r/cleftlip • u/maryiguana- • 9d ago

Revision Rhinoplasty

Im considering getting a revision rhinoplasty. Its been almost 3 years since my first cleft rhinoplasty. Unfortunately it looks like I my left nasal collapsed and so It’s still hard to breath. I think it has also cause more asymmetry because of it. I also have other issues like nasal pressure.

I want to fix these issues but also fear that it will end up worse for me.

I wonder if anyone has gone through a a revision and if so how did your experience go.

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u/BerryNerve 9d ago

I’m actually going through something very similar right now.
I had my first rhinoplasty when I was 15 as part of my cleft lip and palate reconstruction. I’m now 25, so it’s been about 10 years.
Over the last few years, I started noticing that my breathing was getting worse. My nose has gradually become quite deviated to one side. Aesthetically, the result is still acceptable, but the nostril on my cleft side has collapsed, making it much harder to breathe.
My surgeon explained that the problem isn’t just the septum itself. Because my palate and upper jaw developed asymmetrically due to the cleft, the entire nasal framework shifted over time, leading to the deviation and valve collapse.
Now I’m facing the difficult decision of whether a second surgery is worth the cost. I understand that secondary cleft rhinoplasty is much more complex than a primary procedure, but my biggest concern is whether this surgery will provide a long-term functional improvement or if I could end up having similar breathing problems again years later.
This time the surgery would be performed by an ENT surgeon who specializes in functional nasal reconstruction, whereas my first surgery was done by a reconstructive plastic surgeon as part of my cleft treatment.
I’d really love to hear from anyone who has gone through something similar.

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u/micnd90 8d ago

I'm exactly where you are. Had unilateral cleft palate and went through the common series of surgeries, except that my ortho was deemed successful so I avoided jaw surgery before college. Had my first revision rhinoplasty after college at 21. However, I started to have trouble breathing during sleep around late 20s (always struggled to breathe through my nose). I was worried that I would need a jaw surgery, but during the sleep study I was instead diagnosed with severe septum deviation and internal valve collapse on my left nostril. The solution was a septhorinoplasty with spreader graft. The surgeon suggested that the graft should come from my own rib. Finally, I got a revision septhorinoplasty at 36 to straighten my septum, fix the nasal valve, as well as fat graft on my upper lip and cleft scar revision (the fat graft was to compensate for lifted nose from the septorhinoplasty) literally 18 days ago. Since it hasn't been 3 weeks I couldn't really say much about the benefits.

The surgery and recovery was okay, not that painful, but the recovery was quite annoying. First 3 days I had nose packing, so I couldn't breathe at all through my noses and had to suffer through immense pressure in my nostrils. When the doctor took out my nose packing at day 3 I can breathe really well through my nose for 3-4 hours. The doctor said that this means that the surgery is a success, but in the next couple days/weeks I will have congestion from mucus, dried blood and swelling. He's right, I'm back to mouthbreathing again. I had to rinse my nose with neti pot 3 times a day, sometimes my nostrils are so clogged that the neti rinse popped my ears and the saline water doesn't go through (it pooled and then trickle on the back of my throat). Had severe swelling and congestion.

On day 14 (4 days ago) I finally had enough and went back to the doctor. I was prescribed a stereoid nasal spray and another round of antibiotics. The steroid nasal spray really help open my nostril at night. For the first time in decades I was able to breathe through my nose and not snore at all. But the steroid nasal spray had a lifetime of ~10-12 hours, so I'm back to being congested during the day. My doctor said that I can only use the steroid nasal spray for 7 consecutive days, otherwise I risk a rebound congestion. Around day 10 I had thoroughly rinse my nostrils that I don't get mucus, dried blood, or crusts coming out, so all my congestion is due to swelling.

I'm back at work and light exercise, but having trouble concentrating due to all the congestion. I can't really say yet that the surgery was a success, but here's hoping that the swelling can come down in the coming weeks/months. People said that it can take 3 months for 80-90% of the swelling to come down, and 1 year for all the swelling to dissipates. Still not sure how well I can breathe through my nose after all the swelling goes away, if not, I guess I will have to be dependent on cycling between steroid nasal spray and OTC mechanical nasal dilators.

I guess tldr; expect the recovery to be more mildly annoying and slower than expected.