What Is Cleft Rhinoplasty?

What Is Cleft Rhinoplasty?


Children with a cleft lip and palate often have a nose that doesn't look like other children’s noses. Even if the outside of your child’s nose looks normal, the inside of their nose is often twisted.

Rhinoplasty (also called a nose job) is a nasal reconstruction procedure that improves how your child’s nose looks. But rhinoplasty also makes it easier for your child to breathe through their nose.

What Happens During a Rhinoplasty Surgery?

During a rhinoplasty, surgeons make a small, hidden incision—or cut—on the bottom of your child’s nose (called the columella). The incision help surgeons reach and mold the cartilage inside the nose.

In normal noses, cartilage gives the nose a shape so it springs open. But for children with cleft lip and palate, their cartilage is often collapsed and weakened.

During a rhinoplasty, surgeons reshape collapsed cartilage and remove twisted cartilage to provide support where your child's nose needs it. If your child’s nose bone is twisted, surgeons will also repair the nose bone during rhinoplasty.

The goal is to repair your child’s nose so it looks like other normal noses. However, we also want to make sure your child doesn't look like they've had plastic surgery. There's a balance between how the nose looks and how it works. Our surgeons consider both of these to be important goals.

Nose Scars

Children who have cleft rhinoplasty often have scars and asymmetries in the base of their nose and inside their nostril. This area is called the external nasal valve. Surgeons must use different techniques to make these scars less noticeable.

To make these scars less visible, surgeon will make small incisions (cuts) inside your child's nose and move tissue to its correct location. Incisions are usually hidden on the inside of your child's nostril.

For most children, recovering from this surgery isn't more difficult than a rhinoplasty without a nasal scar revision.


Turbinates are tiny structures inside your nose that warm and moisten (or humidify) the air we breathe. When turbinates are swollen, breathing through your nose can become difficult. Swollen turbinates can cause a stuffy nose or even nasal obstruction.

Children with a cleft lip and palate often have a twisted septum. A twisted septum causes the nose to be narrow in the front on one side and narrow in the back on the other side. Turbinates then grow and fill the inside of your child's narrow nose, and your child may not be able to breathe through their nose.

Fortunately, surgeons can make turbinates smaller with special surgical techniques.

During a rhinoplasty, surgeons straighten the septum. But sometimes it's better for children to have rhinoplasty at a later age.

If your child can't breathe through their nose and we want to avoid a rhinoplasty because your child is too young, shrinking the turbinates may help your child breathe better while we wait for them to grow.

Your surgeon can discuss what your child needs based on how large your child's turbinates are.

When Should My Child Have Rhinoplasty?

Surgeons prefer to wait until a child’s face reaches their adult size to perform the final (or definitive) nasal surgery. Surgeons prefer to wait because they are worried your child's nose will not grow as well if your child has surgery when they are younger. But studies that have carefully examined this question have not shown a clear answer.

Sometimes there are good reasons to perform the rhinoplasty surgery earlier:

  • Some children have a very deformed nose and are teased by their peers.
  • Older children can have nasal obstruction, which means they can't breathe easily through their nose. Nasal obstruction can interfere with their quality of life.

Weighing the risks and benefits of performing the surgery early during your child’s life helps surgeons decide if an early rhinoplasty (or intermediate rhinoplasty) is best for your child.

If your surgeon decides an earlier surgery is better, we trade a possible risk of nasal growth problems for the real benefit of your child being teased less while they're young. Performing a rhinoplasty during early childhood can also improve your child’s confidence.

Sometimes the way your child’s nose looks affects their quality of life so much that your child doesn’t want to wait until adulthood to have surgery. Our surgeons can help your family consider their options. Your surgeon will also discuss any possible risks of having surgery when your child is young.

Your pediatric facial plastic & ENT surgeon can discuss the pros and cons of either decision with your family.


Why Should I Choose a Pediatric Facial Plastic & ENT Surgeon?

As pediatric facial plastic & ENT surgeons, we often help children with nasal congestion and obstruction. Part of our comprehensive evaluation involves examining the inside of your child's nose. Sometimes children’s noses are narrow in front of the turbinates. This makes examining your child in clinic very difficult.

Your surgeon can discuss details about what your child's nose looks like and will tailor their treatment to your child's specific problems.

Many children and young adults have deformed noses from trauma, nasal masses, and cleft lip. Our experience with children who have these types of nasal surgeries helps us achieve the best form (the way the nose looks) and function (how well your child can breathe).

We perform many surgeries on the inside and outside of the nose. In addition to rhinoplasties, we often improve breathing through internal and external nasal surgeries. We also have experience removing tumors from the outside and inside of the nose and skull base.

Performing different types of surgeries helps us identify what's best for your child.

Expertise Performing Surgery in Younger Children

As pediatric otolaryngologists (or ENTs), we cannot always wait to remove a tumor from a child's nose until the bones in their face are fully grown. We have expertise with performing surgery in younger children to minimize the risk of problems with how your child's nose grows.

Your surgeon can review the risks and potential benefits of earlier surgery to help determine if it is the right decision for your family.

We also help children with scarring and narrowing inside their noses. Our deep understanding of the anatomy and function of the inside and outside of the nose helps us improve the way your child's nose looks and how it functions. We use this knowledge to help your child breathe more easily.

Your surgeon can discuss details about what your child needs.

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What To Expect

  • After surgery, your child will have dissolvable sutures (stitches) on the bottom and inside of their nose. Your child will also have splints in their nose that will help it heal.
  • Both younger and older children can usually go home after cleft rhinoplasty. Sometimes, a younger child will have more pain and will need to stay overnight. If your child has obstructive sleep apnea, your surgeon may want your child to stay overnight depending on how severe it is.
  • Your child will ooze some mucous and blood while they are healing. Cleft rhinoplasty causes the mucous inside the nose to become thick. For many patients, nasal decongestion will slowly become worse. Using antibiotic ointment and saline spray helps keep this drainage thin and lets your child breath through their nose.
  • You and your child should be careful not to bump the inside of the nose because your child’s nose will be sore. Reconstruction surgery is also delicate.
  • Your child may take an oral antibiotic. Splints can cause infections, and the antibiotic will prevent an infection inside their nose.
  • Your child will receive pain medication. Our staff will adjust how much medication your child receives so their pain is well controlled.

Our surgical staff care for many children who have rhinoplasty. They will provide you with suggestions and compassionate care after your child’s surgery.

Common Questions

Will my child be able to breathe through their nose right after surgery?

Many children need soft splints to help the nose heal. These splints can get clogged with mucus or “boogers.”

Using salt water spray and ointment several times a day usually helps thin out the mucous that clogs the nose and splints. It's common for the nose to slowly feel more stuffy over the first few weeks.

After the splints are removed, most children will breathe through their nose much more easily. Sometimes children say breathing through their nose stings or “feels weird.” This is usually because they haven't had much air moving through their nose before. This sensation usually goes away with saline spray, ointment, and time. 

After your child’s splints are removed, the tissue inside their nose will slowly swell. Your child’s nose may become more stuffy over the next week. The swelling goes down after a couple of weeks. Your child will also get used to being able to breathe through their nose correctly.

Do the splints in the nose hurt?

Soft splints usually make the inside of the nose sore. Sometimes we can avoid placing splints inside the nose, but usually only for children whose nasal reconstruction is less complex.

Most kids with a cleft nasal deformity also have a deformed nose. Splints give your child the best chance of healing well. Your surgeon should be able to tell you before surgery if your child will need splints or not.

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