Purpose: Cleft lip patients routinely require formal rhinoplasty in their teenage years to supplement two earlier nasal surgeries (1) performed at time of initial lip repair at 3 months of age and (2) performed for alar deformity between 3 to 4 years of age. We hypothesize that residual alar deformities may persist despite earlier surgeries because of an underlying attenuated cleft sided alar cartilage.

Methods: Thirty-three unilateral cleft lip patients (15 complete, 18 incomplete) were retrospectively evaluated using preoperative and postoperative worm°¦s eyes photographic images. Postoperative images following the initial surgery were further separated into early ( ≤ T12 months) versus long term ( > 12 months) follow up groups and compared to determine long term nasal repair efficacy. Outcome measures compared differences in sill width, columellar height, internal alar rim distance, as well as nostril aperture

Results: Postoperative outcome measures demonstrated improvement in sill width (decreased), columellar height (increased), internal alar rim (decreased), as well as nostril circumference and area (both decreased) when compared to preoperative measures for both incomplete and complete clefts. Outcome measures for the early (3.8 months) versus long term (90.2 months) follow up groups demonstrated preservation of the sill width and columellar height but continued collapse of the cleft sided internal alar rim (decreased) and nostril aperture circumference (decreased) for both the incomplete and complete clefts.

Conclusions: These findings suggest that the cleft sided alar envelope is not adequately supported by its underlying alar cartilage and thus prone to long term collapse and residual alar deformity.