Final revisions

[Bruce Freeman]

My daughter has a bilateral cleft palate and
cleft lip and has had 15 surgeries including
recent nose surgery and jaw advancement. Her
appearance has improved dramatically but she
still has some concerns about final revisions.
She has two small bumps on either side of her
upper lip which the doctors tell me are unconnected muscles. When she has her nostril
revisions, she will have these muscles conneced.
Does this have a major affect on the appearance
of the upper lip? Is there any way to increase
the fullness of the upper lip? Does tatooing of
the upper lip work effectively? Any help is
appreciated

[Anonymous]

Hi Bruce,
I was born with a bilateral cleft lip and palate 34 years ago and have had over 25 surgeries. Most of the later surgeries were revisions, with the most recent 3 years ago when I had my nose completely revised. I understand your question about the detached muscles on either side of the top lip; this is usually the case with bilateral clefts, and rarely with unilateral clefts. In a recent lip revision, my surgeon attempted to attach the muscles as they are in a non-clefted person. I believe he has done this, but I cannot tell for certain. Since the surgery, the 'way' that my lip moves when speaking, smiling, etc, is slightly different (more normal?) than before. I could be completely imagining it, looking for something positive. Believe me, I am "The Biggest Perfectionist" when it comes to getting myself.....as close to a non-clefted look as possible. I have learned over the years to accept some realities, however. You should expect a surgeon to create the best possible symmetry on your daughter's face. This is a definate measure of success in cleft revisions. I have explored various other surgeries to enhance my features; asking my talented surgeon his opinion on such matters such as collegen injections to increase the top lip area where it is flat. I trust his opinion when he said that collegen injections usually do not move naturally and would be a negative distraction. An option to increase the lip width is the "Abbe Flap" procedure (which I have not had because I have enough lip length). I personally would *never* opt for tatooing the lip line for definition, or 'evening-up' the edges. I don't use lip liner makeup because it looks pretty fake, and draws negative attention. It is very hard to cover this condition up. If your daughter's lip line is uneven, a small lip line revision may be the answer. In the long run, the result will be better. After such a revision, she can put on a little lipstick and look fantastic. I hope I've answered some of your questions. If you would like me to email you some before and after pics to your personal email address, let me know. Good luck!