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01. Basic names |
| To better understand the second surgery for cleft lip and cleft palate, the photo here is used to inform you of the basic names for the nose and lips. |
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02. Nose-lips deformity after the first surgery |
| Due to the lack of potential for growth and speed difference in growth, there are scars around the lips and alar (nostrils) cartilage is deformed. As shown in the photo below, the shape of the affected side, i.e. the left nostril is crushed due to the deformed cartilage. The bridge of the nose on the affected side is also low and uneven. The outer side of the nostril on the affected side is a scarred tissue, and it adheres to the bone underneath and gets strained. This can be a reason for deformity. In addition, lack of soft tissues in the nostril floor and compromised formation of the craniofacial skeleton of the lower nose renders the shape of the nostril crushed. Nasal septum, which is columellanasi, is also bent like a bow, pressing the nostril on the affected side from the outside and causing nasal obstruction inside. In case of bilaterality, being bent to one side or symmetry of the both sides can be better than unilaterality. However, it gets strained more severely than unilaterality, due to being crushed and adhesion. |
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03. When to have the second surgery-aesthetically beautifully |
It is recommended that the corrective surgery should be performed after the surrounding craniofacial skeleton fully grows after adolescence. Usually, it is good to plan a plastic surgery for the nose after 14 years of age for women and 16 years of age for men. |
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01. Second cleft lip and cleft palate surgery for deformity of the nose |
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Surgery for nose deformity |
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01. The extent to which nose shape is deformed varies and accordingly there are many surgery methods available. The basic approach is to straighten the columellanasi by means of cartilage transplantation, then make the nose symmetrical from the new columellanasi. |
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02. The outer side of the nasal wing adhered to the skeleton on the affected side is lifted up through sufficient detachment. As lacking cartilage can cause additional deformity later on, autologous cartilage transplantation is employed to maintain symmetry and shape. |
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03. When the columellanasi and nasal septumget positioned upright, the area causing nasal obstruction is lifted and airway is secured. |
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04. Costal cartilage is most effective in correcting deformity of the tip of the nose and providing support. As the costal cartilage offers sufficient strength and support, extension of the nose tip, improvement on nostril deformity, and correction of angle between the columellanasi and lips are possible. By cartilage transplantation, the sufficient amount allows for improvement on depression at the center of the lips and around the nose which is accompanied by cleft lips. |
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05. For Grade 1(mild) case in which deformity is not severe, only a small amount of cartilage is needed if no accompanying deformity is present, therefore surgery can be performed with nasal septal cartilage and ear cartilage only. |
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06. As for the bridge of the nose, osteotomy, prosthesis insertion and autologous cartilagetransplantation can be used to maximize aesthetic effect. A refined nose line can be created, in harmony with the height of the nose tip to be corrected. |
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07. When the nostril on the affected side gets widened excessively, nasal base reduction can also be performed for symmetry. |
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08. If aplasia of the facial bone (maxilla) on the affected side accompanies and causes difference in the height of the nasal floor, the cartilage can be transplanted to make the height even. |
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Procedure for surgery |
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02. Second cleft lip and cleft palate surgery for repair of philtrum and lips, and scars |
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Two types of surgeries are needed for the philtrum and lips.
1. Surgery to fade scars
2. Surgery to increase volume |
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The scar is a newly formed tissue to heal a wound by itself when the skin is damaged by the outside, and it distinguishes itself from other tissues. Scars dont look good; they easily give a negative impression to people and create aninferior complex. For these reasons, people with visible scars want scar revision.
Unfortunately, scars cannot be completely removed through surgery yet, but it is fair to say that 50-60% of improvement can be made. If scar coverage is wide, several surgeries might be required.
Depending on the type of scars, various methods can be employed, including scar revision, peeling, skin graft and insertion of tissue expander. Usually surgery for scar removal refers to scar revision in which incision is made on the scar site and each skin layer is sutured.
Scar revision is performed under local anesthesia and takes about an hour. For scar removal surgery, care after the surgery is important: as the surgery site tends to be open again, the site should be put together and pressure should be applied onto the site for at least three months after the surgery. The second surgery will be determined three to four months later, when the result of the first surgery can be evaluated, and performed six months later. Usually the second surgery is followed by an additional laser procedure in three months and that is the final step for the scar removal surgery.
With regard to the philtrum and lips, their shapes made after the growth period in each patient cannot be identical, depending on unilaterality, bilaterality and traceability. However, the three have something in common: areas where growth development is compromised are small in size, depressed, and crushed in many cases. For such cases, the volume of the depressed and crushed areas should be increased through autologous transplantation, fat graft or other surgical methods. |
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