Patients who are born with a cleft lip and palate show very typical anatomical features of the nose. The cleft nasal deformity is secondary to the congenital birth defect of cleft lip and cleft palate. The nasal deformity may affect one or both nostrils and is characterized by an underdevelopment and malposition of the lower lateral cartilages as well as loss of nasal lining and tissue of the nasal floor. The nasal tip is broad and asymmetric, the alar base is down-slanting to the cleft side, and there is a lack of projection of the maxilla on the cleft side. These features often remain, despite having undergone multiple surgeries during childhood and teenage years. Commonly patients accept the remaining results just because they do not wish to undergo further surgery, or think that a correction or further improvement is not possible. The later is most often the case, and many patients have been discouraged, or think and an improvement or a correction of a cleft lip nose is unattainable.
Correction of a cleft lip nose is quiet challenging for the patient and the surgeon. The patient has already undergone extensive surgical and medical treatments for his/her cleft lip and palate, and is quiet happy to have left hospitals and surgeons behind. At the same time, there are often persisting visible stigma impacting a patient’s self esteem and social life.The cleft lip noses present special challenges to the rhinoplasty surgeon. Not only is the cartilage deviated and malpositioned, it rarely provides enough internal support to shape and project the malformed tip and nostril. Deficiencies of the soft tissue and nasal lining further restrict reshaping and repositioning the nostril. Most of the times the underlying maxilla / upper jaw is displaced posteriorly (class III malocclusion), further weakening the support of the nose. The surgeon encounters the difficulties to perform a rhinoplasty in a previously operated field, dealing with scarring, potentially missing cartilage, and a hypo plastic base of the nose, the maxilla. Understanding the anatomy of the facial skeleton, surgical techniques of the previously performed cleft lip and palate repairs, and the aesthetic proportions of the face are paramount in cleft lip rhinoplasty.
Depending on the persisting deformity the correction may vary in complexity. Sometimes some small corrections may already lead to the desired result, comparable to a revision rhinoplasty procedure. More commonly the cleft lip rhinoplasty procedure is quiet involved, requiring cartilage grafts from the ribs, correction of the facial bone structures, especially the maxilla. Complex reconstructions require an open rhinoplasty approach. Based on your general health, length and type of the procedure and your personal comfort an overnight stay in the hospital will be required.
Unfortunately, it is quiet difficult to provide any estimated costs of a cleft lip rhinoplasty without having examined and talked to the patient. Having read the information above, it is easy to understand that the costs of the surgery will vary depending on the complexity, length of the procedure, hospital stay, and the details involved. Usually there are 3 different costs associated with a surgery; the surgeon’s fee, hospital fee, and anesthesia fee. In some cases the revision cleft lip rhinoplasty procedure might be full or partially covered by your health insurance.During your office consultation with Dr. Knoll you will be thoroughly examined, allowing us to provide you with information pertaining to surgery, post operative expectations and cost associated with your individual surgery plan. For these reasons a consultation in our Frankfurt office is strongly encouraged. We understand that it can be impartial for some of our out of town / or international patients to travel to Frankfurt for an initial consultation. For this reason, Dr. Knoll offers online consultations. By submitting a series of photographs, information abut your desired outcome, and a little about yourself, we can start to determine if you are a good candidate. Though a virtual consultation starts the consultation conversation, it does have it’s limitations and does not replace the need to be seen in person for a traditional consultation to finalize plans for a procedure.
We understand, that considering another surgical procedure / rhinoplasty can be psychologically very challenging to patients. During your consultation Dr Knoll will carefully listen to your concerns, examine you and thoroughly analyze your facial features. She will then discuss this with you, and explain your available options. You can be confident that Dr. Knoll will be honest about realistic expectations, obtainable results, potential risk and benefits associated with an additional rhinoplasty procedure. In some cases a preoperative CT-scan or additional functional studies of your nose might be required. If you have already some of these testings performed, please bring a copy with you to your consultation. Old operative reports are also very helpful. Some patients opt also to send those medical documents to us, prior to their consultation appointment. The more information Dr Knoll has about your previous rhinoplasty or cleft lip and palate procedures, the more conclusive your consultation will be. Medical photographs will be performed during your consultation. The computer imaging is part of Dr. Bianca Knoll’s consultations in her Frankfurt office. After your consultation appointment, you will receive several computer simulations, based on Dr Knoll’s analysis and your goals that had been discussed. The imaged simulations will serve as an educational tool only, to help you to understand your options and facial proportions, and to discuss your preferences. You will also receive further information about any type of preoperative testing required and additional information about the procedure.Choosing an experienced rhinoplasty surgeon who has performed cleft lip and palate repairs, and craniofacial surgery performing cleft lip rhinoplasties using modern and advanced techniques is important.If you wish to have additional information or would like to schedule a consultation please contact the office of Dr. Bianca Knoll, we will be happy to assist you.