Visible scar
Wide, indented or uneven scar above the lip. Scar correction is the most common cause of repeated operations on the lip.
CONDITION / FACE
Deformations of the lip and nose after a cleft.
Deformations of the lip and nose after cleft plastic surgery — a noticeable scar, asymmetry of the lip, a flattened nostril or a stuffy nose, which remain or appear with growth. They are corrected by repeated operations - in childhood or after growth.
CONCEPTUAL VISUALIZATION- What it is
- Changes in the lip and nose that remained after cleft plastic surgery or appeared with growth.
- How common
- In a review of 34 studies, an average of 21% of patients underwent lip surgery.
- Most often
- Lip scar correction; on the nose - asymmetry of the nostrils and difficulty breathing.
- When corrected
- Gubu - when changes interfere; the nose finally - usually after the growth of the face is complete.
01 / WHAT IS ITWhat is
What is
secondary deformations.
Cleft lip has been treated for years. The goal of the first operation is to avoid repeated operations, but some patients fail to do so. Changes in the lip and nose that remained after cleft plastic surgery or appeared while the child is growing are called secondary deformities.
Most often, it is about a noticeable scar, asymmetry of the lip or a lack of its volume, as well as about the nose: the nostril on the side of the cleft is flattened, the tip is displaced, it is difficult to breathe through the nose. Unilateral and bilateral clefts each give their own characteristic deformation of the nose, so the correction plan is different.
The need for reoperations varies widely: in a review of 34 studies, an average of 21.2% of patients underwent lip reoperation, and in individual studies it ranged from 0 to 91.2%. This is a predictable part of a long-term plan, not necessarily a sign of a failed first operation.
Such changes affect not only the appearance. A noticeable scar on the lip can significantly affect well-being and communication, and nasal asymmetry is often combined with difficulty breathing.
This is general information. What will suit you or your child, the doctor will tell after the examination.
02 / SIGNSWhat worries
What worries
most often
Deformation can be barely noticeable or pronounced. It is important what bothers the child or the adult himself - appearance, breathing or all together.
Lip asymmetry
The lip on the side of the cleft is shorter or higher, the edge of the red border is uneven.
Lack of volume
The lip is thin, on the red border there is a notch - the so-called "whistle".
Nostrils and tip of the nose
The nostril on the side of the cleft is flattened or widened, the tip of the nose is displaced, the base of the nose is asymmetrical.
Stuffy nose
It is difficult to breathe through the nose due to a curved septum or a narrowed nostril.
Jaw and jaw
Residual gingival cleft or maxillary recession alters lip and nose support and bite.
Palate defects after plastic surgery03 / REASONSWhy lip and nose
Why lip and nose
are changing
The deformities are related to the cleft itself and how the face grows, so they often become more noticeable with age.
Cartilage, muscles, jaw
The main causes of nasal deformity with a unilateral cleft are underdevelopment of cartilage, displacement of muscles and underdevelopment of the upper jaw.
Face growth
The lip and nose grow with the face, so the shape changes over the years. Nose operations in childhood and after growth are technically different interventions.
Type of cleft
According to a review of studies, 32.3% of patients with unilateral cleft lip and 78.6% with bilateral cleft lip underwent reoperation, although the difference between the groups was not statistically significant.
Cleft palate
When the cleft took over the palate, the growth of the upper jaw often lags behind: in one center, 55% of such patients underwent surgery on it.
Cleft palate
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Secondary deformations are a planned situation, they do not require emergency care. Urgent help may be needed only after surgery - due to bleeding from the nose or wounds or difficulty breathing.
103 immediately after surgery if:
- bleeding from the nose does not stop after 10-15 minutes of pressing;
- bleeding is very strong;
- weakness or dizziness appeared during bleeding;
- you swallow so much blood that you start vomiting;
- bleeding from a wound on the lip does not stop, although you press it firmly with a clean cloth;
- there is a lack of air, it is difficult to breathe even through the mouth.
To the surgeon if:
On the same day: after the operation, the wound is red, swollen and hurts more and more, pus is coming out of it, the seam has come apart, the temperature has risen, or something else in the healing process worries you - call the surgeon who operated. Planned: if you are concerned about a scar, the shape of your lip or nose, it is difficult to breathe through your nose - make an appointment for a consultation. It is good to come in advance in order to coordinate the terms of correction with the child's growth, treatment at the orthodontist and other stages.
05 / DIAGNOSTICSAs defined,
As defined,
what to fix
- Conversation and documents
What operations were performed and when, what bothers you - appearance, breathing, speech, bite; statements of previous operations, if any.
- Review and photo
Evaluation of scar, lip muscle, lip and nose symmetry; photo in standard angles for planning and comparison.
- Examination of the nose from the inside
The state of the septum and nostrils, whether air passes freely.
- Orthodontist and pictures
Condition of gums, teeth and upper jaw; if necessary — CT.
- The opinion of the patient himself
For children from 8 years and adults there are special questionnaires (CLEFT-Q), where the patient himself evaluates the lip, nose, scar and well-being.
06 / TREATMENTHow to fix
How to fix
lip and nose
There is no single method: the plan is made for a specific deformity and age. Often, the correction consists of several stages, coordinated with the growth of the face and treatment at the orthodontist.
01
The lip
From a small correction of a scar to repeated plastic surgery of the lip.
- Scar correction
- The scar is cut out and stitched so that it lies along the natural lines of the lip. It does not disappear completely, but it becomes less noticeable.
- Repeated plastic surgery of the lip
- If the lip muscle is sewn incorrectly or the lip is asymmetrical, it is sewn up and restored again. In a study of 20 patients, lip asymmetry after such surgery decreased from 26.42% to 18.77%.
- Own fat
- Lipofilling adds volume to the lip and can improve the appearance of the scar. In research reviews, it was safe, and patients with a lack of a red border or "whistle" had the most satisfaction. Excessive fullness, nodules, resorption of part of the fat and a change in the shape of the nostril are possible.
02
Nose
The timing depends on how much the deformity interferes and whether the growth is complete.
- Intermediate correction in childhood
- It is considered if the shape of the nose affects the child's communication and well-being. In a cohort of 342 patients, the majority (55.0%) of the 60 individuals followed up after 18 years did not require subsequent rhinoplasty.
- Final rhinoplasty
- After the growth of the face is completed, the shape and support of the nose is restored with cartilage grafts from the septum, rib, or ear. In a meta-analysis of 842 patients with a unilateral cleft, deformity recurred after surgery in 0.7%, reoperation was required in 6.7%.
- Breathing
- In a review of 29 studies, nasal breathing consistently improved after secondary rhinoplasty, although there is still no consensus on this.
- After surgery
- The shape of the nostrils can be supported by a nasal fixator (stent). Complications from it in the review — 6.0%, mostly the retainer simply fell out.
03
Jaw and jaw
The support of the lip and nose depends on them.
- Bone plastic is clear
- The bone is transplanted into the gum gap, usually at 8-12 years of age. According to a meta-analysis, after a year or more, the success rate was 76.52%, the canine erupted independently through the graft in 80.89%.
- Surgery on the upper jaw
- If the jaw lags behind in growth, it is pushed forward by orthognathic surgery, which is planned together with the orthodontist. In one center, 51% of cleft patients who were followed up to adulthood underwent such an operation.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Secondary deformities of the lip and nose are corrected at Dr. Valikhnovskyi's Institute of Surgery in the field of "Congenital Defects Surgery" - in children and adults who were not corrected in childhood or need a repeat correction. Treatment at the orthodontist and speech therapist is conducted by specialized specialists 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
- Scar correction and replasty of the lip — most often — scar correction; if necessary, the lip and muscle are restored anew.
- Microsurgical technique — magnifying optics and thin suture material to accurately match the tissues, in particular the lip muscle.
- Lipofilling — own fat aligns soft tissues, in particular, can add volume to the lips, — according to indications.
- Secondary rhinoplasty with the patient's own cartilage — the framework of the nose is restored with cartilage from the septum, ear, or rib.
- Bone plastic is clear — the bone is transplanted into the gap of the alveolar process to close the defect and allow the teeth to erupt.
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 face straight on, from the side, and from below, and statements from previous surgeries — the doctor will pre-evaluate the situation.
- ConsultationAn examination of the lips and nose, a conversation about what is bothering you and about the previous stages of treatment.
- PlanWhat to fix now, and what to fix after the growth is over; how to coordinate correction with treatment at the orthodontist.
- SurgeryOne or more stages — depending on what the lips, nose, and jaw need.
- RecoverySwelling subsides gradually; the doctor will explain the care of the suture and the nose and when to come for an examination.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Does repeated surgery mean that the first one was done badly?
Not necessarily. The goal of the first operation is to avoid repeated operations, but some patients do not succeed: the lip and nose change with growth. In a review of 34 studies, an average of 21% of patients underwent reoperation on the lip, and in individual studies this proportion varies greatly — from 0 to 91.2%.
At what age is the nose corrected?
The final correction is usually done after the growth of the face is complete. Earlier, the nose is corrected if its shape interferes with breathing or affects the child's communication and well-being.
Is it possible to remove the scar completely?
No, the cut always remains. But the scar can be made narrower and less noticeable by placing it along the natural lines of the lip.
Where is the cartilage for the nose taken from?
From the septum of the nose, ear or rib. In a meta-analysis of 842 patients, the outcome with all three types of cartilage was similar in terms of re-deformation rates of 0.7%, and re-intervention rates differed between them. The surgeon decides which cartilage is suitable after the examination.
Will it become easier to breathe through the nose?
Mostly yes: in a review of 29 studies, nasal breathing improved after secondary rhinoplasty. What can be expected from you, the doctor will tell you after the examination.
Can it be fixed in adulthood?
Yes. The clinic is also visited by adults who did not undergo surgery or needed correction in childhood.
How many operations will be needed?
Depends on the deformation. With a pronounced initial deformation of the nose, there are several corrections, so the plan is made for years and coordinated with growth.
Sources
18 sources · reviews, guidelines and researchshowCollapse
- The rate of revision surgery for secondary deformities of the lip in cleft lip patients: A systematic reviewJournal of Plastic, Reconstructive & Aesthetic Surgery, 2025doi:10.1016/j.bjps.2025.06.016 ↗
- Cleft lip re-repair: How does it affect the nasolabial appearance?Journal of Cranio-Maxillo-Facial Surgery, 2024doi:10.1016/j.jcms.2024.08.013 ↗
- Fat grafting in patients with cleft lip and palate: A systematic reviewJournal of Cranio-Maxillo-Facial Surgery, 2023doi:10.1016/j.jcms.2023.01.019 ↗
- Autologous fat graft in cleft lip patients: a comprehensive systematic review of technique, outcomes, and complicationsBritish Journal of Oral and Maxillofacial Surgery, 2023doi:10.1016/j.bjoms.2023.06.005 ↗
- Deformity and revision rates after secondary unilateral cleft lip rhinoplasty with different cartilage grafts: A systematic review and meta-analysisJournal of Cranio-Maxillo-Facial Surgery, 2025doi:10.1016/j.jcms.2025.02.030 ↗
- Improvement in nasal airway obstruction after secondary rhinoplasty for cleft lip: A systematic reviewJournal of Plastic, Reconstructive & Aesthetic Surgery, 2024doi:10.1016/j.bjps.2024.01.023 ↗
- Characterizing Cleft Rhinoplasty Across Skeletal Maturity: A Systematic Review of Terminology and Surgical TechniquesThe Cleft Palate-Craniofacial Journal, 2024doi:10.1177/10556656231169479 ↗
- Long-Term Surgical Outcomes of Intermediate Cleft RhinoplastyPlastic and Reconstructive Surgery, 2025doi:10.1097/PRS.0000000000011878 ↗
- Current Treatment Progress of Unilateral Cleft Lip Nasal DeformitiesAesthetic Plastic Surgery, 2024doi:10.1007/s00266-024-04154-3 ↗
- The Role of Postoperative Nasal Stents in Cleft Rhinoplasty: A Systematic ReviewThe Cleft Palate-Craniofacial Journal, 2024doi:10.1177/10556656231190703 ↗
- Orthognathic Surgery Rate in Cleft CareJournal of Craniofacial Surgery, 2022doi:10.1097/SCS.0000000000008002 ↗
- Long-Term Stability of Alveolar Bone Graft in Cleft Lip and Palate Patients: Systematic Review and Meta-AnalysisJournal of Craniofacial Surgery, 2022doi:10.1097/SCS.0000000000008254 ↗
- Secondary surgery techniques to optimise functional and aesthetic outcomes in orofacial cleftingBritish Dental Journal, 2023doi:10.1038/s41415-023-6001-8 ↗
- CLEFT-Q: Detecting Differences in Outcomes among 2434 Patients with Varying Cleft TypesPlastic and Reconstructive Surgery, 2019doi:10.1097/PRS.0000000000005723 ↗
- Primary Cleft Rhinoplasty: A Systematic Review of Results, Growth Restriction, and Avoiding Secondary RhinoplastyPlastic and Reconstructive Surgery, 2023doi:10.1097/PRS.0000000000009924 ↗
- Cleft lip and palate: TreatmentNHS, 2023nhs.uk/conditions/cleft-lip-and-palate/treatment ↗
- NosebleedNHS, 2023nhs.uk/conditions/nosebleed ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
The figures on the page are from these sources.
Troubles the lip or nose
after cleft plastic surgery?
Send photos and statements of previous operations. The doctor will tell you what can be fixed now, and what is better to postpone until the growth is complete.