When someone mentions Plastic Surgery, we may automatically envision Breast Implants, Face Lifts and Liposuction. But there is another side to Plastic Surgery. Surgeries with such significant impacts to our self esteem and growth as human beings we may not even consider–unless we are unfortunate enough to suffer from such maladies.
According to the American Society for Plastic Surgeons (ASPS), 1 out of 800 infants have cleft palate or cleft lip, a genetic abnormal separation of the lip or roof of the mouth, or both. The severity can range anywhere from a slight irregularity of the vermillion of the lip to complete separation extending all the way to the nose. Unfortunately, the genes responsible for cleft palate/lip have not yet been identified. Furthermore, left palate/lip may be isolated or be a part of a larger genetic disorder. Fortunately, isolated cleft palate/lip is more common and does not include other genetic misfortunes. Besides aesthetics, other problems which may be present are difficult feeding, hearing disorders, dental issues, and speech conditions. Clearly treating this condition early in developmental years can contribute to normal psychological and physical development.
However cleft palate or cleft lip (with consideration of the severity of its effects) isn’t as simple as suturing the two segments together. According to the ASPS, an entire team specifically trained in treating cleft lip/palate is necessary in correcting the condition effectively. These specialists may include a reconstructive plastic surgeon, a otolaryngologist (ENT), a speech therapist, a dentist, a pediatrician, and a psychologist. he plastic surgeon is obviously the talent behind the aesthetic procedures. The ENT, to consult on related disorders of the ears, nose, and throat. The speech therapist to help with treatment of abnormalities of speech as related to the deformity of the mouth and palate (if applicable). A pediatrician can help correct a deficient diet which may be associated with having cleft palate/lip, nutrients necessary for normal growth and development.
Surgical Procedures to Correct Aesthetic Factors in Cleft Lip Patients
After a genetic counselor has determined if the patient has any other present genetic abnormalities, and the ENT can determine if other physical abnormalities exist, surgical corrections are considered. The surgery is normally performed during infancy (at about 10 weeks old) under General Anesthesia. After the area is thoroughly cleansed with an anti-microbial, the incision line is drawn using an surgical pen. The incision is commonly made just outside both sides of the cleft. Muscular irregularities are normally corrected at this time. After muscular issues have been addressed, the skin is then joined via sutures. Every effort is made to give the appearance of “normal” physiology. Although I hesitate to say “normal”, truth is truth. The hard truth is that, no matter how much I dislike to admit it, cleft lip./palate disorder is an abnormal genetic occurrence.
Cleft Lip Surgery Recovery
With Cleft Lip Correction Surgery, the risks associated with anesthesia will apply. As will risks such as infection, inflammation, abnormal swelling, seroma (a build up of fluid), hematoma (a pocket of blood from internal bleeding), abnormal scarring. and numbness. It is recommended that elbow restraints be utilized during the healing phase to prevent additional irritation and rubbing by the infect. Touching the treatment area without proper anti-bacterial treatment can further increase the risk of infection and abnormal scarring.
All in all, discomfort will more than likely be present, but no more than pain management medications can counter. Speak to your child’s doctor for further information on what to look out for and medications prescribed to treat the after effects of your child’s surgery.
A Personal Interview With A Cleft Lip Patient
I have a very close friend, we’ll call her Michelle, who was born with a cleft lip and has had extensive surgery to correct its effects.
- Q. On a scale of 1 to 10, how do you feel your surgical team would rate the severity of your cleft lip?
A. Probably a 4. - Q. On a scale of 1 to 10, how would you rate the severity, and its psychological impact on your childhood?
A. Probably a 7 as for how it affected my childhood. I was teased a lot. - Q. When did you first start treatment?
A. My original surgery was as an infant. I don’t remember it. I had follow-up surgery when I was 20 for lip and rhinoplasty, and revision again at 30. - Q. What was the most difficult memory related to your cleft lip?
A. Kids called me “Ellen” for a while, until one of them told me it was “L – N” for Lips and Nose since they were “messed up.” - Q. How many specialists were on your team? Did you have a plastic surgeon, speech therapist, dentist, otolaryngologist (ENT), etc.?
A. Don’t know as a child, but I would guess just one surgeon. No speech therapy or anything else. I had orthodontist like normal kids. - Q. How many procedures or treatments have you had to treat your cleft lip?
A. Well, 3, if you count the rhinoplasty/cleft revision (although that was mostly rhinoplasty and they never finished the cleft revision. I’m actually supposed to go back for cleft lip revision). - Q. Do you remember any pain associated with any of your procedures. If yes, do you feel it was worth it?
A. For the cleft lip, no. For rhinoplasty, it was MISERABLE. - Q. Are you satisfied with the results, or do you feel more progress could be made with further surgeries?
A. I would like further procedures. The last surgery was left incomplete because of swelling, the lip revision could not be done as intended with the rhinoplasty. I still feel my lip is noticeably assymetric, longer on one side. I also have some extra tissue at the base of my nose/top of my lip that makes my nostrils look small and uneven. - Q. If you could redo anything, are there any changes in treatment you would make?
A. If I could go back in time, I would have had the 2nd surgery at a younger age, say 15 (instead of 20) and would have gone to a better surgeon. I was not happy with the results from the 2nd surgery. - Q. If you had anything to say to any parents reading this article, what advice or comments would you like to offer? Any words of encouragement?
A. Some kids might try to act tough about their birth defect and say it doesn’t effect them. This is a facade. It dramatically effects childhood, especially the early teenage years. Adolescence is hard enough when you’re normal. A noticeable birth defect on the face brings on perpetual derision and compounds it’s traumatic effect from early childhood through young adulthood, the most critical time in the development of self-esteem. If you are a parent of a child with a cleft lip, you should do everything in your power to minimize the difficulty of growing up with this deformity. Encourage your child to be open and honest about how it effects them. And if you can do anything about it, it should be a priority.
In closing, there have been recent studies suggesting that folic acid may significantly decrease the incidence of cleft palate., cleft lip disorders. If you are considering becoming pregnant, or have recently become pregnant and are not taking folic acid regularly, discuss with your obstetrician the benefits of taking folic acid during gestation.
Also, on a personal note, please discuss with your children about teasing or making fun of other children who do not fit the mild of “normal”. The effects of off-color and derogatory comments can significantly impact another child’s developmental growth and social nature. Teaching a child tolerance and acceptance is a lifelong lesson in empathy and kindness. If the tables were turned, your child would not appreciate the teasing often dished out by fellow playmates. The Golden Rule is an amazing concept that can surely be embraced easily by every individual. Life lessons are first taught in the home.
