Cleft Lip Repair

Introduction

If your baby has been diagnosed with a cleft lip — either before birth on an ultrasound scan or after delivery — you are likely reading this with a mix of feelings: love for your child, worry about what comes next, and questions about surgery, feeding, speech, and how your child’s face will look and work over time. These feelings are normal, and they are shared by almost every family who walks this path.

The good news is that cleft lip repair is one of the most well-established operations in modern surgery. Children who have their cleft lip repaired in infancy and who receive coordinated care from a cleft team usually grow up speaking, eating, and looking very much like their peers. The journey is rarely a single operation, though — it is a sequence of steps that unfolds over years, with the first lip repair as one important milestone among several.

This article explains what cleft lip is, why and when surgery is done, how the operation is performed, what recovery looks like, and what to expect in the longer term. It is written primarily for parents, but older children, teenagers, and adults considering revision surgery will also find the information relevant.

What Is Cleft Lip Repair?

A cleft lip is a gap or split in the upper lip that is present at birth. It happens very early in pregnancy, when the tissues that form the face do not fully join together. The gap can range from a small notch on the edge of the lip to a wide separation that extends up into the nostril. About half of children with a cleft lip also have a cleft palate — an opening in the roof of the mouth — which is treated in a separate operation later.

Cleft lip repair, sometimes called cheiloplasty, is the surgery that closes this gap. The surgeon brings together the separated skin, muscle, and lining of the lip and rebuilds the natural shape of the upper lip and the base of the nose. The goal is not only how the lip looks but also how it works — the lip muscle needs to be reconnected so that it can move properly for feeding, facial expression, and later for speech.

Cleft lip is described by where it is and how deep it goes:

• Unilateral cleft lip — the gap is on one side of the upper lip, most often the left.
• Bilateral cleft lip — there are gaps on both sides of the upper lip, leaving a small central segment.
• Incomplete cleft lip — the gap involves only part of the lip and does not extend to the nostril.
• Complete cleft lip — the gap goes all the way up to the nostril, and the nose on that side is usually flattened or pulled to one side.
• Cleft lip with or without cleft palate — the lip and the palate can be affected together or separately.

Each of these forms is treated with the same general principle — reconstructing the lip and nose — but the surgical plan is tailored to the individual child.

Why Is Cleft Lip Repair Performed?

Cleft lip repair is performed for both functional and developmental reasons. The lip is not only a feature of the face; it is an active muscular structure used many times every minute — for sucking, sealing the mouth, forming sounds, smiling, and expressing emotion.

The main reasons surgery is done include:

• Feeding. Babies with a cleft lip alone often feed reasonably well, but those with a wider cleft, or a combined cleft lip and palate, may have trouble creating suction. Closing the lip can help with feeding, although feeding support before surgery is also a major focus.
• Speech development. A well-formed upper lip and a continuous lip muscle support the production of certain speech sounds. Early repair gives the structures time to grow and adapt before the child begins to talk.
• Facial growth and symmetry. Bringing the lip and the underlying tissues into a normal position helps guide more balanced growth of the upper jaw and nose.
• Dental development. The lip and gum tissues are closely linked to how the upper teeth come in. Lip repair is one part of a wider plan that includes dental and orthodontic care.
• Appearance and social development. Restoring a more typical lip and nose shape supports a child’s confidence and social comfort as they grow.

Cleft lip repair is considered a standard part of care for any child born with a cleft. It is not optional cosmetic surgery; it is reconstructive surgery that helps a child eat, speak, and grow.

Who Is a Candidate?

Almost every child born with a cleft lip is a candidate for surgical repair. The questions are usually about timing and readiness rather than whether to operate.

Surgeons and paediatricians look at several factors before scheduling surgery:

• Age and weight. A common guide used in many cleft centres is the “rule of tens” — the baby is at least 10 weeks old, weighs at least 10 pounds (about 4.5 kg), and has a haemoglobin level of at least 10 g/dL. These are general signals that the baby is growing well and can safely have anaesthesia.
• Overall health. The baby should be free of active infection, feeding well, and gaining weight.
• Heart, lung, and airway assessment. Some children with a cleft also have other conditions that need to be ruled out or treated first.
• Family readiness. Surgery is also a major event for parents, and the team will discuss preparation and aftercare in detail before booking the date.

Most cleft lip repairs are performed in infants between 3 and 6 months of age. Children who were not operated on in infancy — sometimes because they were born in places without easy access to cleft surgery — can still have repair successfully at older ages. The principles of the operation are the same; the planning of scars and nasal shape is adjusted to the older face.

Timing of Surgery

The timing of cleft lip repair has been studied for decades, and current cleft care guidelines generally favour the first six months of life. Operating in early infancy has several advantages: babies tolerate the surgery well, the tissues heal with very fine scars, and the repaired lip can guide the growth of the face during a period of rapid development.

For wider clefts, the surgeon may use a step before lip repair called presurgical infant orthopaedics, which includes techniques such as nasoalveolar moulding (NAM) or lip taping. These methods gently reshape the gum ridges and bring the edges of the cleft closer together over a few weeks or months. They can make the surgery easier and improve the final shape of the nose, especially in babies with wide unilateral or bilateral clefts.

For bilateral cleft lip, some surgeons repair both sides in a single operation; others repair one side first and the other a few months later. The choice depends on how wide the cleft is and the surgeon’s assessment of the tissues.

If a child also has a cleft palate, the palate is usually repaired in a separate operation later, often between 9 and 18 months of age, before major speech development.

Alternatives and Adjuncts to Surgery

There is no non-surgical alternative that closes a cleft lip. The gap involves missing or separated tissue, and only surgery can bring the structures together. However, several supportive treatments form part of the wider care plan and may be used before, alongside, or after surgery:

• Specialised feeding support. Cleft-specific bottles and teats, positioning techniques, and lactation guidance help babies feed and grow before surgery. This is essential, as good weight gain is one of the conditions for safe surgery.
• Lip taping and nasoalveolar moulding. As described above, these are not alternatives to surgery but tools that prepare the tissues so that the surgical result is better.
• Speech and language therapy. Started after surgery and continued as the child grows, particularly if a cleft palate is also involved.
• Dental and orthodontic care. Important throughout childhood and adolescence to guide tooth development and jaw alignment.
• Ear, nose, and throat (ENT) care. Many children with clefts have fluid behind the eardrum and may need small ear tubes (grommets) to support hearing.

These are not substitutes for cleft lip repair but parts of a coordinated plan that surrounds the surgery.

Surgical Techniques

Several established surgical techniques are used to repair a cleft lip. The surgeon selects the approach based on whether the cleft is unilateral or bilateral, how wide it is, and their training and experience. The patient-facing outcome is more similar than different across techniques — a closed, balanced lip with a continuous muscle — but the geometry of the incisions differs.

Millard Rotation-Advancement Technique

Fisher Anatomic Subunit Repair

A more recent technique in which the incisions are placed precisely at the borders between the natural “subunits” of the lip, so that scars sit along anatomical lines. Many surgeons favour this approach for the way the scar matures over time.

Bilateral Cleft Lip Repair

For bilateral clefts, the surgeon rebuilds the central lip segment (the prolabium) and connects it to the two side segments, while also reconstructing the central tubercle of the lip and the base of the nose. This is technically more complex and may be staged.

Primary Cleft Rhinoplasty

In most modern cleft lip repairs, the surgeon also adjusts the cartilage of the nose at the same time, lifting the flattened nostril and improving symmetry. This is called primary cleft rhinoplasty. It does not replace later nasal surgery in adolescence but gives a better starting point.

The technique is one of many decisions made by the cleft team. What matters most for the long-term result is the experience of the surgeon and the wider team in caring for children with clefts.

The Cleft Care Team

Cleft lip repair is rarely the work of one person. Care guidelines from cleft and craniofacial associations recommend that children with clefts be treated by a multidisciplinary team. Depending on the centre, this team may include:

• A plastic or craniofacial surgeon who performs the lip and palate repairs
• A paediatrician who oversees the child’s general health and growth
• An anaesthesiologist with experience in infants
• A specialist nurse or feeding therapist for preoperative feeding support
• An ENT surgeon for ear and hearing care
• A speech and language therapist
• An orthodontist and paediatric dentist
• A psychologist or social worker for family support
• A geneticist, if a syndromic cause is suspected

Preparation usually begins weeks before the operation. The aim is to ensure that the baby is healthy, feeding well, and ready for anaesthesia, and that parents understand what will happen.

Steps in preparation typically include:

• Pre-operative consultation. The surgeon examines the baby, takes photographs to plan the repair, discusses the technique, and explains the risks.
• Paediatric and anaesthetic review. Blood tests, an assessment of weight and growth, and confirmation that the baby is well enough for surgery.
• Feeding optimisation. The feeding team checks that the baby is gaining weight and may suggest changes to bottles, teats, or positioning.
• Vaccinations and infections. Routine immunisations are usually up to date, and any current cold or chest infection may delay surgery by a few weeks.
• Fasting instructions. The anaesthetist will explain how long before surgery the baby should stop having milk and clear fluids. Following these times closely is important for safety.
• Practical preparation at home. Setting up a comfortable feeding station, soft clothing that does not need to go over the head, and arm restraints or soft splints if recommended to stop the baby touching the wound.

Parents are usually given written instructions and a contact number in case questions arise in the days before surgery.

What Happens During Surgery

Cleft lip repair is performed under general anaesthesia in a hospital operating room. The baby is asleep throughout and feels nothing during the operation.

A typical sequence is:

1. The baby is brought into the operating room and given anaesthesia, usually first by mask and then through a small breathing tube.
2. The surgical area is cleaned and the surgeon marks the lip carefully, using fixed anatomical landmarks to plan a symmetrical result.
3. The cleft edges are opened along the planned lines, and the layers of the lip — skin, muscle, and inner lining — are identified.
4. The muscle that runs across the upper lip (the orbicularis oris) is released from its abnormal position and reconnected across the cleft. Restoring this muscle is one of the most important parts of the operation.
5. The lining of the mouth, the muscle, and the skin are closed in separate layers with fine sutures.
6. If primary cleft rhinoplasty is included, the cartilage of the nose is repositioned through the same incisions.
7. The wound is covered with a thin layer of ointment or a small dressing.

The operation usually takes between one and three hours, depending on whether the cleft is unilateral or bilateral and whether nasal work is included. After surgery, the baby is taken to a recovery area where anaesthesia wears off and breathing, heart rate, and oxygen levels are monitored.

Recovery and Healing

Most babies stay in hospital for one or two nights after cleft lip repair, although some centres discharge healthy babies the same day. The early recovery focuses on comfort, gentle feeding, and protection of the wound.

The First Few Days

In the first day or two, the lip is swollen and bruised, and the suture line looks raised and red. This is normal. Pain is usually well controlled with paracetamol and, for the first day, sometimes a stronger medicine. Babies are often back to their usual temperament within 24 to 48 hours.

Feeding may be slightly different in the early days. Some teams ask parents to feed by spoon, syringe, or a soft cup for a short period; others allow bottle or breastfeeding from soon after surgery. Your team will advise based on the technique used.

To protect the wound, the surgeon may recommend:

• Soft arm splints (no-no sleeves) that stop the baby from bending the elbows to reach the face, usually for one to two weeks
• Avoiding pacifiers, hard toys, or anything that could press on the lip
• Gentle cleaning of the suture line with saline as instructed
• A thin layer of ointment to keep the area moist

The First Few Weeks

Sutures are often dissolvable; if not, they are removed in a clinic visit about a week after surgery. Swelling settles over two to three weeks. The scar looks pink and raised for several months and then gradually softens and pales.

Most babies return to their usual routine of feeding, sleeping, and play within a couple of weeks. Bathing, going outside, and travel can usually resume as soon as the wound has healed.

Scar Care Over the Long Term

Scars from cleft lip repair mature over many months, often a year or more. Common parts of scar care include:

• Sun protection — covering the lip or using paediatrician-approved sunblock once recommended
• Gentle massage of the scar after it has healed, if advised by the surgeon
• Silicone gel or sheets in some cases
• Patience — a scar at six weeks looks very different from the same scar at twelve months

Follow-up visits are scheduled at regular intervals so the team can check healing, growth, and feeding.

Risks and Complications

Cleft lip repair is generally considered a safe operation when performed by an experienced surgical team in a hospital equipped for paediatric anaesthesia. As with any surgery, there are some risks, and parents are told about these as part of the consent discussion.

Possible risks include:

• Bleeding during or shortly after surgery
• Infection of the wound
• Wound separation (dehiscence), where part of the repair opens; this is uncommon but may require another operation
• Scarring — some scarring is unavoidable; in a small number of children, the scar is more raised or wider than expected and may benefit from later revision
• Asymmetry of the lip or nose, especially as the face grows
• Nasal deformity needing later correction, which is common and usually planned for in adolescence
• Anaesthetic risks, which are low but real in any operation

Children who have wider clefts, who also have a cleft palate, or who have other medical conditions may have a somewhat higher risk profile, and the team will explain this individually.

Life After Cleft Lip Repair

Infancy and Early Childhood

• Cleft lip repair at around 3–6 months
• Cleft palate repair (if needed) at around 9–18 months
• Hearing tests and ear care, often including ear tubes (grommets) for fluid behind the eardrum
• Speech and language assessment, with therapy as needed once the child begins to talk
• Dental check-ups starting at age one or earlier

School Years

• Continued speech therapy if needed
• Orthodontic assessment as the permanent teeth come in
• Possible alveolar bone graft, often around 8–11 years of age, to fill a gap in the gum if there is one
• Monitoring of facial growth and jaw alignment

Adolescence

• Orthodontic treatment such as braces
• Possible jaw surgery (orthognathic surgery) in a small number of children whose upper jaw has not grown as much as the lower jaw
• Definitive nasal surgery (secondary rhinoplasty), often after facial growth has slowed
• Lip revision if the scar or shape would benefit from refinement

Most children grow up with normal speech, eating, and hearing, and with a lip and nose that look balanced and natural. Some areas — especially the nose — commonly need further refinement later, and this is anticipated rather than a sign that the first operation did not succeed.

Cleft Lip Repair in Older Children and Adults

Although most cleft lip repair is done in infancy, the operation can be performed at any age. Older children, teenagers, and adults may seek repair if:

• They were born in a setting where surgery was not available in infancy
• They had earlier repair but would like revision of the scar, lip shape, or nose
• They have residual asymmetry of the nostril or upper lip

The surgical principles are similar, but the planning takes into account that the bones and soft tissues are fully or largely grown. Revision surgery in older patients often combines lip refinement with rhinoplasty and, in some cases, with dental or jaw treatment. Recovery is usually quicker in older patients in terms of returning to normal activity, although the emotional adjustment to a changed appearance can be significant and is supported by the team.

Supporting Your Child Emotionally

Surgery is one part of cleft care; the other is how a child feels about themselves and how the family and wider community respond. Children with clefts grow up healthy, confident, and well-adjusted in the vast majority of cases, and parents play the central role in this.

Things that the cleft care literature consistently highlights include:

• Speaking openly and age-appropriately about the cleft as the child grows
• Connecting with other families who have been through cleft care, including through patient organisations
• Preparing for questions from other children at school in a matter-of-fact way
• Watching for signs of low mood or social withdrawal in older children and adolescents, and asking the team for support if needed
• Celebrating progress without making every conversation about the cleft

Many cleft teams include a psychologist or social worker, and parents can ask for this support at any stage of the journey.

Frequently Asked Questions

What causes a cleft lip?

Cleft lip happens when the tissues that form the upper lip do not fully join together in the first weeks of pregnancy. The exact cause is usually unknown. Genetic factors, certain medications, smoking, alcohol use during pregnancy, and some nutritional deficiencies have been linked to a higher risk, but in most cases, no single cause is identified. Parents almost never “cause” a cleft through anything they did or did not do.

Was the cleft visible on an ultrasound?

Many cleft lips are now seen on prenatal ultrasound scans, typically in the second trimester. A cleft palate alone is much harder to see before birth. Finding out before birth gives families time to plan, meet the cleft team, and arrange feeding support for the early days.

Can my baby feed normally before surgery?

Many babies with a cleft lip alone feed well, sometimes with small changes to position or bottle. Babies with cleft palate or wider clefts usually need cleft-specific bottles and feeding guidance. The feeding team is one of the first people the family meets after diagnosis.

What age is best for surgery?

Cleft lip repair is most commonly performed between 3 and 6 months of age. The exact timing depends on the baby’s growth, health, and the surgeon’s assessment.

Will my child have a scar?

Yes. A scar is part of any cleft lip repair. Modern techniques place the scar along natural lines of the lip and nose, and over time it usually fades to a fine line. The scar continues to mature for a year or more after surgery.

Will my child need more operations?

Often, yes. Cleft care is a journey rather than a single procedure. Common further steps include palate repair (if a palate cleft is present), ear tubes, possible bone grafting around age 8–11, orthodontics, and later nasal or lip refinement in the teenage years.

Will my child be able to speak normally?

Most children with cleft lip alone develop completely normal speech. When a cleft palate is also present, some children need speech therapy and a small proportion need further surgery to support speech. The cleft team monitors speech development closely.

Could other children we have also have a cleft?

Having one child with a cleft slightly increases the chance that a future child will have one, although the overall risk remains low. A genetic consultation can give parents personalised information.

Is cleft lip repair painful for the baby?

Pain after cleft lip repair is usually mild to moderate and is well managed with paracetamol and, in the first day, sometimes a stronger medicine. Most babies are comfortable enough to feed and sleep within a day of surgery.

How do we choose where to have surgery?

It helps to look for a hospital that has an organised cleft team, regular experience performing cleft repairs, and a clear plan for follow-up over the coming years. Meeting the surgeon and the team in advance and feeling comfortable with their answers is also part of the decision.

Conclusion

Cleft lip repair is a well-established operation that closes the gap in a baby’s upper lip and rebuilds the muscle, skin, and shape of the lip and nose. It is usually performed in the first six months of life, as part of a longer plan of cleft care that may also include palate repair, hearing and speech support, dental and orthodontic treatment, and refinement procedures in later childhood and adolescence.

For families, the most important things are often the simplest: a team that understands cleft care, clear information at each step, good feeding support before and after surgery, and patience as the lip and the child grow over time. With this foundation, children born with a cleft lip typically grow up to eat, speak, learn, and play like any other child — with a story of cleft care that becomes one small part of who they are.