If your child had surgery to repair a cleft lip, there may be one more step to complete the process -- rhinoplasty. Depending upon how your child’s nose develops, if you need to make further repairs, turn to the plastic surgeons at Up Pediatric Plastic Surgery. Both Shitel Patel, MD, and Jacqueline Wegge, MD, are trained in craniofacial plastic surgery, making them ideal surgeons for your rhinoplasty needs. If you’re in Houston or Webster, Texas, call one of the offices or use the online booking form to schedule a consultation.
Cleft patients have noses that form abnormally and cartilage that is usually very weak. The surgeons at Up Pediatric Plastic Surgery do as much as they can to fix the nose at the time of the initial lip repair. However, most of the techniques necessary to properly fix a nose cannot be performed on a baby because they are still growing. As a result, as your child gets older, they may still have some trouble breathing, or may want the appearance of the nose improved.
In order to get the best results, you should wait until your child has gone through puberty and is fully developed. The surgeons at Up Pediatric Plastic Surgery recommend that you wait until your child is between 16 and 18 years of age.
If your child is having social problems beforehand because of their nose, the doctors discuss other techniques with you, such as a kindergarten rhinoplasty, to improve your child’s nose before a more formal rhinoplasty.
For a rhinoplasty, the surgeons at Up Pediatric Plastic Surgery make most of the incisions inside the nostrils where they’re hidden, and one small incision along your child’s columella (the tissue between the nostrils).
The surgeon lifts the skin off of the cartilage and removes a large piece of cartilage from your child’s septum, if needed. The surgeon then straightens the septum and, if necessary, breaks and straightens the bones as well.
The surgeon usually needs to add a number of cartilage grafts in different places to strengthen, shape, and give your child’s nose projection. There are several possible sources for the cartilage grafts:
Once all the cartilage is shaped, and the grafts are in place, the doctor sutures the skin closed.
During the surgery, the surgeon places splints around your child’s nose, which they remove in five to seven days when you return to the offices at Up Pediatric Plastic Surgery. Your doctor also removes the stitches at this time.
While the splints are in place, your child’s nose should be kept dry. Your child will feel like they’re congested and it’s hard to breathe through the nose. While you can gently clean the nose with a swab, your child shouldn’t blow their nose, and they should try to sleep propped up on pillows.
Bloody drainage is normal for the first week or so, and your child’s face and eyes may swell or look bruised. You’re able to go home the same day as the surgery, and your child may return to school whenever they feel ready, but they should refrain from sports, heavy exercise, and gym class for six weeks.
If your child undergoes a rhinoplasty due to a cleft lift and cleft palate, the surgeons at Up Pediatric Plastic Surgery have usually addressed most other issues by the time they perform the rhinoplasty. This includes an ABG (alveolar bone graft), as well as any jaw surgery that is required. However, in instances where the nose is significantly deformed, and is causing problems with self-confidence and school, the surgeons may consider performing the rhinoplasty earlier. In this case, if jaw surgery is still planned, another small revision of the nose might be needed afterwards.
To send your child into adulthood with a nose that functions well and looks good after a cleft repair, call Up Pediatric Plastic Surgery, or schedule an appointment using the online booking tool.