By Mr. Shaheel Chummun, Consultant Plastic, Reconstructive and Cosmetic Surgeon
Prior to the 1990s, cleft repair in the UK was performed by a wide range of surgeons, often with limited specialist training.
While many achieved excellent results, the lack of national standards meant that some patients were left with functional and aesthetic challenges that lasted into adulthood.
Today, the landscape is dramatically different. Cleft care is now centralized and highly regulated, delivered by multidisciplinary teams at designated centers of excellence.
However, as a consultant plastic surgeon specializing in nasal reconstruction, I still see the legacy of those decades ago, adults who underwent primary reconstruction as children and now present with complex nasal deformities requiring cleft rhinoplasty or revision surgery.
Modern advances in imaging, surgical planning, and tissue engineering allow us to restore both form and function with a level of precision that was previously impossible.
The evolution of cleft care
In the past, cleft lip and palate procedures were performed by general or oral surgeons, ENT specialists, and plastic surgeons.
There were no formal training routes or multidisciplinary structures. As a result, results varied widely.
In the early 1990s, growing evidence on the effects of speech, breathing and facial development prompted major reform of the NHS.
The Clinical Standards Advisory Group (CSAG) recommended the centralization of cleft services, a landmark change that improved surgical consistency and long-term outcomes for patients born with cleft conditions.
However, for many adults who had surgery prior to these reforms, residual nasal asymmetry, airway restriction, and scarring-related differences remain common.
These patients now seek specialized cleft rhinoplasty, a highly complex procedure that aims to correct both aesthetic imbalance and functional breathing difficulties.
Technology in cleft rhinoplasty: From intuition to innovation
Modern split rhinoplasty combines art with engineering.
Mr. Shaheel Chummun
The nose is a three-dimensional, asymmetrical structure, which is already difficult to reshape in standard rhinoplasty, but even more so in post-cleft cases, where the anatomy has been altered by scarring and previous surgery.
Today’s technology-driven approach allows surgeons to plan, predict and execute with remarkable precision:
- 3D visualization and simulation allows accurate preoperative analysis of nasal asymmetry, airway dimensions, and tissue volume. This digital mapping is the blueprint for each stage of correction.
- Virtual Surgical Planning (VSP) and 3D printed models Allow surgeons to visualize deformities from multiple angles and even practice or plan graft placement before entering theatre.
- High definition endoscopic systems enhance intraoperative visualization, particularly when dealing with internal nasal valve collapse or septal deviation (common issues in post-cleft patients).
- Cartilage transplantation techniquessupported by image guidance, now allow reconstruction of the nasal tip and dorsal architecture with millimeter precision.
Together, these innovations mean that cleft rhinoplasty today is not only safer but capable of providing both structural and aesthetic harmony.
The Role of Imaging and Functional Assessment
Functional results are central to any cleft rhinoplasty.
Advanced airflow analysis tools such as acoustic rhinometry and rhinomanometry are now routinely used to measure nasal obstruction and guide surgical planning.
Intraoperative navigation systems, once limited to neurosurgery, are increasingly being adapted for facial reconstruction work.
These technologies help align surgical maneuvers with digital plans in real time, minimizing errors and improving post-operative symmetry.
Artificial intelligence-assisted postoperative imaging and outcome monitoring are also emerging, enabling long-term data collection that may improve future cleft care protocols.
Challenges in Revision Surgery
Revision cleft rhinoplasty remains one of the most technically demanding procedures in facial plastic surgery.
Scar tissue, deformed cartilage, and limited donor graft material complicate every step.
For these patients, accuracy is everything.
The introduction of patient-specific graft templates, high-definition magnification and digital photo comparison software allows for accurate reproduction of preoperative planning.
Ultimately, technology augments, rather than replaces, the judgment of the surgeon. It provides clarity, predictability and a platform for data-driven creativity.
Restoring confidence, functioning and identity
Cleft rhinoplasty is more than a restoration, it is a restoration.
For patients, the procedure often represents the final chapter in a lifelong journey. Advanced technology helps us not only correct anatomy but also restore identity and confidence.
Every successful redesign combines innovation with empathy.
By integrating imaging, navigation and biological principles, surgeons can deliver results that honor both the science of precision and the art of human expression.
Looking ahead
The future of cleft rhinoplasty lies in the integration of artificial intelligence-assisted surgical planning, machine learning outcome prediction, and biological tissue regeneration.
These tools will allow us to predict healing patterns, personalize graft design, and potentially engineer tissue tailored to the individual patient.
For those of us working at the intersection of cosmetic and reconstructive surgery, the goal remains the same: to improve, restore and rebuild, not only appearance but also comfort, function and confidence.
Author biography
Mr Shaheel Chummun is a Consultant Plastic, Reconstructive and Aesthetic Surgeon and Co-Founder of Emendo Surgical Groupwith specialization in facial surgery, body and breast surgery as well as specialized expertise in cleft rhinoplasty.
He is passionate about precision, safety and patient-centered innovation in restorative care.
