This surgery helps provide harmonious balance to your facial features so you feel better about your appearance. The plastic surgeon may often recommend chin surgery along with nose surgery in order to achieve balanced facial proportions − this is because the size of the chin can increase or decrease the perceived size of the nose.

Abnormal development

Cleft lip and palate repair is a type of plastic surgery to correct abnormal development, aiming to restore function and bring the appearance closer to normal.

Cleft lip and cleft palate are among the most common congenital malformations that affect children. Incomplete formation of the upper lip (cleft) or roof of the mouth (palate) can occur individually or together. Conditions can vary in severity and may include one or both sides of the face.
The cleft or separation of the upper lip and/or the roof of the mouth occurs very early in the development of the fetus. During fetal development, some components of the upper lip and roof of the mouth do not form normally. Most clefts can be repaired through specialized plastic surgery techniques, improving a child's ability to eat, speak, hear and breathe.

Early intervention by a team of experts is essential in cleft lip and/or cleft palate repair. The team can work together to define treatment planning, including the surgical procedure, speech therapy rehabilitation and dental restoration. These teams are multidisciplinary and generally include:
• Plastic surgeon;
• Pediatrician;
• Pediatric dentist;
• Otolaryngologist;
• Speech therapist;
• Genetic Consultant;
• Social Worker.

Surgery to repair a cleft of any type is an individualized procedure that aims to not only treat the imperfection, but also to ensure that the oral structures function and develop normally. Cleft lip repair, also called cheiloplasty, includes the reconstruction of a more normal appearance, that is:

• Closing the cleft results in a scar located in the normal structure of the upper lip;
• Formation of a cupid's bow (the curve in the center of the upper lip);
• Considerations regarding the appropriate distance between the upper lip and the nose.

Because the palate creates the floor of the nasal cavity, considerations regarding cleft palate repair include:
• Normal development, function, growth and speech;
• Better relationship between the palate and the ear canal and hearing;
• Development of teeth and jaw in an aligned manner.

Where the cleft also affects the shape of the nose, additional procedures may be recommended to:
• Achieve symmetry between the nostrils;
• Create adequate length of the columella (tissue that separates the nostrils);
• Increase the angle of the tip of the nose, to avoid a flat or drooping nasal tip.

The timing of surgery will depend on your child's individual circumstances. Cleft lip repair is performed when the child is at least 10 weeks old, weighs 10 pounds, and has a hemoglobin (or blood count) of at least 10. Cleft palate repairs are usually done when the child is a slightly older, from 9 to 18 months old. Repair of the fissure can be postponed in order to treat other pathologies that can be life-threatening, such as heart or lung pathologies.

The success and safety of the procedure begins with consultation with the plastic surgeon and largely depends on your sincerity.

• Options available for cleft lip and/or cleft palate repair;
• Probable results of the surgery, potential risks and complications associated with the procedure;
• Treatment planning.

Be honest about your concerns. The success and safety of the procedure requires that you:
• Share your concerns;
• Describe your child's health history accurately, including current medications, vitamins and natural medications;
• Commit to following all the plastic surgeon's instructions precisely.

The decision to undergo surgery is a personal one and your plastic surgeon will explain the benefits, goals and potential risks or complications. The plastic surgeon and/or assistants will explain in detail the risks associated with the surgery. You must sign the consent form to ensure that you fully understand the procedure, the alternatives and the most likely risks or potential complications.

• Bleeding (bruise);
• Infection;
• Poor healing of incisions;
• Irregular tissue healing, including contracture;
• Residual irregularities and asymmetries;
• Anesthetic risks;
• Allergies to tape, sutures, materials, glues, blood products, topical or injectable medications;
• Damage to deeper structures such as nerves, blood vessels, muscles and lungs, which may be temporary or permanent;
• Possibility of a new surgical procedure (touch-up).

It's natural to feel a little anxiety, whether it's anticipation about the expected results for your child or pre-operative stress. Discuss these feelings with your plastic surgeon

Prior to surgery, the plastic surgeon will discuss with you:
• Pre-surgical considerations, diagnostic tests and medications;
• Instructions for the day of surgery (fasting time, medications, bath);
• Specific information related to anesthesia;
• Post-operative and follow-up care.

The plastic surgeon will also discuss where your child's procedure will be performed. It is usually carried out in a hospital environment.

Prior to surgery: In some cases, the child may receive an intraoral device to use before cleft lip repair, with the aim of helping with feeding and maintaining the lip arch before surgery.

Step 1 – Anesthesia

Medications are administered for your child's comfort during surgical procedures. Options include intravenous sedation and general anesthesia. Your doctor will recommend the best option for your child.

Step 2 – Incision

The goal of cleft surgery is to close the lip defect and provide a more normal upper lip structure, function, and appearance. Incisions are made on both sides of the slit to create the fabric flaps that are drawn and joined together to close the slit. Repairing a cleft palate requires careful repositioning of tissues and muscles to close the cleft and rebuild the roof of the mouth. Incisions are made on both sides of the cleft, flaps are used to reposition the muscle and hard and soft components of the palate. The repair is then sutured generally to the midline of the roof of the mouth, providing sufficient length of the palate to allow for normal eating, speech development, and continued growth throughout life.

Step 3 – Closing the Incisions

Cleft lip and palate incisions can be closed with removable or absorbable sutures.

Note: It is important to understand that while the cleft can be repaired surgically in a simple plastic surgery procedure, treatment for a child born with a cleft continues through adolescence and sometimes even into adulthood. As the child grows, new procedures to improve function and appearance may be necessary.

Step 4 – Results

The resulting scars are usually positioned along the normal contours of the upper lip and nose. Over time they tend to become more discreet.

After surgery, bandages or bandages may be placed on incisions outside your child's mouth.

How to care for the surgical site after the procedure, medications to take by mouth to help reduce the risk of infection, specific concerns about your child's overall health, and when the return appointment will be.

The plastic surgeon or assistants will instruct you about your child's nutrition, as well as any restrictions or special activity instructions.
Don't be surprised if limitations are placed on your child's arm during recovery. Such limitations will prevent you from injuring the surgery site. Restraints can be removed several times during the day as long as your child is supervised and prevented from touching the surgical site or sucking their thumb.
Your child's restlessness can be controlled with pain medication. If necessary, sutures will be removed after surgery. Healing will continue over several weeks and the swelling will subside.
After surgery, protection from the sun is essential to prevent the formation of irregular scars.

The result will make a big difference in the quality of life, in the ability to breathe, eat and speak. However, secondary procedures may be necessary for functional or enhancement reasons. Even though cleft lip repair scars are usually located within the normal contours of the face, it will always be visible.

Cost is always a consideration in elective surgery. A surgeon's fees may vary depending on their experience and the type of procedure performed.

• Surgeon's fee;
• Hospital and surgical center costs;
• Anesthetist's fees;
• Prescribed medications;
• Medical exams.

When choosing a plastic surgeon to perform this procedure, remember that the surgeon's experience and your good relationship with him or her are as important as the final cost of the surgery.

• Ear canal: Passage of the ear.
• Cheiloplasty: Surgery to repair cleft lip.
• Cleft lip: Incomplete formation of the upper lip.
• Cleft palate: Incomplete formation of the roof of the mouth.
• Cleft: Separation of the upper lip and/or roof of the mouth.
• Columella: Tissue that separates the nostrils.
• Contracture: Scar that pulls neighboring tissues, a potential complication of palatal surgery.
• General anesthesia: Drugs and/or gases used during surgery to relieve pain and reduce consciousness.
• Hemoglobin: Blood cell count in the blood count.
• Intravenous sedation: Sedatives given by injection into a vein to help you relax.
• Obturator: An intraoral device that your child can wear before cleft lip repair, helping with feeding and maintaining the lip arch before surgery.

Use this list as a guide during your consultation
• Are you a specialist by the Brazilian Society of Plastic Surgery?
• Have you been trained specifically in the field of plastic surgery?
• How many years of plastic surgery training have you had?
• Is the installation of the procedure room in your office authorized by the Health Surveillance of your city?
• Am I a good candidate for this procedure?
• What is expected of me so that the best results are obtained?
• Where and how will the procedure be performed?
• Which surgical technique is recommended for my case?
• How long can I expect to recover, and what kind of help will I need during my recovery?
• What are the risks and complications associated with my procedure?
• How are complications treated?