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Component Primary Unilateral Cleft Rhinoplasty: Balancing Dynamics of Overcorrection and Relapse.

Isabel A Ryan1, Philip D Tolley, Carrie Z Morales

  • 1From the Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.

Annals of Plastic Surgery
|January 26, 2026
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Summary
This summary is machine-generated.

Primary rhinoplasty (PR) for cleft nasal deformity improves symmetry initially but shows ~20% relapse within a year. Overcorrection may enhance long-term results for cleft lip repair patients.

Keywords:
cleft lipcleft nasal deformityprimary rhinoplasty

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Area of Science:

  • Plastic Surgery
  • Craniofacial Surgery
  • Pediatric Surgery

Background:

  • Primary rhinoplasty (PR) aims to correct cleft nasal deformity during unilateral cleft lip repair.
  • Establishing well-defined components and outcomes for PR remains a challenge.
  • This study introduces a component-based PR technique and evaluates its results.

Purpose of the Study:

  • To present a detailed component-based primary rhinoplasty technique for unilateral cleft nasal deformity.
  • To compare immediate and intermediate-term (1-year) anthropometric outcomes of this technique.
  • To identify patterns of symmetry changes and relapse post-primary rhinoplasty.

Main Methods:

  • A 6-component approach addresses specific cleft nasal deformities: nasal floor/sill, alar base, septum, alar rim, and tip.
  • Technical maneuvers for each component are described.
  • Retrospective review of 29 patients undergoing component PR (2018-2024) with 2D/3D photographic analysis at baseline, immediate post-op, and 1-year post-op.

Main Results:

  • Immediate post-PR symmetry improved significantly in nostril width, nasal base width, columellar height, alar height, and reduced columellar deviation (P < 0.05).
  • These improvements were maintained from pre-op to 1-year post-op.
  • However, a ~20% relapse towards the original deformity was observed between immediate post-op and 1-year post-op for nostril width, nasal base width, columellar height, and alar height (P < 0.05).

Conclusions:

  • Component primary rhinoplasty effectively improves nasal symmetry in the short and intermediate term.
  • A significant ~20% relapse occurs within the first year postoperatively for key nasal dimensions.
  • Consideration of ~20% overcorrection may be beneficial for achieving durable long-term symmetry in primary cleft rhinoplasty.