The secondary cleft lip nasal deformity presents an extreme challenge to the plastic surgeon. The cleft nose is a result of a birth defect and the deformity involves all tissue layers from the skeleton to the nasal lining, cartilage and overlying skin. The characteristic cleft nasal deformity is normally what draws attention to a face after a well-performed cleft lip repair. To correct a cleft nose defect requires the surgeon to understand the treatment of cleft lip and palate as well as understand the techniques and applications of rhinoplasty to this problem.

The characteristic appearance of a cleft nose deformity is deviation of the nasal septum to the non-cleft side, nasal asymmetry and displacement of the nasal cartilages.

The secondary cleft rhinoplasty procedure aims to correct the following deformities:

1. Correction of septal deviation and realignment of the nose
2. Augmentation of the nasal dorsum
3. Correction and reconstruction of hypoplastic nasal cartilage using cartilage grafts and suture techniques
4. Correction of nostril and nasal base deformities
5. Improvement of nasal function (breathing)

The timing of the definitive cleft rhinoplasty surgery should take into consideration both the psychological and physical maturity of the patient and the overall facial skeleton. Definitive nasal reconstruction is delayed until any orthognathic surgery is completed. This is usually 17-18 for females and 19 for males.

With the aid of sophisticated 3D imaging computer software, we are able to simulate the surgery to allow patients a preview of how the surgery may change their nose and appearance. This is a very useful tool for patients to be able to see the changes that they will have after surgery and also to describe to our surgeons the type of changes that they want, no matter how subtle

*Cleft Rhinoplasty and Reconstructive Rhinoplasty are medical procedures and are covered by most health insurance plans, although coverage varies according to the different plans and the level of coverage may vary for different procedures.

The results of rhinoplasty surgery will be long lasting and the best results can be noted after 1-2 years when most of the swellings subside completely. As your body ages, it is natural to have some gradual changes to your face including your nose. But most of your improvement should be relatively permanent. A healthy lifestyle and life-long sun protection will help extend the results of your new appearance.

Our plastic surgeon will explain in detail the risks associated with surgery. Rhinoplasty surgery risks include:

• Infection
• Bleeding, haematoma and swelling
• Surgical scars. Whilst the surgical scars are usually well concealed and heal well, there are occasions when it may scar.
• Nasal septal perforation (a hole in the nasal septum) is rare. Additional surgical treatment may be necessary to repair the septum but it may be impossible to correct this complication.
• Difficulty breathing
• Unsatisfactory nasal appearance
• Change in skin sensation (numbness or pain)
• Skin discoloration and swelling
• Possibility of revisional surgery
• In the event when there is rib harvest, there is a possibility of pneumothorax.
• Anaesthesia risks

Rhinoplasty surgery involves many choices and there are also many different techniques. The first and most crucial step is to select a certified surgeon you can trust. 

During the consultation with your surgeon, be prepared to discuss:

• The goals of your surgery, with regard to both appearance and breathing
• Medical conditions or previous nasal trauma, drug allergies and previous surgeries 
• Current medications, vitamins, herbal supplements, alcohol, tobacco. The use of certain health supplements may increase the risk of bleeding and prolong healing. Please check with your surgeons on the impact of these medications. 

It's very important to understand all aspects of your rhinoplasty procedure. It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with your plastic surgeon.