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July is National Cleft and Craniofacial Awareness and Prevention Month, a time to raise awareness and improve understanding of children with craniofacial differences. UC Davis Children’s Hospital’s Cleft and Craniofacial Team, co-led by Craig Senders, professor emeritus of pediatric otolaryngology, and Travis Tollefson, professor and division chief of facial plastic and reconstructive surgery is a patient-centered group of interdisciplinary professionals providing care to these children.

Some of the more common craniofacial differences in patients include children born with clefts of the lip and palate and other conditions of the head, face and neck. Each year in the United States, approximately 2,600 babies are born with a cleft palate and 4,400 babies are born with a cleft lip, with or without a cleft palate. Children with cleft or other craniofacial differences may need special care in areas such as early feeding, speech instruction and socialization. This care is ideally provided by interdisciplinary teams from infancy to young adulthood. Comprehensive care includes nutrition specialists, speech-language pathologists, orthodontists, otolaryngologists and surgical teams.

The UC Davis Cleft and Craniofacial Team includes these specialists and offers comprehensive, interdisciplinary care to patients with cleft and craniofacial problems. More importantly, explains Tollefson, the team emphasizes ongoing support to patients and their families. Since the beginning of the pandemic, Christy Roth, program coordinator, and Adebola Olarewaju, nurse practitioner, have done extra work with families to provide regular social support. The team also has an ongoing quality improvement project, in which Spanish-speaking medical students validate the forms of primarily-Spanish-speaking parents, ensuring that their concerns are properly understood and addressed by the team.

“It’s all about the kids and their parents, making sure that they are cared for,” says Tollefson about the team. “The person who makes it all work in our pediatric multidisciplinary teams is an incredible person, Kathy Porter, our cleft team coordinator.” Porter, Pediatric Special Programs Coordinator, explains that she feels her role with the craniofacial team is that of a patient advocate. “I love helping families navigate the intricacies and complexity of the medical field. The families can spend years – even decades – with our providers and services and I want to ensure it is as seamless and stress free as possible.”

The faculty of the UC Davis Cleft and Craniofacial Reconstruction Program conduct research on the prevention and treatment of cleft and craniofacial issues. Tollefson notes that there are many exciting projects currently being conducted by the team.

One project, funded by a grant from the March of Dimes, will study the use of folic acid to decrease the incidence of cleft lip and palate. This will be a multicenter study, in which UC San Francisco and UC Davis will partner to determine the effectiveness of folic acid in preventing cleft lip or palate. 

Jamie Funamura, chief of pediatric otolaryngology, is working on an ongoing research project examining the varying health priorities at different ages for children with cleft lip and/or palate from the patients’ and families’ perspectives. The goal is for multidisciplinary teams to better understand how to provide the best patient and family- centered care.

Tollefson and Roth have joined an exciting new study on the shape of muscles in the palate after surgical correction. This study will use a novel MRI that allows the 4–5-year-old child to have headphones and goggles on while the cleft team speech pathologist prompts them to speak. The MRI images are then interpreted to choose the best speech surgery for the child.

Tollefson, Roth, Olarewaju and UC Davis Pediatric Pulmonologist, Rory Kamerman-Kretzmer are key contributors to a group of cleft team professionals called Stakeholder Alliance for Children with Robin  Sequence (StARS): Building Capacity for PCORI (Patient Centered  Outcomes Research). They have enlisted parents and experts to better define strategies to improve care for children born with Robin Sequence.

Meet the Team

Craig W. Senders, M.D., FACS
Pediatric Otolaryngology Cleft & Craniofacial Program Co-Director

Travis T. Tollefson, M.D., M.P.H., FACS
Facial Plastic and Reconstructive Surgery Cleft & Craniofacial Program Co-Director

Christy Roth, M.S., CCC-SLP
Cleft & Craniofacial Program Coordinator

Madelena Martin, M.D.
Pediatric Geneticist

Robert S. Byrd, M.D., M.P.H.
Pediatrician

Adebola Olarewaju, M.S.N., P.N.P., Ph.D.
Nurse Practitioner

Audrey Bracchi, Au.D., F-AAA
Audiologist

Samantha McKinney, A.uD., F-AAA
Audiologist

Chuen Chie Chiang, D.D.S., M.S.
Orthodontist

A child born with an opening in the upper lip is a common craniofacial difference in newborns called a cleft lip. Similarly, a cleft palate is also a congenital finding where the baby’s palate (aka roof of the mouth) has a opening between the nose and mouth. In medical terms, such congenital malformations are also called orofacial clefts or simply oral clefts.

For the uninitiated, congenital malformations can be defined as present in the baby from the time of birth. These can potentially change the function, shape, and appearance of the child, while the vast majority of these amazing children overcome these obstacles. The child’s progress is greatly enhanced by a strong relationship between the family, child and a multidisciplinary Cleft Team, such as at the University of California Davis.

Cleft lip and palate are among the most common congenital differences globally.

The incidence live births in the United States shows an estimated:

• 1/600 babies have cleft lip +/-  cleft palate
• 1/1,000 babies have just cleft palate

Typically, oral clefts happen in the initial stages of pregnancy. The baby’s lips are formed during the first 6-8 weeks of pregnancy, and the cleft palate develops around the second month of pregnancy. For some unknown reason, boys have more of a chance of having a cleft lip with or without cleft palate than girls. Girls are prone to developing a cleft palate without a cleft lip.

How Cleft Lip & Palate affects a Baby’s Facial Appearance

A cleft lip may occur on the two sides of the baby’s lip (bilateral ) or just one side (unilateral) . Some newborn babies with cleft lips may have a tiny notch on their upper gumline (also know as an alveolus) . Babies with a complete cleft lip have an opening in their lip that continues up into the nostril(s). A cleft appearing right in the center of the lip is called a median cleft and is very uncommon.

A cleft palate is known to affect either the soft palate, hard palate, or both. Some babies with a cleft palate may be born with an opening in both the front and back part of the palate, while others have small openings only in one part of the palate.

Cleft Lip and Cleft Palate – Primary Known Causes

There’s not enough evidence to confirm what causes either a cleft lip or cleft palate. It can be a blend of various contributing factors, including genes, environment, diet, medicines, etc.

However, a family history  cleft lip and or cleft palate is a reason for children to have a cleft.

Some of the things that may increase the chances of a baby having a cleft lip or palate are:

Family History

If either of the parent or anyone in the immediate family is known to have been born with  oral clefts, the chances of your baby having orofacial defects do increase. Cleft lip with and without cleft palate are do occur more often in some areas of the world and within certain race/ ethnicities for unknown reasons.

It is wise to share your family history with your doctor and genetic counselor if your family has a history of having cleft lip or palate.

Smoking & Alcohol Consumption

Pregnant women drinking alcohol or smoking during the first few weeks of their pregnancy are susceptible to having babies with cleft lip or palate. It should be avoided not only to reduce the risk of orofacial defects but for the overall health of the mother and optimal growth of the baby.

Nutritional Deficiency

Nutritional deficiency is another reason cleft lip or palate may occur. One of the important nutrients a pregnant woman needs is folic acid.

The deficiency of folic acid may cause the formation of cleft lip or palate and can be the reason for other congenital disabilities as well.

Diabetes

Being diabetic (type 1 or 2) before pregnancy has been shown to be associated to children born with cleft lip and palate, but the reasons are unclear.

Medicine

Medications that can lead to birth deformities should be avoided during pregnancy. Epilepsy or seizures medications during pregnancy are one example that have been associated with a newborn having a cleft lip or palate.

Best Advice for Mothers before and during pregnancy

Oral clefts cannot be completely prevented. However, following a healthy routine, avoiding certain things, and taking a few preventive measures can minimize the risk of your baby having a cleft lip or cleft palate.

• Don’t smoke.
• Avoid alcoholic drinks.
• Prenatal vitamins are offered by your OB/GYN so you can consume Folic Acid –
• Take these multivitamins as per your doctors recommendations
• Maintain a healthy and balanced weight
• Consult with your doctor about the medications you’re already on.
• Get into a prenatal care routine as soon as you get pregnant.

Diagnosis For Cleft Lip and Palate

Newborns with cleft lip or palate are diagnosed right after birth. Your doctor may be able to identify and detect oral clefts during pregnancy in an ultrasound.  New Technology has allowed 3 dimensional images to be created from your ultrasound. In some cases, the pregnant mother and father may meet  with the multidisciplinary Cleft Team and cleft surgeon in a prenatal visit, after the ultrasound shows a cleft.  This can help alieviate fears and prepare the family for caring for their newborn with a cleft. Contact your local ACPA accreditied Cleft Team for more information.

Problems Cleft Lip and Cleft Palate Can Cause

• Feeding Problems
• Dental Problems
• Speech Problems
• Ear Infections
• Hearing Problems

Some babies with cleft lip or palate may experience problems with breastfeeding or may need more than usual time to get started. Cleft palate in babies nearly always restricts them from breastfeeding. 

But in these cases, babies can be fed pumped breast milk through a bottle. There are also special bottles (sometimes called feeders) available to feed babies with cleft lip or palate. Your doctor may ask you to see a lactation consultant to learn techniques on how to breastfeed your baby.

Treatment For Cleft Lip and Palate

Oral clefts can be treated through pediatric otolaryngology, facial plastic surgery, or plastic surgery. If your baby is born with a cleft lip, it’s highly recommended to undergo repair before the first year completes. Surgery for cleft palate must be ideally done before the baby is around 10-14 months old.

Pediatric plastic surgery for oral clefts helps aid with breathing and improves the baby’s facial aesthetics, speech development, and hearing. In some cases, the babies may need a few more surgeries later in life.

In cases where multiple pediatric plastic surgeries are required, care from other medical specialists like speech therapists, oral surgeons, dentists, and ENT (otolaryngology)  may be required to help with issues caused by oral clefts.  This is why the Cleft Team is so important in the care or a baby with a cleft. With proper treatment, children with oral clefts live healthy, fulfilling lives. Health care providers can also help babies with orofacial clefts get the proper care they need to go about their life as they grow older and lead healthy, normal lives.  They inspire all of us.

The nose is one of the most prominent facial features. If it’s too small, crooked, or too wide, it can be seen as out of proportion to the rest of the face. The nose is one of the first things that someone sees when they meet you. Some studies suggest that people first look at each of your eyes (to see if you are happy, curious, friendly, or mad), then at your mouth to see if you are smiling, then back past your nose to your eyes again. They look at the center of your face in an upside triangle pattern. This is why the shape of the nose is so important to many people.

A Rhinoplasty, which can be referred to as a nose job, is a kind of surgical procedure that changes the shape of the nose structure while improving or maintaining your nasal breathing. The goal is to help restore balance to your facial aesthetics. It is one of the most sought-after cosmetic surgery procedures today.

If you’re considering having a Rhinoplasty, the first question that comes to mind is, “What are the things I need to know about Rhinoplasty?”.

This article will discuss the top 10 things you need to know about Rhinoplasty, so let’s begin.

Have Realistic Expectations

When getting a Rhinoplasty, it’s essential to understand that it’s not magic. If you want to have the nose structure of a celebrity, it may not be possible to duplicate the same on your face exactly. Why? It is because of many factors, including your face and nose’s bone structure. Getting the same nose may not be proportionate with your facial features, making it look out of place.

You Need To Take Time Off

One of the things you need to know about a Rhinoplasty is that it’s not a cosmetic surgery procedure you get in the afternoon and enjoy at a party in the evening.

When you get Rhinoplasty, it’s not only important but also mandatory to take time off to heal. The time needed to heal after the Rhinoplasty procedure varies from person to person. The point is to prepare in advance and manage your schedule accordingly to take time off.

You May Not Like Your New Appearance Immediately: have patience.

The results of a nose job are not visible immediately after the procedure. After Rhinoplasty, the body takes time to recover, and the nose region would likely be swollen or bruised. The nose may also have a splint after the nose job, and there might be lingering pain and discomfort.

The results would start surfacing in a few days or weeks after taking proper rest, taking anti-inflammation medication like ibuprofen or a steroid (if prescribed), and keeping your head elevated when sleeping.

However, it’s important to avoid strenuous activities for a couple of weeks and allow swelling to subside, bruises to go away, and nasal structure to heal completely. Avoid activities that place your head below your heart level (like yoga) for the first several weeks.

Final Results May Take Time

As mentioned earlier, swelling and bruises would remain for the first couple of weeks, sometimes even more. It depends on the cosmetic surgery procedure and your body’s response to the surgery. Don’t worry, though, as all the visible signs of bruises and swelling would be gone in four to five weeks.

However, note that some of the last signs of swelling may take a few months to even a year to go away. It’s important to stay patient and follow the after-care routine prescribed by your cosmetic surgeon.

When Done Well, It Should Look Natural

There’s no doubt that when cosmetic surgery is done well, it should enhance your natural beauty.

A good Rhinoplasty doesn’t always have to be complicated. It only alters your nose slightly to make it look proportionate with the rest of the facial features. When the nose blends well, it looks natural and doesn’t attract any peculiar attention.

Rhinoplasty Is For All Genders

Many men are opting to go for Rhinoplasty today, and the figure continues to rise every year. The number of men going for a Rhinoplasty has risen by over 300 percent since 1997.

Rhinoplasty Is Not For Everyone

If you’re unhappy with your nose and its appearance, it makes you a probable candidate for Rhinoplasty.

However, it’s important to know that you must be flexible, have realistic expectations of the procedure, understand its risks, and discuss other pros and cons with your surgeon.

Also, your health should be in good condition to support the post-surgery healing process. If you smoke, make sure to quit before the procedure, or at least ensure you don’t smoke till the nose has completely healed after a Rhinoplasty procedure.

You May Need To Consider Other Procedures

In some cases, it’s possible that once you change the shape, size, or look of your nose, other facial features may start to appear disproportionate.

For example, a small chin may look out of proportion from the profile (side view). Your surgeon may recommend you have both a Rhinoplasty and chin surgery to create more balanced facial aesthetics.

Sometimes, Revisions Are Needed

Even if the Rhinoplasty procedure is completed, the results may not be as you envisioned. At times, the healing process may not go as planned, resulting in a minor flaw still visible. In such cases, revision surgery is needed to correct any remaining flaws to get that perfect nose.

Make Sure To Choose The Right Surgeon

Rhinoplasty is a rather complex surgery, the results of which primarily depend on the skills of the hand that performs it. Make sure to do your research well and zero in on a board-certified facial plastic surgeon or plastic surgeon who is reputable, experienced, and skilled with an excellent track record.

Your relationship with the surgeon is crucial to achieving positive results, as you work together to develop a pre and post-surgery care routine that ensures excellent results, complementing your natural beauty.

Summary

If you’ve been considering going for a Rhinoplasty for a while, it’s time to make a move and go for it.

Consult with a facial plastic surgeon to gain knowledge about the Rhinoplasty procedure and to help prepare you for the surgery.

Rhinoplasty is a common cosmetic surgery procedure that has evolved over the years to become a safe procedure that you should learn more about.

Rhinoplasty is a surgical procedure to improve nose structure, facial aesthetics, and breathing. Rhinoplasty is often referred to as a ‘nose job’ and has many benefits. Many factors contribute to the success of a Rhinoplasty including care before the procedure, the quality of surgery and surgeon, and Rhinoplasty aftercare.

This article will extensively focus on and discuss Rhinoplasty aftercare, which can help reduce recovery time, especially the Rhinoplasty recovery diet. Rhinoplasty aftercare is not only necessary to reduce the recovery time and boost the healing process but is integral to achieving the desired results.

Taking proper rest is an essential component of Rhinoplasty aftercare. However, one more key component that’s often overlooked is having a proper diet. The person must make conscious meal choices post-Rhinoplasty surgery and have a proper Rhinoplasty recovery diet to accelerate healing.

Here we will discuss some of the foods to include, and the foods to avoid after Rhinoplasty. Following the Rhinoplasty recovery diet would help with boosting recovery while minimizing any discomfort post-nose surgery.

What To Eat After Rhinoplasty?

Let us go through the step-by-step Rhinoplasty recovery diet for your better understanding.

First 24 Hours Post Nose Surgery

The first 24 hours post-Rhinoplasty surgery are crucial to the recovery process. Make sure you pick the right food to eat after Rhinoplasty surgery to avoid the side effects from anesthesia. Bland foods with balanced protein and carbohydrates that are like a Mediterranean diet are felt to be helpful to reduce inflammation. The key is to stay hydrated with water and avoid excessive caffeine and alcohol consumption.

For the first 24 hours, it is important to have bland food to avoid any major side effects or feeling nauseated. Ideally, the food you eat when you have stomach ache or pain is what you should eat post-Rhinoplasty, at least for the first 24 hours.

You can carefully expand your Rhinoplasty recovery diet once the medications from anesthesia are out of your system.

First Week Post Rhinoplasty – What To Eat?

For the first-week post Rhinoplasty surgery, stick to foods that are soft and easy to chew. For example: yogurt, oatmeal, scrambled eggs, mashed potatoes, and porridge.

Such foods are nutritious and easy to chew, making them the perfect addition to your list of what to eat after Rhinoplasty.

It is also vital to stay hydrated during the first-week post Rhinoplasty. Increase your water consumption, and you may want to add freshly squeezed fruit juices to the mix.

You may also want to add fruits to your Rhinoplasty recovery diet having high water and nutritional content, such as strawberries and watermelon.

Second Week Post Rhinoplasty Surgery

Most patients get back to a regular life and diet during this period. However, everyone reacts differently to Rhinoplasty surgery, so it is important to stay alert. In general, avoid crunchy or hard foods.

If you feel even a bit of discomfort, you might want to shift back to softer foods.

What Foods To Avoid After Rhinoplasty

One of the most common questions doctors are asked is what can I eat after Rhinoplasty? It is important to understand what you can and cannot eat after Rhinoplasty holds equal importance.

Sticking to healthy foods for the first few weeks post-Rhinoplasty is recommended. However, even some healthy foods are known to cause problems.

Some of the common foods to avoid after Rhinoplasty include:

Alcohol

During the first couple of days, alcohol consumption can interfere with the anesthesia and cause serious and unpleasant side effects.

Consuming alcohol must be strictly avoided post-Rhinoplasty. It would greatly increase the Rhinoplasty recovery time and may even cause swelling.

While it is technically possible in most cases to have alcohol post the first week of surgery, it is
best to avoid it till the swelling has receded entirely.

Spicy Foods

There’s no doubt that spicy foods offer plenty of benefits, including reducing body inflammation. But, it is best to avoid spicy foods for the first week after Rhinoplasty to avoid nausea, interference with anesthesia, and other side effects.

High Sodium Foods

Salt and high-sodium foods cause swelling and greatly increase Rhinoplasty recovery time. As a precautionary measure, it is best to plan a Rhinoplasty recovery diet that’s low on sodium.

It would help you recover faster and ensure you get back to normal life much earlier than anticipated.

Hard Foods

Hard to chew, sticky, and crunchy foods are on top of the list of foods to avoid after Rhinoplasty. It can contribute to your swelling, cause discomfort or even pain, and add to Rhinoplasty recovery time.

Don’t chomp on those bags of crunchy potato chips during the Rhinoplasty aftercare period, which usually is around 3-4 weeks, depending on how your body responds to Rhinoplasty surgery. Wait for at least a couple of weeks before you can have these foods without thinking twice.

Conclusion

Don’t worry if you find this list of foods to avoid after Rhinoplasty extensive, as it’s just a matter of a couple of weeks. It’s important to take the Rhinoplasty aftercare period seriously and not binge eat even especially the foods that aren’t allowed. Once your doctor gives the green light after a post-surgery check-up in a few weeks, you can get back to your regular diet cycle.

Once the swelling is gone and there’s absolutely no feeling of discomfort from the surgery, you can enjoy your favorite foods and beverages without the fear of it causing any side effects. However, if consuming the foods to avoid after Rhinoplasty, even after a few weeks, causes discomfort or swelling, extending the aftercare period is recommended.

Also, monitor your body for elevated temperatures, re-injury, unusual bleeding, or elevated pain. Consult your surgeon immediately if you feel any of these symptoms after a few weeks of Rhinoplasty.

Rhinoplasty recovery time depends a lot on the amount and quality of care you take postsurgery. If you’re not careful, don’t take proper rest, indulge in alcohol or other foods and beverages you’re asked to avoid, the recovery process will be extended and painful. And you certainly don’t want that!

Cleft palate forms during the first weeks of the baby growing in the mother. Two sides of the
face don’t fuse, resulting in a gap in the mouth’s roof. Cleft lip and cleft palate in newborn
babies are among the most common facial deformities among babies in the United States,
affecting one of every 600 newborn babies, while an isolated cleft palate is less common at one
in every 1000 newborn babies.
The babies with a cleft may only have a cleft lip, a cleft palate, or both a cleft palate and a cleft
lip. The orofacial clefts are considered one of the most common congenital craniofacial
differences worldwide.
Babies born with cleft palate can also have a visible gap in their upper lip, also known as cleft
lip. As mentioned earlier, it is a fairly common occurrence, and there’s no apparent reason why
it occurs. So, if you’re wondering why a child is born with a cleft palate – there’s no single
answer.
However, there are a few factors that play a minor role in increasing the risk of having a cleft
palate or cleft lip, including:

• Maternal Alcohol & Drug Consumption
• Genetics and Family History
• Maternal Smoking
• Maternal Malnutrition During Gestation
• Use of some medicines, e.g.: anti-seizure medicines, during the gestation period
• Exposure to some chemicals

So, is there a cure for cleft palate and cleft lip?

The answer to preventing a cleft is NO, but treatment is very effective. This condition is
common (1/600 live births) and prompt treatment is the standard of care. Let us go ahead and
discuss what to do when your child has a cleft lip or palate and what to expect.

What Problems Can Cleft Lip and Cleft Palate Cause?

This condition can cause various problems for the child, including:

• Feeding
• Optimal Development & Growth
• Hearing issues
• Ear Infections
• Teeth and jaw disturbances
• Speech Development

Correcting the condition during childhood with surgery is essential for the overall wellbeing and
development of the child. Care is given with a team of doctors, nurses, speech therapists,
hearing specialists, geneticists, dentists, and more. An accredited team from the American Cleft
Palate Association is recommended in the USA, while other regions have their own
accreditations.

When Is A Cleft Palate and Cleft Lip Diagnosed?

Typically, the condition is identified as soon as the child is born during the first newborn
examination. At times, the cleft palate and cleft lip are also identified during prenatal
ultrasound.
In the absence of a cleft lip, identifying a cleft palate can get harder with the 20-week
ultrasound. This is why newborn examination becomes crucial when the doctor examines the
inside of the newborn’s mouth.

Why Cleft Lip and Cleft Palate Should Be Treated Immediately?

As mentioned earlier, there are many issues that a child can face when cleft lip and palate are
left untreated. Let us have a closer look at these problems and understand why this condition
should be treated right away.

Difficulty Feeding

Feeding cleft lip and palate infants can get difficult if not treated. Having a cleft palate and lip
makes it difficult or even impossible for babies to breastfeed or suck from bottles. For feeding
through suckling, babies need to compress the nipples of the breast or bottle against the
mouth’s roof and create sufficient suction to draw milk. This process is entirely compromised
with the cleft palate/lip as suction isn’t created due to air inflow, and liquid may leak out into
the nose.
Parents can use specially made feeding devices with a valve system that acts as a palate for
proper feeding till corrective surgery is performed.

Speech Issues

The palate primarily functions as a valve system to stop air from leaking through the nose while
the person speaks. It makes treating children with cleft lip and palate during infancy nonoptional. When children with this condition are not treated earlier, they may develop speech
problems and have difficulty speaking later.
Other than “m,” “n,” and “ing,” all other consonant sounds we make while speaking requires
some degree of pressure created in the mouth. However, this won’t be possible in the presence
of a cleft palate, making its treatment extremely important.

Psychological & Social Problems

Speech difficulty and facial deformity will inevitably lead to psychological and social dilemmas
for the patient. A child with a cleft lip and palate may admit to some bullying or children making
fun of their craniofacial difference in public places, schools, colleges, and the local community.
These acts can hurt the child’s self-esteem and self-confidence.
Reading the book or watching the movie “Wonder” can be a helpful way for a family to start to
think of how to provide support for these amazing kids.

What Does Cleft Palate and Cleft Lip Surgery Require?

Surgery is an important attribute of the cleft treatment for children born with cleft palate and
cleft lip. Often parents seek answers to one of the most common questions: What age do you
repair a cleft palate?
The repair through surgery is done during infancy, when a child is three to four months old for
cleft lip. In the case of just cleft palate, the surgery is done when the child is just a year old.
The Cleft Lip and Cleft Palate Surgery goals include improving facial aesthetics, eliminating any
potential or imminent speech-related issues, and remedying feeding issues. One of the goals
during cleft lip surgery is to reduce the appearance of scarring as much as possible. To ensure
this, the surgeons try to mirror the appearance of the child’s face without the cleft lip. It helps
with:

• Increasing the lip’s length to look natural
• Even out the red color portion of the lip without any palpable differences
• Smoothen any nose deformity and hide any scars between the upper lip and nostril. It should help improve the symmetry between the nose and upper lips.

Cleft Treatment and Timing

Parents often look for basic crucial cleft lip and palate information: Is there a cure for cleft
palate? At what age do you repair cleft palate? Are cleft treatment and surgery safe? And so on.
However, the treatment for children with cleft lip and palate can vary from child to child. The
doctors assess the child with cleft and explore various treatment and surgical options based on
in-depth examination and screening of the child’s health.
The treatment depends on the severity of the cleft, the child’s age, and if there are other health
concerns that may interfere with cleft treatment and surgery.

What other Surgeries Children with Cleft may Require in the Future?

Some children with cleft lip and palate may require additional surgeries as they get older. It
includes:

• Speech Surgery
• Alveolar Bone Grafting (repairing the teeth gum line)
• Nose Surgery (rhinoplasty)
• Orthognathic Surgery (jaw advancement surgery)

Cleft treatments have advanced and become safer, and most surgeries occur successfully
without any lasting side effects or problems. However, it is important to choose a surgeon who
is experienced and specializes in conducting surgeries for cleft lip and palate.
As parents, you want nothing but the best for your child, so educate yourself about cleft lip and
palate. Research extensively to find a doctor who can perform surgery while creating a custom tailored treatment plan for your child.
All the best to you and your child as you go through this process. We are here to help.

Exercising after Rhinoplasty: What To Know?

Rhinoplasty is a surgical procedure that improves and reshapes your nasal shape and function. The nose is the central part of the face, its size and shape affect your appearance. However, when a surgeon operates on a patient and works out immediately after the surgery, the patient could have increased swelling or may feel unwell.  Therefore, it is important to let your body recover after rhinoplasty before you resume exercising.  Consider reading about Guided Mindfulness strategies to help you with your recovery see recent article in Facial Plastic Surgery and Aesthetic Medicine Journal, for which Dr Travis Tollefson is the Editor-in-Chief.

Exercise After Rhinoplasty: A Typical Timeline

After a cosmetic nose procedure like rhinoplasty, it is recommended to take at least 2 to 7 days of rest. You can take light walks to improve blood flow and reduce the chances of blood clots. Improved blood flow helps speed up the healing process of the surgery. If you experience diminishing breath and feel tired, stop the activity. Your blood pressure is likely to rise. If you ever experience this condition, rest so you can recover, and take your medications to help reduce the swelling. Avoid strenuous exercise after the cosmetic procedure for about six weeks.

Yoga after rhinoplasty

At least a week after a nose job, it is advisable to start with minimal exercise and in ways that do not place your head below your hearts.  No downward facing dog position.  Yoga is a less intense exercise and does not involve jumping and running around. It is the best place to start after a few weeks of recovery. Yoga will help in the recovery process and can reduce tension and stress.  You can undertake light exercises after surgeries like rhinoplasty, but no contact sports that could lead to injuries.

Cardio after rhinoplasty

Physicians encourage mild walking daily after your surgical procedure because it does not interfere with your healing process. Intense Cardio or High Intensity Interval Training after rhinoplasty should be avoided since heightened blood pressure at this period can cause bleeding. You can start cardio exercises at the end of the second week after your surgery.

Swimming after rhinoplasty

It is advisable that you don’t go swimming for at least 3 to 4 weeks after undergoing rhinoplasty. The swimming pool is decontaminated, but why take the risks. Swimming in lakes or open water should be avoided as this could lead to infections in your wound. Swimming pools are treated with chlorine or any other decontamination agents and this may affect your skin if it hasn’t fully healed. Swimming also might involve bumping your nose on the pool surface or with people around you.

Weight training after rhinoplasty

You should avoid weight lifting for several weeks after your surgery. Weight lifting is a strengthening exercise and its intensity can yield poor results in the end. Starting off at a low workout pace will help avoid nose bleeding, swelling, and throbbing in the future.

Don’t panic if you get swollen

You may experience changes in swelling of the nose and face when you begin exercising after your nose surgery and after you finish exercising. But don’t worry, the swollen nose is healing and will take a year or more until you have a final result.

Why do people avoid exercising after rhinoplasty?

Exercising during the first week after facial plastic surgery can cause irritation and pain in your nose and face. After a rhinoplasty, take about 2 days to rest. For the other 6 to 12 weeks, avoid straining yourself. Light exercises such as yoga and walking around the house are recommended after your facial surgery.

Reference

1. Natalie A. Krane, J. Kai Simmons, Kevin J. Sykes, J. David Kriet, and Clinton D. Humphrey. Facial Plastic Surgery & Aesthetic Medicine. ahead of print http://doi.org/10.1089/fpsam.2021.0184
2. https://www.liebertpub.com/doi/10.1089/fpsam.2021.0184

Rhinoplasty also popularly referred to as “nose job,” is performed to change the shape of the nose or to improve breathing. It offers dramatic results by altering the nose structure’s shape, size, and/or proportion to achieve functional or aesthetic goals. 

During Rhinoplasty procedure, the nose structure is changed by aligning or removing the nasal region’s cartilage, skin, or bone structure. It’s important to consult thoroughly with your surgeon before the Rhinoplasty surgery to clear any doubts about your expectations, Rhinoplasty aftercare, and things not to do after Rhinoplasty for faster and hassle-free recovery.

This article will cover the fundamentals of what not to do after the Rhinoplasty procedure and understand the essentials of post Rhinoplasty care. It would ensure you’re equipped with all the information you need to prevent complications after a Rhinoplasty and enjoy faster recovery.

However, before we get into things not to do after Rhinoplasty, let us answer another important question –

What To Expect After Rhinoplasty?

Rhinoplasty surgery takes around 2-3 hours, and in most cases, the patients are allowed to head home after the surgery.

The Rhinoplasty procedure is performed under general anesthesia. Patients with health issues will have clearance from their primary care doctor, which helps prepare for the best possible patient’s response to surgery.

The surgeon would prescribe several medications (often over the counter) as part of the Rhinoplasty aftercare routine to alleviate any discomfort and prevent swelling, infection, or discomfort  around the nasal region. These medications are also meant to help improve healing process.

The doctor would provide a list of instructions to follow as a part of the post Rhinoplasty care routine to ensure the recovery happens without any complications.

Some of the common instructions and things patients need to follow after a Rhinoplasty include:

• Resting with head in a position higher than the chest. It reduces the chances of swelling bleeding and alleviates discomfort.
• Expect to experience nasal congestion for a few days after a Rhinoplasty. It is primarily due to the nasal region’s swelling and the splints installed inside the nose for Rhinoplasty surgery.
• The doctor needs to remove the splint inside the nose and the internal dressing after a week following the Rhinoplasty surgery. Make sure to make a follow-up appointment, if not already.

Now, let us delve deeper into –

Things Not To Do After Rhinoplasty Surgery

Avoid Strenuous Activities

Avoid any forms of physically strenuous activities after the Rhinoplasty.

It includes going to the gym, performing rigorous workouts, aerobic exercises, high-intensity exercises, lifting heavy weights, intense physical movements, and just any form of physical activity that exerts pressure on your body. This is to be followed for at least two weeks after the Rhinoplasty.

Similarly, swimming should be avoided till around 4 weeks following the Rhinoplasty procedure. The splint or cast placed inside the nose must remain dry until removed. Avoid any form of contact sports, such as basketball, volleyball, etc.

The idea is to allow your nose to recover without any additional stress on the nasal region that can negatively influence the recovery process.

Sexual Activity

Sexual activities should be limited for the first few weeks following the Rhinoplasty surgery. Applying pressure to the nose after Rhinoplasty is a big “No.”

Any form of physical activity that would risk injuring the nose, including sexual activities, should be avoided. However, it doesn’t mean you need to sit idle all day as light walking in and around the house is always a good idea to avoid blood clot formation.

Blowing Your Nose

It’s needless to say that you feel the urge to blow your nose during cold, cough, and flu. However, during and after Rhinoplasty, it is essential to stay sanitized, wash your hands regularly and stay away from people who are ill. Carry a sanitizer around to kill the germs immediately after contact and avoid infection.

Remember, applying pressure to the nose after Rhinoplasty is strictly prohibited, at least for a few weeks. Take preventive measures in your environment to stay safe and avoid catching a cold, cough, or flu.

Avoid wetting the nose in a Shower

The nasal region and the cast installed inside the nose need to remain dry till removed by the doctor a week after a Rhinoplasty. Using a shower can hinder this.

You can wash the rest of your body in a bath or shower. It is important to keep in mind that the nasal area remains humidified by applying saline (ocean) sprays to the nostrils throughout the recovery process.

Wearing Glasses

One of the things not to do after Rhinoplasty includes wearing glasses. If you wear glasses, arrange for contact lenses before the Rhinoplasty surgery. As glasses rest on the nose’s bridge, they can put pressure on your nose, impacting recovery. It is one of the essential points of post Rhinoplasty care you should prepare for in advance.

Exposure To Sunlight

It’s natural to feel like getting out and catching a little sun after a Rhinoplasty. However, avoid temptation and stay indoors, away from sunlight for a while. The nasal region is sensitive post Rhinoplasty and needs to recover fully before being exposed to sunlight like before.

Too much exposure to sunlight during the recovery process may lead to discoloration, infection, and other unwanted complications. You may use sunscreen or some other patch over the nasal region or wear a hat outdoors to protect the nose from sunlight.

Smoking or Alcohol Consumption

Rhinoplasty aftercare routine includes avoiding smoking and drinking alcohol. These are considered dangerous activities that may impact the recovery process negatively, delaying the healing process.

Smoking restricts blood flow, and alcohol is known to interfere with the activities of prescribed medicines during the recovery process, which may lead to excessive bleeding, infection, and more. Stay away from smoking and consuming alcohol for at least 3 to 4 weeks after the Rhinoplasty.

Touching the Nose

You might be curious about your nose structure post-Rhinoplasty and may be tempted to touch, poke, or push it. Refrain from doing so at all costs.

One of the most common questions patients have for Rhinoplasty aftercare includes – Can I touch my nose three weeks after Rhinoplasty? Well, the answer is yes, you may touch but very softly and sensitively, only if required.

Avoid touching until your surgeon certifies that the goal of Rhinoplasty has been achieved and that the nasal region has fully recovered.

Any unwanted touch, push, or poking can misalign the cartilage or bone and even undo the positive results. Keep the nasal region protected from any external threats, including your temptation to touch.

For this reason, it is also suggested to avoid using makeup for a month post Rhinoplasty as it would inevitably lead to touching the nasal region, causing unwanted complications.

Conclusion

These are the few pointers that comprehensively answer what not to do after Rhinoplasty. It is recommended that you rest and sleep a lot for the first few days after Rhinoplasty surgery. It accelerates the healing process without hindrance, ensuring faster recovery.

Expect some redness, bruising, and swelling around the nasal region where the cast is installed or where the surgery has taken place. You might even feel a little discomfort or pain but contact your cosmetic surgeon immediately if any of these symptoms worsen or become unbearable.

As one of the most common cosmetic surgical procedures performed these days, rest assured there isn’t much to worry about if you follow the surgeon’s Rhinoplasty aftercare instructions.

It is a great procedure to uplift your facial appearance or get rid of nasal or breathing issues that have been impacting your quality of life.

Rhinoplasty is one of the most common plastic surgeries, often referred to as “nose job.” It is a surgery that enhances facial harmony by modifying the nose’s shape through corrective procedures applied on skin, bone, or cartilage. This surgery is primarily performed to improve breathing or facial appearance.

One thing to note here is that Rhinoplasty is not for everyone. Before considering Rhinoplasty, the surgeon will consider a wide range of other factors, including your facial features, skin, bone structure, etc.

Once the surgery is finalized, the surgeon will help you understand the intricacies of the Rhinoplasty surgery, associated risks, dos and don’ts, treatment plan, post-procedure care, pre-surgery precautions, and more.

What is Rhinoplasty?

Nose reshaping surgery, nose job, or Rhinoplasty is a commonly performed surgical procedure that enhances facial appearance or improves breathing by changing/rectifying the nose’s shape. The shape of our nose plays a pivotal role in our facial appearance. A deformed or poor nose structure can impact the overall appearance and look, making it one of the most requested and recommended cosmetic procedures to improve the overall appearance.

What are the Goals of Rhinoplasty Procedure?

There are many goals of Rhinoplasty, including the following:

• Improving the shape of the nose
• Preserving and improving breathing
• Enhancing facial appearance
• Creating a natural balance with other facial features
• Increased confidence

Different people have different goals of the Rhinoplasty procedure, but it mainly revolves around the above-mentioned goals.

Factors to Consider Before Rhinoplasty

Many factors need to be considered before going in for the Rhinoplasty procedure. Your surgeon would guide you through the process and evaluate the considerations together to decide if you’re an ideal candidate for Rhinoplasty or not.

The below-mentioned factors impact the outcome of the Rhinoplasty procedure and help personalize the surgical plan. Let’s dive in.

Age

Ideally, the Rhinoplasty procedure is not performed at a very young age. It is recommended to go for Rhinoplasty after the growth is complete, usually 15-16 years for girls and 17-18 years for boys. Going for a Rhinoplasty procedure before complete growth can negatively influence the natural growth of the nose.

Moreover, if the nose job is done before completion of growth, any growth after the Rhinoplasty procedure would change the overall shape of the nose, causing unwanted results.

However, younger patients suffering from severe nasal obstruction and breathing problems may choose a nose job procedure.

Skin Thickness

The primary aim of nose surgery is to rectify or modify the nose’s underlying structure. The thickness of the skin plays a vital role in how the nose looks after nose surgery. For people with very thin skin, the changes made to the nose’s underlying structure are easily visible.

Similarly, changes made to the nose’s bone and cartilage is harder to notice in people with thick nasal skin. The thickness of nasal skin plays a crucial role in helping surgeons decipher Rhinoplasty risks and decide on a treatment plan.

Gender and Ethnicity

It’s a well-known fact that facial structure and nasal shape vary across genders and ethnicities. When it comes to Rhinoplasty procedures, one size fits all approach doesn’t work. After careful examination, the surgeon would define an operational plan that tailors specifically to your gender and ethnicity. Such a tailored approach is essential to get the desired outcome.

Surgical History

If the patient has had a Rhinoplasty procedure or deviated septum surgery done in the past, it can influence how the nose job surgery would be done. If you’ve had a nose job or any other facial procedure done, it is essential to tell your surgeon beforehand to decide the treatment plan.

Facial Harmony

The nose plays a critical role in the overall facial appearance of a person. The changes you desire from a nose job procedure should create facial harmony by improving, preserving, and uplifting the facial appearance.

It is essential to consider other facial features before deciding to go for a nose job. If you have multiple facial features that are off-balance, consider addressing all the facial features together to bring a facial harmony.

If not, the nose job procedure would create a dissonance that would negatively impact the facial appearance. For this reason, the surgeon suggests computer-generated image simulation to demonstrate and visualize how the face will look after the nose surgery.

Medical History

One other factor that is considered before the Rhinoplasty procedure is performed, is comprehensively checking your medical history.

It is vital to inform the surgeon about past surgeries (if any), current medications, and any allergies or medical conditions. It would help decide if Rhinoplasty can be performed while also influencing the recovery process.

Types of Rhinoplasty

The incision type decides the type of Rhinoplasty. There are two types of Rhinoplasty, including:

• Open Rhinoplasty
• Closed Rhinoplasty

Rhinoplasty Procedure

#1 Anesthesia

During the surgical procedure, the patients are administered medications for comfort, including either general anesthesia or intravenous sedation. The surgeon will choose which medication to administer as per your health, the scale of the nose job procedure, complexity, and other factors.

#2 Incision

As mentioned earlier, the Rhinoplasty procedure can be of two types – open or closed. In closed Rhinoplasty, the incisions are done inside the nose.

In open nose surgery, the incisions are done on the tissue known as Columella, which separates the nostrils. The incisions help raise the skin covering cartilages and nasal bones, reshaping and restructuring the nose.

#3 Reshaping the Nose Structure

Reshaping a large nose may include removing cartilage, and at times, cartilage grafts may be added. The cartilage present in the middle portion of the nose called the septum is often used for this purpose. At times, cartilage from the rib cartilage or ear can be used as well.

#4 Correction of Deviated Septum

The deviated septum can be corrected by straightening and reshaping the projections in the nose structure. It helps to improve breathing, and enhances appearance and facial harmony.

#5 Closing the Incision

The incision is closed once the underlying bone and cartilage are restructured and reshaped as desired. The nasal tissue and skin are redraped after the surgery.

#6 Results – Post Surgery Care

For a few days after the surgery, the nose would be supported using gauze and splints to support and accelerate healing. The patient has to follow the post-surgery care instructions given by the surgeon. Some of the standard post-surgery instructions include:

• Not blowing the nose for few weeks post-surgery.
• The head should be elevated for a few days while sleeping post the surgery.
• Avoid sun post-surgery.
• Don’t exert the nose region for any reason and minimize risks causing any injuries.
• Consult with the surgeon immediately in case of any changes in the surgical area or any abnormal pain. These indications include – excessive bleeding, visual impairment, high fever, unbearable pain, skin rash, and other abnormalities.
• Visit the surgeon regularly for routine checkups after the surgery.

Rhinoplasty Recovery Time

Patients are discharged from the hospital after 3-4 days or a week after the surgery. However, the Rhinoplasty recovery time may exceed 4-5 weeks, depending on the scale and complexity of the nose job procedure.

Rhinoplasty Risks

As with any other major surgery, nose surgery comes with a few risks as well. While medical science has advanced and modern procedures carry far fewer risks than earlier, it is always a possibility. Some of the significant Rhinoplasty risks include:

• Infection
• Bleeding
• Adverse reaction to generation anesthesia
• Difficulty in breathing through the nose
• Results not as expected – the final nose shape doesn’t appear as desired.
• Pain, swelling, and discoloration may last for a long time, sometimes even for life.
• Scarring
• Septal perforation
• Additional surgery may be required at times

However, it needs to be noted that risks and complications with Rhinoplasty are far less than most other major surgeries. The risks and complications mentioned above are rare.

Consulting with a surgeon beforehand to tailor a treatment plan and following post-surgery care instructions would help achieve the results you seek with Rhinoplasty. So, if you have a deformed or poorly shaped nose, going for Rhinoplasty is an ideal solution.

The birth of a baby is a joyous time for new parents, which comes with its own challenges. However, for the parents of a child born with certain facial differences like cleft lip and/or palate, the challenges may seem overwhelming. Children with cleft lip and palate encounter many different challenges throughout their life, but it will be alright.  There are biological factors that can affect their speech, hearing, and dental appearance and function. In addition, the type of cleft, age, and gender also affect individuals.  

What is a Cleft Lip and Palate?

Children with cleft lip and palate are born with an opening in the roof of their mouth, and it leaves a hole between the upper lip and the nose resulting in a split. A cleft lip can be a unilateral cleft lip or on both sides of the lip. The cleft may vary in size and can be just a tiny notch, or others may extend through the upper gum up till the nostril.

A cleft may happen when the bones, muscles and the skin of the baby’s upper jaw, mouth, and nose fuse together to form the roof of the mouth in the early weeks of pregnancy. While doctors still don’t know why it happens, some factors increase the chances of such congenital disabilities like:

• Genetic factors
• Exposure to some chemicals during pregnancy
• Not getting prenatal nutrients
• Consuming certain medicine during pregnancy
• Drinking alcohol, using drugs, or smoking cigarettes during pregnancy

There are a number of side effects of cleft lip and palate, such as feeding difficulties, speech and language delay, ear infections, hearing loss, and dental problems. The only way to repair cleft lip and palate is with surgery. Treatment for cleft lip or cleft palate will extend over several years, needing multiple surgeries, and is best coordinated with an accredited Cleft and Craniofacial Team.  This team will include specialists in communication, speech, hearing, dental, social work, feeding, nursing, genetics, and others.

Psychosocial Challenges of Adolescents and Teens with Cleft Clip and Cleft Palate

With the advancement in medical services and awareness among people, it is rare to find any adult with cleft lip and palate that have not been operated upon. Most children who have their cleft lip repaired early on have a healthy social life. But teenagers with cleft lip/palate are at a higher risk of developing psychosocial challenges, especially those relating to appearances, peer relationships, and self-concept. The psychosocial challenges in adolescence and teens with cleft lip and cleft palate can affect their confidence, self-esteem, and the way they engage in social relationships.

Some of the problems that adolescents and teens with cleft lip/ palate encounter include:

• Staring
• Teasing and bullying
• Name-calling
• Self-consciousness
• Questions about their deformity
• Overprotection of their parents
• Discomfort in social settings
• Difficulty being understood

Overcoming Negative Social Attitude and Stigma

While many individuals with cleft lip/cleft palate have experienced negative experiences due to their facial conditions, they resisted it through:

• Joining cleft lip support groups
• Different coping strategies and methods such as restructuring thoughts, problem- solving, and regulating their emotions
• Timely intervention such as surgery

Support from Family and Friends

According to a number of studies, psychosocial challenges among adolescents with cleft lip or palate see a positive impact on their self-esteem with high family and family support. It resulted in:

• Better adjustment to social situations
• Less stress
• Lower psychological distress

While they have certain dissatisfaction about their facial differences, they were more content with other facial features like their eyes, hair, and even teeth compared to their peers with no facial deformity. Reconstructive surgeries help raise their confidence levels, and this feeling is heightened due to the comparison of their past feelings about their appearances before the surgery.

Coping as an Adult

Individuals with cleft lip and/or palate may experience emotional distress persisting into adulthood. As they venture into adulthood and outside the safety net of their friends and family, many experience fear and anxiety. Social comfort levels are put to the test as adults delve into many new experiences like:

• Meeting new people
• Taking job interviews
• Getting into romantic relationships

Empowering teens to be open at their medical appointments helps them start their journey on the road to independence and boosts their confidence. Integrating a cleft lip support group right from an early age is highly recommended, and so is the right information for adults with cleft lip who are about to complete their treatment. Adults with cleft lip may also benefit from support with the following:

• Accessing information about new treatments
• Concerns about their appearance and speech
• Making the transition from their childhood treatment services
• Self-esteem, confidence, and social anxiety
• Dealing with social stigma at the workplace
• Intimacy
• Impact on their parenting style

While most adults cope well, some may need additional support to deal with any ongoing issues along with any new issues arising in adulthood. Thorough psychological screening for adults with a cleft lip is also recommended for managing cleft palate problems in adulthood and to ensure good emotional well-being. Ensuring ongoing support can help build confidence and greatly improve the quality of life that is going to last a lifetime.