Ask Dr. Barber

Q. I am in my mid-twenties and I was born with a cleft lip. My lip was repaired when I was a baby and it looks fine to me. However, my nose does not look normal and I was wondering if there is anything that can be done to improve its appearance? I have never had any surgery on my nose as far as I know, unless something was done when I was a baby.

A. Of course, there is something that can be done to improve the appearance of your nose, but you should be seen by someone who specializes in what we call a “cleft-lip nose”. A cleft lip nose can be very noticeable in some, yet exhibit only minor deformities in others, and the difference is usually related to the severity of the original cleft lip. It is unlikely that any corrective surgery has ever been done to your nose, since it is rare to operate on a baby’s nose while it is still developing. At your age, however, your nose has fully developed and you are a candidate for surgery at any point. The most common appearance of a cleft lip nose is collapse of the nostril on the side that the cleft lip occurred, so that if your cleft lip was on the left side of your upper lip, then the nasal deformity will also be on the left side of the nose. Characteristic findings of a cleft lip nose include asymmetry of the nostril openings, some lateral flaring of the base of the nose on the affected side, and lack of cartilaginous support of the nostril on the cleft side creating a flattened look. The basis for correcting this problem is to add support to the nose by transferring cartilage to the nose to allow it to sit up correctly and more symmetrically. This surgery is commonly performed and can often deliver very beautiful results. The surgeons who take care of this are typically pediatric plastic surgeons or craniofacial plastic surgeons, who specialize in acquired or congenital anomalies of the face. My recommendation is for you to make an appointment at one of the Universities in North Carolina where there is a cleft lip team, and those universities are Duke, UNC or Wake Forest. All of them have excellent teams, so I cannot say one is better than the other. When you make your appointment, let them know that you had a cleft lip as a baby and would like to see one of the plastic surgeons on the cleft team who specializes in rhinoplasties in patients who have had a cleft lip. Good luck.

Q. I am the mother of 4 children and nursed all of them for nearly a year each. I have small breasts but my nipples are too big and honestly just look like they are stretched out. They were not like that before I had children so I think it is related to four years of nursing. Can this be fixed? 

A. Yes, yes, yes. You have what is called nipple ptosis. It absolutely was caused by 4 years of nursing. The procedure to correct the problem is relatively simple. The reason nipple ptosis occurs is that the nipple gets stretched by the nursing baby. This creates the problem that the base of the nipple no longer has the tissue strength to support the nipple, so it basically just hangs down. The surgery to correct nipple ptosis is performed under local anesthesia and involves shortening the height of the nipple. This is done by removing some of the redundant skin at the base of the nipple, but no tissue from within the nipple is removed. The surgery takes less than an hour to perform and there is no significant down time other than avoiding vigorous activities such as jogging for a couple of weeks.  

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