Cleft Lip Revision Surgery: Improving Results Over Time

The primary repair of a cleft lip is one of the most transformative surgeries in plastic surgery, converting a significant facial deformity into a near-normal appearance in a single operation. However, as the child grows, the repaired lip and nose may develop imperfections that benefit from additional surgery. Cleft lip revision surgery is an important part of the comprehensive cleft care pathway, and Dr. Prasanna Somvanshi, a Smile Train fellowship-trained plastic surgeon in Mumbai, has extensive experience in optimising results for cleft patients at every stage of their journey.

Why Revisions May Be Needed

Even with the best primary repair, several factors can necessitate revision surgery as the child grows:

Growth-related changes: The face grows significantly from infancy to adulthood. The repaired tissues may not grow at the same rate as the surrounding normal tissues, leading to asymmetry that becomes apparent over time
Scar widening or hypertrophy: The primary repair scar may widen, become raised, or become more noticeable as the child grows. Lips are highly visible, and even minor scar irregularities can be noticeable
Muscle discontinuity: The orbicularis oris muscle (the circular muscle of the lip) may not have been perfectly reconstructed during the primary repair, leading to a notch or irregularity in the lip contour, particularly when the child smiles
Vermilion (red lip) irregularity: A mismatch in the height, volume, or contour of the vermilion border is one of the most common reasons for revision. Even a 1-millimetre discrepancy in the vermilion border is noticeable from conversational distance
Tight or short lip: Scar contracture can make the repaired side of the lip shorter than the normal side, creating asymmetry at rest and during expression
Nasal deformity: The cleft-side nose is almost always affected, with a depressed nasal dome, deviated septum, flattened alar base, and asymmetric nostrils. While intermediate rhinoplasty may be performed during childhood, definitive cleft rhinoplasty is typically deferred until nasal growth is complete

Timing of Revision Surgery

Dr. Prasanna Somvanshi follows evidence-based timing guidelines for cleft lip revisions:

Early childhood (3 to 5 years): Minor lip revisions may be performed if there is a significant functional or aesthetic issue that affects the child's early social development. These are kept to a minimum to avoid excessive scarring in tissues that are still growing
School age (6 to 10 years): Lip scar revision and muscle repair are commonly performed during this period, before the child's increasing social awareness makes the deformity more psychologically impactful
Adolescence (14 to 18 years): Definitive cleft rhinoplasty is performed once nasal growth is essentially complete. This is the most important revision procedure for many cleft patients, as the nose is often the most noticeable residual deformity. Dr. Somvanshi performs open rhinoplasty with cartilage grafting to correct the asymmetric nasal framework
Adulthood: Some patients seek revision surgery as adults, either because they did not have access to revision during childhood or because they desire further refinement. There is no upper age limit for cleft revision surgery

Cleft Lip Scar Improvement

The lip scar from the primary cleft repair is a permanent feature, but its appearance can be significantly improved through revision surgery. Dr. Somvanshi uses several techniques to optimise the lip scar:

Scar excision and precise re-closure: The old scar is carefully excised, and the wound edges are meticulously realigned using layered closure with fine sutures
Z-plasty or geometric broken line closure: These techniques break up the straight-line scar, making it less conspicuous
Muscle repair: The orbicularis oris muscle is carefully dissected and repaired to restore the natural muscle ring, improving lip function and contour
Vermilion realignment: The white roll (the pale ridge at the junction of skin and vermilion) and the vermilion border are precisely matched to create a smooth, symmetric lip
Dermabrasion or laser resurfacing: Performed six to eight weeks after revision surgery, these techniques can further blend the scar with surrounding skin

Cleft Nose Correction

The cleft nasal deformity is characterised by asymmetry of the nasal tip, deviation of the septum, and collapse of the alar cartilage on the cleft side. Definitive correction requires open rhinoplasty with:

Repositioning and suturing of the lower lateral cartilages to correct tip asymmetry
Septoplasty to straighten the deviated nasal septum and improve breathing
Cartilage grafting (from septum, ear, or rib) to provide structural support to the weak cleft-side nose
Alar base repositioning to create symmetric nostrils

Dr. Prasanna Somvanshi's cleft rhinoplasty approach prioritises both functional improvement (breathing) and aesthetic refinement (symmetry and shape).

Dr. Somvanshi's Smile Train Fellowship and Expertise

Dr. Prasanna Somvanshi completed a prestigious fellowship with Smile Train, the world's largest cleft-focused organisation, where he received advanced training in primary and secondary cleft surgery from internationally recognised experts. This fellowship provided intensive exposure to a high volume of cleft cases, including complex revisions and secondary deformities. His training informs his meticulous surgical technique and his understanding of the long-term trajectory of cleft care.

Dr. Somvanshi practices at six major Mumbai hospitals: NH SRCC, SevenHills, Surya Hospital, HN Reliance, MRR Hospital, and Sushrusha Hospital. He is committed to providing comprehensive, longitudinal cleft care, supporting patients from their first surgery in infancy through their final revision in late adolescence or adulthood.

If your child has had a cleft lip repair and you are concerned about the lip scar, nasal shape, or overall appearance, schedule a consultation with Dr. Prasanna Somvanshi. Revision surgery, performed at the right time by an experienced cleft surgeon, can make a meaningful difference in your child's appearance and confidence. Contact our clinic today to book an appointment at any of our six Mumbai hospital locations.