What Is a Cleft Lip?
A cleft lip is an opening or split in the upper lip that occurs when the facial structures of an unborn baby do not fully close during the first trimester of pregnancy. The lip normally forms between the fourth and seventh weeks of pregnancy, and a cleft results when the tissue does not join completely.
Cleft lip can range from a small notch in the colored portion of the lip (incomplete cleft) to a complete separation that extends through the lip into the nose (complete cleft). It may occur on one side of the lip (unilateral) or on both sides (bilateral).
Cleft lip is one of the most common birth differences, affecting approximately 1 in 700 babies born worldwide. With expert surgical care, children with cleft lip can achieve excellent functional and aesthetic outcomes.
Types of Cleft Lip
Understanding the different types helps guide the surgical approach and expected outcomes.
Unilateral Incomplete
A notch or partial opening on one side of the upper lip that does not extend into the nose. This is the mildest form and typically requires a single surgical repair.
Unilateral Complete
A full separation on one side of the lip that extends through the lip and into the nostril. This affects the shape of the nose and requires careful reconstruction of both the lip and nasal structures.
Bilateral Incomplete
Partial openings on both sides of the upper lip. The central portion of the lip (prolabium) remains partially connected to the lateral lip segments.
Bilateral Complete
Full separations on both sides of the lip, with the central portion of the lip and nose (premaxilla) projecting forward. This is the most complex form and often requires staged surgical repair.
Causes & Risk Factors
The exact cause of cleft lip is often unknown, but it is believed to result from a combination of genetic and environmental factors. In most cases, there is no single identifiable cause.
Genetic Factors
A family history of cleft lip or palate increases the likelihood. If one parent has a cleft, the chance of having a child with a cleft is approximately 2–8%. Certain genes involved in facial development, when altered, can contribute to cleft formation.
Environmental Factors
Factors during pregnancy that may increase risk include tobacco use, alcohol consumption, certain medications (such as some anti-seizure drugs), diabetes, and inadequate folic acid intake. Exposure to these factors during the critical first trimester can interfere with normal facial development.
Key Risk Factors
Prevention tip: Taking prenatal vitamins with folic acid before and during early pregnancy, avoiding tobacco and alcohol, and discussing all medications with your healthcare provider can help reduce the risk of cleft lip.
Symptoms & Diagnosis
Signs & Symptoms
Visible opening or split in the upper lip (may be detected on prenatal ultrasound)
Separation that may extend from the lip through the gum and into the nostril
Difficulty with breastfeeding or bottle-feeding due to inability to create suction
Nasal regurgitation of milk during feeding
Asymmetry of the nose, particularly with complete clefts
Dental problems if the cleft extends through the gum line (alveolus)
Diagnosis
Prenatal Detection
Cleft lip can often be detected during a routine prenatal ultrasound, typically during the second trimester (around 18–20 weeks). This early detection allows families to prepare and connect with a craniofacial team before birth.
At Birth
A cleft lip is immediately visible at birth through physical examination. The medical team will assess the extent of the cleft and refer the family to a craniofacial specialist.
Additional Evaluation
Genetic testing may be recommended to determine if the cleft is part of a broader syndrome. Hearing tests and feeding assessments are also part of the initial evaluation.
Treatment Options
Treatment for cleft lip involves a carefully planned sequence of interventions, beginning in infancy and continuing through adolescence.
Pre-Surgical Preparation
Birth – 3 MonthsNasoalveolar Molding (NAM)
A custom-made appliance worn by the baby to gradually align the lip, gum, and nose before surgery. NAM helps narrow the cleft gap, improve nasal symmetry, and can lead to better surgical outcomes.
Feeding Support
Specialized bottles and nipples (such as the Haberman feeder or Dr. Brown's Specialty Feeding System) help babies with cleft lip feed effectively. A feeding specialist works with the family to ensure proper nutrition.
Team Evaluation
The craniofacial team — including the plastic surgeon, pediatrician, geneticist, and feeding specialist — evaluates the baby and develops a comprehensive treatment plan.
Cleft Lip Repair (Cheiloplasty)
3 – 4 MonthsSurgical Technique
Dr. Chaiyasate uses advanced techniques such as the Millard rotation-advancement or Fisher subunit repair to reconstruct the lip. The goal is to create a natural-looking lip with proper muscle function and minimal scarring.
Primary Rhinoplasty
During the lip repair, Dr. Chaiyasate also performs a primary nasal correction to improve the shape and symmetry of the nose. This is done through the same incision and adds no additional recovery time.
What to Expect
The surgery typically takes 1–2 hours under general anesthesia. Most babies stay in the hospital for 1–2 days. Stitches are usually dissolvable, and the incision is protected with tape or a small bandage.
Ongoing Monitoring & Support
6 Months – 5 YearsScar Management
Dr. Chaiyasate provides guidance on scar care including silicone sheeting, massage techniques, and sun protection to optimize healing and minimize the appearance of the scar.
Speech Development
Regular speech evaluations begin around age 2–3 to monitor language development. If the cleft also involves the palate, speech therapy may be needed.
Dental Monitoring
If the cleft extends through the gum line, the child's dental development is closely monitored. An orthodontist joins the team to plan future dental care.
Revision & Refinement
8 – 18 YearsAlveolar Bone Graft
Around age 8–11, bone from the hip is grafted into the gum line to support permanent teeth and stabilize the dental arch. This is timed with the eruption of the permanent canine tooth.
Lip & Nose Revision
As the child grows, minor revisions to the lip scar or nasal shape may be performed to improve aesthetics. These are typically done during school breaks.
Rhinoplasty
A definitive rhinoplasty may be performed after facial growth is complete (around age 16–18) to achieve the best possible nasal appearance and function.
Orthognathic Surgery
In some cases, jaw surgery may be needed in the late teens to correct any growth discrepancies and achieve proper bite alignment.
The Multidisciplinary Care Team
Comprehensive cleft care requires a coordinated team of specialists working together to ensure the best outcomes.
Plastic Surgeon
Leads the surgical treatment plan, performs lip repair, nasal correction, and revision surgeries.
Pediatrician
Monitors overall health and development, coordinates with the craniofacial team.
Speech-Language Pathologist
Evaluates and treats speech and language development, monitors for velopharyngeal dysfunction.
Orthodontist
Manages dental alignment, provides NAM therapy, plans alveolar bone grafting and braces.
ENT Specialist
Monitors hearing, manages ear infections, and places ear tubes when needed.
Pediatric Dentist
Provides dental care from infancy, monitors tooth development in the cleft area.
Geneticist
Evaluates for associated syndromes, provides genetic counseling for families.
Psychologist / Social Worker
Supports the emotional well-being of the child and family throughout the treatment journey.
Feeding Specialist
Helps with feeding strategies in infancy, ensures proper nutrition before and after surgery.
Schedule a Consultation
Dr. Chaiyasate and his team are here to answer your questions and discuss the best treatment options for you or your child.