Cleft Lip Deformity Research Articles

Modified Abbé flap for reconstruction of Cupid's bow and vermilion tubercle in secondary cleft lip deformity.

Background Abbé flap technique is one of the most challenging operations to correct horizontal deficiencies in secondary cleft lip deformity. Since its first introduction, the operative method was dynamically modified from simple variation to complete conceptual change, but conventional Abbé flap has many drawbacks in esthetic and functional aspect. Our purpose was reconstructing the symmetry of Cupid’s bow and central vermilion tubercle with minimal sequalae.Methods From 2008 to 2016, this technique was applied to 16 secondary cleft lip patients who had total or more than 60% of unilateral deficiency of Cupid’s bow and central lip or tubercle pouting deficiency. A quadrangular-shaped flap was transferred from vermilion including skin and white line of central or contralateral lower lip. Pedicle division and insetting were made at 9 (unilateral) or 10 (bilateral) days after transfer. Secondary lip revision was done with open rhinoplasty after wound maturation.Results Overall satisfaction was high with modified technique. Scar was minimally noticeable on both upper and lower lip especially. Balanced Cupid’s bow and symmetric vermilion tubercle were made with relatively small size of flap compared to conventional Abbé flap. An accompanying benefit was reduced ectropion of lower lip, which made balanced upper and lower lip protrusion with more favorable profile.ConclusionA new modified Abbé flap technique showed great satisfaction. It is worth considering in secondary cleft lip patient who has central lip shortage and asymmetry of upper lip vermilion border line. Our technique is one of the substitutes for correction of horizontal and central lip deficiency with asymmetric Cupid’s bow.

Effect of early correction of nasal septal deformity in unilateral cleft lip and palate on inferior turbinate hypertrophy and nasal patency

ObjectivesA relatively neglected aspect of cleft lip nasal deformity is the effect of septal deviation and inferior turbinate hypertrophy (ITH) on the functional airway. In particular, ITH in the noncleft side can be especially problematic, because it reduces the healthy nasal area, creating bilateral nasal obstruction that might affect the growth of the maxillofacial skeleton. Although these anatomic and functional changes are documented, few recommendations have been developed regarding the proper approach to ITH. The aim of the present study was to asses the ITH severity and determine the degree of nasal airway patency in patients who have undergone primary correction of the nasal septum during lip repair compared to patients operated on without primary septal correction. MethodsThe study population included two groups. One group consisted of twenty unilateral cleft lip palate UCLP patients who have previously undergone primary rhinoseptoplasty as part of their treatment plan. The control group consisted of twenty UCLP patients operated on without rhinoseptal correction.The Nasal Obstructive Symptom Evaluation (NOSE) scale and nasal endoscopy were used to assess nasal obstruction. ResultsThe overall untreated group reported severe symptoms across all NOSE scale dimensions more frequently than children who have undergone primary rhinoseptoplasty. The difference was statistically significant for each dimensions (p < 0.05). The mean NOSE score for group A and group B was 21.4 ± 9.4 and 70.8 ± 17.2 respectively (p < 0.0001).In group A turbinate size decreased significantly (p < 0.05) compared to pre-operative data.Comparing the two groups a statistically significant difference in turbinate size was observed (p < 0.0001). ConclusionThe results of the present study confirm that there is a significant degree of ITH and nasal airway dysfunction in patients with UCLP. Early septal repositioning during primary cleft lip repair results in a statistically significant reduction in IT size and improvement of nasal patency.

Islamic attitude and Rhinoplasty

Introduction: Although the psychological aspects of rhinoplasty have been fully investigated in the medical literature, the religiosity of rhinoplasty candidates has not been taken into consideration. Materials and Methods: In this cross-sectional study, the religious attitudes of 157 rhinoplasty candidates were compared with those of 74 subjects who had not requested rhinoplasty. A domestic validated reliable questionnaire was completed by all subjects to classify them with respect to religious attitude. Other factors such as age, sex and economic and educational status were also taken into consideration. From the surgeon’s perspective, subjects were put into three categories: subjects who had a relative indication for rhinoplasty (Category.1), subjects with a well-defined nose based on accepted standards of facial aesthetic analysis (Category.2) and finally subjects with a severely deformed nose, such as deviated nose or nasal cleft lip deformity (Category.3). Results: The mean age among subjects was 28.63 ± 7.05 years, and the majority were female (87%). The two groups of participants (those who did and did not express a desire for rhinoplasty) were analyzed from the point view of age, sex, economic and educational status. The economic and educational status of the two groups did not differ significantly (P>0.05). The religious score showed a significant difference between those who were interested in rhinoplasty (122.75±23.49) and those were not interested (138.78±21.85; P<0.001). Conclusion: Religion may affect a patient’s decision to undergo rhinoplasty surgery, such that persons with a higher religious attitude tend to undertake it less often. However, individuals with major nasal deformities tend to decide undertake the surgery, irrespective of religious beliefs.

Repair of the Nasal Floor by the Cleft Margin Flap in Bilateral Complete Cleft Lip.

Bilateral complete cleft lip deformity has been the most challenging to plastic surgeons, and lots of methods of repair have been described in the literature. The basic principles are to achieve continuity of the orbicularis oris muscle, a balanced Cupid's bow with nasal ala, and a complete reconstruction of the nasal floor. The last one is, however, easily neglected. A well-reconstructed nasal floor serves as a good support of the nasal cartilage, which minimizes secondary deformity. In addition, a nasal floor with sufficient soft tissue and minimal contracture makes bone grafting easier in the future. The cleft margin flap was first introduced by Tajima in 1983 and used for the nasal floor repair in the unilateral complete cleft lip. The authors have used this technique in bilateral complete cleft lip repair, and from our practice, tension-free repairs of the nasal floors could easily be achieved by the cleft margin flaps. The results were satisfying and no significant scar contracture or deformity of the nasal floor was observed during follow-up. The authors conclude that the cleft margin flaps are viable and alternative choices for the repair of the nasal floors in bilateral complete cleft lip without major complications.

Conscious Perception of Facial Asymmetry in a Unilateral Cleft Lip Model.

Lip asymmetry after a unilateral cleft lip repair can be perceived as an unsatisfactory result. The objective of this study is to determine the degree of upper lip asymmetry and/or nasal alar hooding required for recognition of asymmetry in a simulated model of unilateral cleft lip. A model of unilateral cleft lip was created using digital morphing software to simulate asymmetries in vermilion height and nasal hooding in photographs of children. Volunteers were shown photographs for different time intervals and with varying degrees of asymmetry. Ability to detect facial asymmetry was recorded and analyzed. This study was conducted by surveying layperson volunteers in public community settings. 108 layperson volunteers were randomly surveyed. The primary outcome measure was a reported lip or nose asymmetry by the volunteers. Proportions and corresponding 95% confidence intervals were obtained to estimate the probability of reporting an asymmetry at 3- and 10-second intervals. After 3- and 10-second exposure, labial asymmetry was perceived by ≥50% of subjects at 2 mm (62%, P = .001) and 1 mm (89%, P < .0001), respectively. Nasal asymmetry was detected by <50% of subjects at 3 seconds, but ≥50% perceived a 3-mm alteration at 10 seconds (64%, P < .0001). Photographs with combined nasal and labial modification did not lower the threshold for asymmetry perception compared to either deformity alone. This study is the first to determine a predictable millimeter threshold for perceived asymmetry in cleft lip deformity using a digital model.

Comparative Evaluation between Sevoflurane and Propofol for Endotracheal Intubation without Muscle Relaxants in Pediatric Cleft Surgeries.

Background and Objectives:Endotracheal intubation is the most important and crucial step during administration of general anesthesia. It is more so in pediatric patients with associated deformities of cleft lip, palate, and alveolus. Propofol, an intravenous (i.v.) induction agent, has profound depressant effect on airway reflexes with a quick and smoother induction. Similarly, sevoflurane, an inhalational agent, has relatively pleasant smell, low airway irritability, and more cardiostable properties. Hence, we sought to compare effectiveness of propofol with sevoflurane in achieving good intubation conditions without the use of muscle relaxants.Materials and Methods:In this prospective randomized study, eighty children belonging to American Society of Anesthesiologist physical status Class I and II, aged 1–10 years, scheduled for cleft surgery were included. All participants were premedicated. Patients were allotted to Group A and Group B randomly. Group A received propofol and Group B received sevoflurane as induction agents. Tracheal intubation was attempted in all patients at 150 s. Intubation conditions were assessed by using Steyn modification of Helbo–Hansen intubating conditions score. Statistical analysis was done using Student's t-test and Chi-square test with P < 0.05 regarded as significant.Results:Group B patients receiving sevoflurane had significantly more clinically acceptable intubation conditions than patients of Group A receiving i.v. propofol (P = 0.001).Conclusion:We conclude that intubation conditions using inhalational 8% sevoflurane are superior to i.v. propofol of 3 mg/kg for tracheal intubation without muscle relaxants in children undergoing cleft surgeries.

Fascial Graft Repair of Wide Bilateral Cleft Lip Deformity.

Wide bilateral cleft lip deformity reconstruction represents a special difficulty as it affects the lip, nose, and maxillary segments making single-stage reconstruction sometimes unobtainable. Many surgical and nonsurgical techniques have been prescribed to facilitate the definitive repair. Although some of these techniques proved to be useful, they have their inherent limitations and add another treatment step with all its possible complications and costs. The authors present a new method to address muscle layer repair in 1-stage procedure. It entails using fascial graft obtained from the temporalis muscle fascia or fascia lata, to reconstruct orbicularis oris lip muscle. Seven patients of wide bilateral cleft lip deformity (mean 17 mm) with a mean age of 4.4 months were subjected to single-stage lip reconstruction. After measuring the defect between both lateral muscle segments in front of the premaxilla intraoperatively ensuring that direct muscle repair could not be obtained, a fascial graft was harvested and sutured to both muscle edges. The authors found that, regardless the defect size or premaxilla protrusion, all wide clefts could be reconstructed satisfactorily in 1 stage procedure. No serious postoperative complications have been encountered in the lip or donor areas. Early follow-up reporting of the patients revealed stable repair. However more follow-up is still needed to assess late sequelae. In conclusion, fascial graft muscle repair of wide bilateral cleft lip deformity enables early 1-stage lip reconstruction without tension. The added donor morbidity is minimal and well tolerated.

The Skoog Lip Repair for Unilateral Cleft Lip Deformity: The Uppsala Experience

The Uppsala Craniofacial Center has been treating patients with unilateral cleft lip deformity using the lip repair technique described by Tord Skoog. The aim of this study was to determine complications after lip surgery and the incidence and indications for lip revisions in all patients born with unilateral cleft lip from 1960 to 2004. All patients who were born from 1960 to 2004 with unilateral cleft lip, cleft lip and alveolus, or cleft lip and palate and underwent lip repair were studied retrospectively. The timing, indication, complications of the primary procedure, and type of secondary surgery were recorded. Kruskal-Wallis and Fisher's exact tests were used, with Bonferroni correction. The study included 443 patients. The total rate of early surgical complications was 6 percent (n = 26). Secondary surgery for short upper lip was performed in 3.8 percent (n = 17), 8.4 percent (n = 37) underwent reduction of excess vermillion, 8.6 percent (n = 38) underwent scar revision, 11 percent (n = 51) underwent revision for incongruent vermillion-cutaneous border, and 10 percent (n = 45) underwent revision for other indications. Altogether, 45 percent had no secondary revisions. In conclusion, the Skoog lip repair is associated with a low total revision rate, and a short-lip deformity is rare. Therapeutic, IV.

Discussion: A New Method for Reconstruction of Vermilion Deficiency in Cleft Lip Deformity: The Bi-Winged Myomucosa Switch Flap.

Discussion: A New Method for Reconstruction of Vermilion Deficiency in Cleft Lip Deformity: The Bi-Winged Myomucosa Switch Flap.

Reply: Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty.

Sir: After reviewing the comments by Drs. Lu and Chen with regard to our recent publication in Plastic and Reconstructive Surgery entitled “Primary Septal Cartilage Graft for the Unilateral Cleft Rhinoplasty,”1 we would like to respond with the following rebuttal. The purpose of primary septal cartilage graft was to prevent alar rim collapse and improve nasal symmetry in patients with unilateral complete cleft lip deformity. Cleft-side nostril width was one of the measurements made in this study to assess our postoperative outcome. The use of the alar rim graft, however, was not to decrease the cleft-side nostril width. The inquiring authors suggested malpositioning of the labial and philtral muscles as the main contributing factor of the nasal deformity described in this article. We would like to clarify that all patients included in our study had adequate muscle dissections and mobilization of the perialar and philtral musculature to reestablish appropriate muscle orientation and function. There was no significant difference in cleft-side nostril width between the two groups of patients in this study. Our techniques of primary cheiloplasty with muscle dissection and repositioning have been described in Neligan’s Plastic Surgery textbook2 and the Noordhoff Craniofacial Foundation’s instructional DVD.3 The inquiring authors also raised the concern of harvesting a 0.5 × 2-cm septal cartilage from the caudal portion of the nasal septum with regard to facial growth. They commented that a 0.5 × 2-cm septal cartilage rim graft was insufficient in size to support the nostril shape when these patients reach adulthood. The use of a primary septal cartilage rim graft was to provide better nasal symmetry and aesthetic as they grow throughout childhood and early adolescence. Whether these patients need secondary cheiloplasty or rhinoplasty as they reach adulthood is still unknown. Although a septal cartilage graft is unlikely to proliferate after being transplanted to the recipient site, cartilage graft has been shown to remain viable with minimal graft resorption based on histologic findings reported by several studies. With regard to the donor-site defect, we performed a limited subperichondrial dissection at the caudal aspect of the septal cartilage at the time of graft harvesting. The perichondrium surrounding the donor site remains intact. Whether the donor-site defect fills in with chondral matrix that eventually matures into cartilage is still unknown. This certainly warrants a separate investigation by computed tomographic or magnetic resonance imaging studies when we follow these patients long term to evaluate their facial growth and surgical outcomes. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Ting-Chen Lu, M.D.Chuan-Fong Yao, M.D.Craniofacial CenterDepartment of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital, and College of MedicineChang Gung University Susie Lin, D.D.S.Department of Plastic and Reconstructive SurgeryChang Gung Memorial Hospital Philip Kuo-Ting Chen, M.D.Craniofacial CenterDepartment of Plastic and Reconstructive SurgeryChang Gung Memorial HospitalTaoyuan, Taiwan

Formation of the Philtral Column Using a Dermal Graft in Secondary Unilateral Cleft Lip.

The philtral column has an important aesthetic significance and is especially important in patients with cleft lip. If the integrity of the philtrum cannot be preserved in patients of unilateral clefts, these patients will have profound abnormalities in their facial musculature. The purpose of this study was to analyze the effects of dermal grafting on the philtral column in patients with a unilateral alveolar cleft. The authors retrospectively studied dermal grafts performed in Konkuk University Medical Center between January 2009 and January 2015. A total of 26 patients with unilateral cleft lip were included in this study; the authors measured philtral symmetry based on differences in convexity and angle using clinical photos. Additionally, panel evaluation was performed. Of 26 patients enrolled, 21 completed follow-up and had adequate photographs. Five patients who were lost to follow-up were excluded. The difference in convexity decreased from 0.25 to 0.15 (P < 0.005) and the difference in angle decreased from 10.76 to 6.43 (P < 0.005). The panel evaluation indicated that patient appearances were significantly improved (P < 0.001). In patients with secondary cleft lip deformity of the philtral depression, the authors' procedure may augment the thickness of the philtral ridge and have positive aesthetic outcomes.

Description of facial symmetry in patients with unilateral cleft lip and palate using geometric morphometry and computerized tomography

Objective: To describe the maxillary asymmetry in patients with single cleft lip and palate by using morphometrics geometric methods.&#x0D; Materials and Methods: Applied morphometrics geometric methods to analyze images captured from 3D reconstructions of CT scans of 9 patients with unilateral cleft lip and palate, mean age of 13.7 years was used. Tps Dig2 software was used to digitalize 6 maxillary landmarks shaping both the affected and the sides unaffected. TpsPower and TpsPLS to a small sample for relative warps and consensus for superimposition. Thin plate function and asymmetry was used applying ASI-CLIC® package, and the principal component analysis was performed with the PAST software version 2.17.0.&#x0D; Results: There is a statistically significant difference (p&lt;0.05) between the conformation of the maxilla on the affected side compared to unaffected. The study of asymmetry indicated different degrees and differences in the nature of the asymmetry that characterizes different deformities of unilateral cleft lip and palate. The principal component analysis demonstrates both inter-group variability and recognizes two principal components, 39.4%, to the first component and 27.5% to the second component. There is a high correlation between the formation of the unaffected side and affected side conformation r= 0.93847. The thin plate deformation is uniform. The allometry study indicated that there is no association between the shape and size.&#x0D; Conclusions: Morphometry Geometric method is a useful tool for assessing preoperative maxillary conformations in patients with unilateral cleft lip and palate. The side without the cleft is also affected, and is associated with the formation on the side of the cleft. The frontonasal suture is also affected, in a greater proportion than the fronto zigomatic.

Abstract: Comparison of Efficiency of Z Plasty and Diamond Shape Excision for Correction of Secondary Deformities in Unilateral Cleft Lip Patients

INTRODUCTION: Many different methods have been described for the revision of cleft lip scars in patients with unilateral cleft lip. The aim of this study is to compare Z plasty and diamond shape excision that commonly used techniques to correct secondary lip deformities. METHODS: 10 patients and 8 patients were operated diamond shape excision and Z plasty respectively in 2013–2016. Patients photos after lip revision were studied with facial symmetry program and by having the symmetry of the non-cleft side; a normal lip appearance without cleft was obtained. In the late period after surgery, VAS (visual analogue scale) was performed to determine the satisfaction rates of operation. When looking at the scale, patients were given 10 points for their photographs without cleft lip and the pre-revision photographs are considered 0 point. By the surgeon, the non-clefted lips and post-revision lips were overlaid in the 2015 version of Adobe Reader Photoshop CC program, and the asymmetry of the vermillion and the filtral colon distances were determined. The surgical outcome was evaluated by the surgeon. The result is excellent if there is a difference less than 0.5 mm, good result if difference between 0.5 and 1 mm, bad result is if the difference is more than 1 mm. Whether there is a statistically difference in patient and surgeon satisfaction between the two surgical techniques was evaluated by using the PearsonÂ’s squared test in the scale data in the SPSS 15 analysis. RESULTS: There was no statistical significance between the patients and surgeon satisfaction rates and two surgical procedures. CONCLUSION: Z plasty and diamond shape excision are the most commonly used methods for correcting the secondary cleft lip deformity. These methods, which have no difference in terms of surgeon and patient satisfaction, can be used according to shape of the deformity.

Effect of Carbon Dioxide Laser on Increasing Vestibular Depth in Cleft Lip and Palate Patients.

Shallow upper buccal sulcus deformity in cleft lip and palate patients is one of the common secondary deformities after primary cleft lip and palate repair; this deformity may prevent or complicate orthodontic and prosthodontic procedures causing aesthetic and functional problems. A number of methods are described to increase the anterior maxillary sulcus in these patients. This study assessed the use of a carbon dioxide laser (CO2) to increase the sulcus depth. Fifteen patients with cleft lip and palate (eight unilateral and seven bilateral) were studied. The surgical procedure was performed using CO2 laser. The vestibular depth and lip length were measured at three time points namely before surgery (T0), 1 week following surgery (T1), and 4 months following surgery (T2). After data collection, statistical analyses were done using PASW® version 18 SPSS. The mean values of vestibular depth were 9.46 ± 1.92, 13.83 ± 1.88, and 13.23 ± 1.76 mm for T0, T1, and T2, respectively. The vestibular depth significantly increased after 4 months of follow-up (p = 0.001). The mean amount of vestibular depth gain was not significantly different in unilateral and bilateral cleft groups (p = 0.908). The mean value of upper lip length increased by a mean of 1.23 mm and was statistically significant (p = 0.001). Upper buccal sulcus reconstruction with CO2 laser provides successful and stable results. CO2 laser application is suggested as an alternative to conventional vestibuloplasty.

Bilateral cleft lip revision: techniques and results

Bilateral cleft lip deformities can be difficult to correct and it is universally agreed that a large number of cases will require further revisions after the primary repair. The need for secondary repair and the type of secondary deformities is determined by the following:1.Type and severity of the initial cleft.2.The principles applied in the primary repair of these deformities. This presentation will look at the effect of different principles applied during the primary repair and how to manage the secondary deformities resulting from use of different principles of repair. The principles of repair will be considered under the following heads:1.Presurgical orthopaedics2.Lip adhesion procedures3.Staging of bilateral lip repair4.The utilisation of the prolabial tissues5.Muscle approximation6.Reconstruction of the central vermilion7.Sulcal release incision8.Management of the nasal deformities.

Periumbilical Dermal Graft as a Good Option for Volume Enhancement in Secondary Cleft Lip Deformity: A Case Report.

Periumbilical Dermal Graft as a Good Option for Volume Enhancement in Secondary Cleft Lip Deformity: A Case Report.

Lip prints as a genetic marker in inheritance of cleft lip and palate: A case–control study

Aim: The aim of the study was to study the various pattern types of lip prints in parents of cleft lip and palate (CLP) siblings to detect if any specific pattern can be considered as a genetic marker. Patients and Methods: The study included 100 participants (study group parents with children having CLP, fifty fathers and fifty mothers) and fifty participants (control group parents having children without CLP, 25 fathers and 25 mothers. The lip prints of the participants were obtained using the cellophane method and analyzed using Suzuki and Tsuchihashi classification of lip prints. The data were subjected to Chi-square test. Results: On the basis of the logistic regression, prediction of 27% of abnormal pattern in more than one-quadrant of lip can be considered as genetic marker for cleft lip (palate) deformity. Discussion: In our study, abnormal pattern Type V had been found which was considered as genetic marker for transmission of cleft lip (palate) deformity and a predominant pattern of Type II was found which was same in lines of An Egyptian study. Conclusion: A highly significant correlation was observed in lip patterns in parents with cleft anomalies.

Primary treatment of lip and nasal deformity in unilateral cleft lip or cleft lip and palate

A Revista Brasileira de Cirurgia Plástica é o órgão oficial de divulgação da Sociedade Brasileira de Cirurgia Plástica (SBCP), tem como objetivo registrar a produção científica em Cirurgia Plástica, fomentar o estudo, aperfeiçoamento e atualização dos profissionais da especialidade.

Domino Flaps for Repairing of Secondary Bilateral Cleft Lip With Severe Columella Deformity.

The patients with secondary bilateral cleft lip and nasal deformity always suffer from a serious part of the horizontal and vertical soft tissue deficiencies in the upper lip and nose, especially the columella. Normally, the Abbe flap is used to increase the soft tissue volume of upper lip. However, how to reconstruct the sever columella deficient, how to make full use of the Abbe flap and the remaining soft tissue of the upper lip, are always the problems that need to be solved by plastic surgeons. Twenty-nine patients with secondary bilateral cleft lip and severe columella deficiency were simultaneously reconstructed with several local flaps like dominos that was called "Domino sliding flaps." Six of the patients had their nasal tip and dorsum or collumella augmented and modified with autologous costal cartilage at the same time. The other 23 patients underwent the autologous auricular cartilage augmentation. The patients were followed from 15 months to 50 months. No secondary deformation occurred in any of the patients. 93.1% patients were satisfied with the aesthetics postoperatively, 89.7% patients were satisfied with the incision and donor site scar. Among them, 3 of the patients got hypertrophic scar on the upper lip and were modified 1 year after their first operations. The operational technique of the domino sliding flaps could better play the role of the Abbe flap. It also gave plastic surgeons an effective method to modify the severe deformities of bilateral cleft lip in 1 stage.

Structural Fat Grafting to Improve Reconstructive Outcomes in Secondary Cleft Lip Deformity.

To describe the technique and results of structural fat grafting in cleft lip revision, including patient satisfaction and aesthetic outcome. Retrospective case series. Multidisciplinary cleft care center. All patients who underwent structural fat grafting between June 2006 and September 2012 for cleft lip revision, with appropriate photographic follow-up included. Twenty-two cases were reviewed; 18 had sufficient data to be included. Patients underwent structural fat grafting for cleft lip revision, most commonly injecting fat under deficient philtral columns, the nostril base, and upper lip. Blinded observers rated outcomes using the Asher-McDade nasolabial appearance rating scale. Patients completed questionnaires assessing their satisfaction. A paired Student's t-test was used to test outcomes for significance (alpha = 0.05). Patients were an average of 16 years old (range: 6-43); average length of follow up was 11.7 months. Overall symmetry and aesthetics were improved based on the nasal form (P = 0.006) and vermillion border (P = 0.04) when rated using the Asher-McDade scale. No complications were recorded. Patients were significantly happier with their appearance after fat grafting (P < 0.001) and were uniformly positive when questioned about the ease of the surgery and rate of recovery. Structural fat grafting is a safe and effective way to improve symmetry and enhance facial proportions in patients with cleft lip. Given the high degree of patient satisfaction, few complications, and durable results, fat grafting offers many advantages in cleft lip revision.