nose.
- How common
- Cleft lip and/or palate occurs in approximately one in 700 children.
- When surgery is performed
- Lip plastic surgery is usually done at 3-6 months.
- Who treats it
- The team: surgeon, orthodontist, speech therapist and other specialists — from birth to adulthood.
01 / WHAT IS ITWhat is
What is
cleft lip.
A cleft lip is a gap in the upper lip that a baby is born with. It appears when parts of the face do not grow completely during fetal development. The cleft can be on one side or on both sides, from a small notch to a wide gap that reaches the nose, and can be combined with a cleft of the gums and palate.
In everyday life, it is called "hare's lip". This is a colloquial name that can hurt parents and children, so doctors say "cleft lip".
Cleft lip and/or palate is one of the most common birth defects, occurring in about one in 700 babies. According to a large meta-analysis, isolated cleft lip occurs in 0.3 per 1,000 births, and combined cleft palate occurs in 0.45 per 1,000 births.
Most children whose clefts were repaired in time grow up and lead normal lives. The scar after lip plastic surgery fades over the years and becomes less noticeable.
This is general information. What will suit your child, the doctor will tell after the examination.
02 / SIGNSHow does it look
How does it look
cleft lip.
Cleft lip can be seen immediately after birth, and often on ultrasound during pregnancy.
The shape of the nose
When the cleft reaches the nose, the shape of the nostril on the side of the cleft also changes.
Gum and palate
The cleft can take over the gums and palate - then the treatment is longer.
Cleft palateFeeding
It can be difficult for a child to tightly grasp a breast or a nipple, so it may not be full.
Other defects
With an isolated cleft lip, accompanying defects occur less often than when combined with a cleft palate, so the child is examined completely.
03 / REASONSWhy does it occur?
Why does it occur?
cleft
The exact cause in a particular child is usually not known. The cleft is almost certainly not the result of anything the mother did or didn't do during pregnancy.
Development of the face
The lip is formed in the womb, when parts of the face grow. If they do not converge, a gap remains.
Heredity
Sometimes genes play a role, but in most cases clefts run in families. If there is already a child with a cleft in the family, the probability for the next child is about 2-8%.
Factors during pregnancy
Clefts are linked to smoking and alcohol, obesity, lack of folic acid, and some anticonvulsant medications. In a meta-analysis, women who took folic acid supplements had a lower risk of cleft lip, but the conclusions are cautious.
Syndromes
Sometimes the cleft is part of a wider condition, such as 22q11 deletion syndrome or Pierre Robin sequence.
Sequence by Pierre Robin
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
The cleft lip itself does not require emergency care - it is treated in a planned manner. But a baby with a cleft, like any baby, can get sick, and some signs require immediate help.
103 immediately if:
- the child has difficulty breathing or breathes very often, croaks or pulls in the stomach during inhalation;
- lips, tongue or skin turned blue, gray, pale or marbled;
- the child is difficult to wake up or does not wake up;
- convulsions;
- weak, shrill or continuous crying;
- a rash that does not fade if you press on it;
- the child did not urinate for 12 hours;
- a temperature of 38 °C and above in a child up to 3 months or 39 °C and above — in 3–6 months;
- after the operation, the wound on the lip is bleeding and the bleeding does not stop, although you press it firmly with a clean cloth.
See a doctor if:
On the same day: the baby is not eating or eating much less than usual, or after surgery the suture is red, swollen, oozing pus, separated, or has a temperature (below the threshold for 103) - call the pediatrician or the surgeon who operated. In the coming days: the child does not gain weight, feeding is difficult. Planned: cleft was seen on ultrasound or after birth - make an appointment to make a plan for feeding and surgery in advance.
05 / DIAGNOSTICSAs discovered
As discovered
cleft lip.
- Ultrasound during pregnancy
Cleft lip is usually seen on a screening ultrasound at 18-21 weeks, but not always: in different studies, conventional ultrasound has detected between 9% and all such clefts. Volumetric 3D ultrasound shows cleft lip more reliably.
- Examination after birth
If the cleft was not seen on the ultrasound, it is detected immediately after birth or at the first examination of the newborn.
- Search for other defects
The child is examined completely. If other defects are found, the doctor may recommend a genetic examination.
- Assessment of feeding and weight
From the first days, they monitor how the child eats, breathes, sleeps and gains weight.
- Consultation of a surgeon
The surgeon assesses the width of the cleft, the condition of the nose, gums and palate and plans the timing of the operation.
06 / TREATMENTHow we treat
How we treat
cleft lip.
Cleft lip can be repaired with surgery, but treatment begins earlier — with feeding — and lasts for years. Therefore, a team of specialists guides the child.
01
Feeding before surgery
The main task of the first weeks is for the child to eat and gain weight.
- Breast or bottle
- A nurse or doctor will show you how to put your baby to the breast. With an isolated cleft lip, breastfeeding is usually easier than when there is also a cleft palate.
- Special bottles
- If breastfeeding does not work, special bottles help. A Cochrane review found that soft, squeezable bottles are more comfortable than hard bottles, although no difference in baby growth was found between the bottles.
- After surgery
- In reviews of studies, breastfeeding or bottle feeding after lipoplasty did not increase the risk of the suture coming apart, and in two studies, breastfeeding resulted in better weight gain than spoon or cup feeding. The surgeon will explain how to feed your child before discharge.
02
Preparation
It is not always necessary, but with a wide cleft it can facilitate the operation.
- NAM plate
- From the first weeks of life, the child wears an orthodontic plate, which gradually brings the edges of the cleft closer together and forms the wing of the nose. It reliably reduces the width of the cleft, although the quality of the evidence is low. In remote observations, the shape of the nose and lip was more often good than without any plate.
03
Lip plastic surgery
Cheiloplasty is the main operation.
- Deadlines
- Usually in 3-6 months. In an American study of 241 children, half of them were operated before 4.5 months, and 79.3% - before 6 months.
- Sooner or later
- In a study of 6,786 children, after surgery up to 3 months, gross scarring was less common than after surgery at 3–12 months (3.2% vs. 5.2%), but reoperations were more common (6.6% vs. 2.6%). The terms are chosen together with the surgeon.
- What is being restored
- Not only the skin is sutured, but also the muscle of the lip, and the scar is placed along the natural lines of the lip.
- Nose in the same surgery
- The shape of the nostril can be corrected in the same operation. In a review of studies, eight out of nine studies found it did not prevent the nose from growing; the quality of research is mostly low.
04
Then there are years of observation
- Team
- The American Association for Cleft Palate and Craniofacial Disorders believes that children with clefts should be managed by an interdisciplinary team of specialists. An orthodontist, a speech therapist and check-ups accompany the child as he grows.
- Other operations
- If there is a cleft palate, it is closed separately — usually at 6–12 months. Some children later need lip or nose correction.
- Psychological support
- According to a meta-analysis, the psychological state of children with a cleft is generally similar to that of their peers, although anxiety and depression occur more often, so the support of a psychologist is not superfluous.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Cleft lip is operated at Dr. Valikhnovskyi's Institute of Surgery in the field of "Congenital Defects Surgery". Cleft treatment is a plan for years: the clinic is responsible for the surgical part, and the orthodontist and speech therapist guide the child together with the surgeon.
CLINIC SERVICE
Surgery of birth defects
Congenital defects of the face and body in children and adults — from the first operation to the correction of the consequences.
View service
What we do for this condition
- Lip plastic surgery (cheiloplasty) — in the first months of life, often at 3–6 months: the lip and its muscle are restored, the scar is placed along the natural lines of the lip.
- NAM orthodontic plate — from the first weeks of life until surgery gradually brings the edges of the cleft closer together and forms the wing of the nose.
- Microsurgical technique — magnifying optics and thin suture material to accurately match the tissues, in particular the lip muscle.
- Correction of secondary deformations — repeated operations on the lip, most often scar correction, if they are needed later.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of the child or an ultrasound report - the doctor will pre-evaluate the cleft.
- ConsultationExamination of the child, conversation about feeding, answers to parents' questions.
- PlanIs the NAM plate necessary, when to operate on the lip, which specialists will be involved next.
- SurgeryLip plastic surgery under general anesthesia.
- Recovery and supervisionThe feeding regimen will be explained before discharge; then follow-up examinations as the child grows.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Why is the cleft called "hare's lip"?
This is a colloquial name. It can hurt, that's why doctors say "cleft lip".
Is it my fault that the child has a cleft?
Almost certainly not. The exact cause is usually unknown; a cleft is very rarely related to something the mother did or did not do during pregnancy.
Will I be able to breastfeed?
With an isolated cleft lip, breastfeeding is usually easier than when there is also a cleft palate; a feeding specialist will help. If it doesn't work, special bottles and expressed milk help.
At what age is the lip operated on?
Usually in 3-6 months. Early operations, up to 3 months, are also done; the terms depend on the condition of the child and are discussed with the surgeon.
Will there be a scar?
Yes, a small scar above the lip will remain, but it is placed along the natural lines of the lip, and it fades over the years.
Will the next child have a cleft?
For the most part, a cleft is an isolated case. If there is already a child with a cleft in the family, the probability of the next one is about 2-8%. If one of the parents has a cleft or the child is diagnosed with the syndrome, the risk is assessed by a geneticist.
Will another operation be needed?
Some children later need lip or nose correction. Most often, this is the correction of a scar. How many children need it varies greatly between studies, so the plan is made over years.
Sources
19 sources · guidance, reviews and researchshowCollapse
- Global prevalence of cleft palate, cleft lip and cleft palate and lip: A comprehensive systematic review and meta-analysisJournal of Stomatology, Oral and Maxillofacial Surgery, 2022doi:10.1016/j.jormas.2021.05.008 ↗
- Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palateCochrane Database of Systematic Reviews, 2011doi:10.1002/14651858.CD003315.pub3 ↗
- Breastfeeding and Cleft Lip and Palate: A Systematic Review and Meta-AnalysisThe Cleft Palate-Craniofacial Journal, 2024doi:10.1177/10556656231170137 ↗
- Impact of breastfeeding and/or bottle-feeding on surgical wound dehiscence after cleft lip repair in infants: A systematic reviewJournal of Cranio-Maxillo-Facial Surgery, 2019doi:10.1016/j.jcms.2019.01.019 ↗
- Postoperative Feeding in Cleft Surgery: A Systematic ReviewThe Cleft Palate-Craniofacial Journal, 2025doi:10.1177/10556656241283186 ↗
- Diagnostic accuracy of transabdominal ultrasound in detecting prenatal cleft lip and palate: a systematic reviewUltrasound in Obstetrics & Gynecology, 2010doi:10.1002/uog.7472 ↗
- A systematic review of associated structural and chromosomal defects in oral clefts: when is prenatal genetic analysis indicated?Journal of Medical Genetics, 2012doi:10.1136/jmedgenet-2012-101013 ↗
- Maternal Cigarette Smoking and Cleft Lip and Palate: A Systematic Review and Meta-AnalysisThe Cleft Palate-Craniofacial Journal, 2022doi:10.1177/10556656211040015 ↗
- Folate intake, markers of folate status and oral clefts: An updated set of systematic reviews and meta-analysesBirth Defects Research, 2020doi:10.1002/bdr2.1827 ↗
- Don't Delay: Sociodemographic Factors Impacting Timing of Cleft Lip RepairJournal of Craniofacial Surgery, 2025doi:10.1097/SCS.0000000000011448 ↗
- Optimal Timing of Cleft Lip Repair: Correlation With Scar Formation and Revision RatesOtolaryngology–Head and Neck Surgery, 2026doi:10.1002/ohn.70133 ↗
- Long-Term Effects of Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate: A Systematic Review and Meta-AnalysisThe Cleft Palate-Craniofacial Journal, 2022doi:10.1177/10556656211009702 ↗
- Effectiveness of nasoalveolar molding treatment for babies with nonsyndromic complete unilateral cleft lip, alveolus, and palate: A systematic review and meta-analysisAmerican Journal of Orthodontics and Dentofacial Orthopedics, 2025doi:10.1016/j.ajodo.2025.01.012 ↗
- Primary Cleft Rhinoplasty: A Systematic Review of Results, Growth Restriction, and Avoiding Secondary RhinoplastyPlastic and Reconstructive Surgery, 2023doi:10.1097/PRS.0000000000009924 ↗
- Psychological and Peer Difficulties of Children with Cleft Lip and/or Palate: A Systematic Review and Meta-AnalysisThe Cleft Palate-Craniofacial Journal, 2024doi:10.1177/10556656221125377 ↗
- Parameters of CareAmerican Cleft Palate-Craniofacial Association, 2024acpacares.org/parameters-of-care ↗
- Cleft lip and palateNHS, 2023nhs.uk/conditions/cleft-lip-and-palate ↗
- When to get urgent medical help for babies and children under 5NHS, 2026nhs.uk/baby/health/when-to-get-urgent-medical-help-for-babies-and-children-under-5 ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
The fissure was seen
on ultrasound or after childbirth?
Send a photo or ultrasound report and tell us how the baby is eating. The doctor will explain when to operate and what to do before the operation.