Cleft lip repair, planned as one journey from the first feed to the final scar, by Dr. Ashutosh Shah, Plastic, Reconstructive & Cosmetic Surgeon (DNB).
A cleft lip is usually repaired at 3 to 6 months and a cleft palate at 9 to 18 months, with bone grafting around 8 to 11 years and any nose or scar refinement after facial growth finishes. Most children need two to four planned operations over childhood, and in India the functional stages are covered under Ayushman Bharat PM JAY.
A cleft is a gap left when the tissues of the lip or the roof of the mouth do not join in early pregnancy. It affects roughly 1 in 700 births in India, making it the most common facial difference we treat. The gap is visible, but the real consequences are functional: feeding, hearing, speech and the growth of the upper jaw.
Craniofacial conditions are broader. Premature fusion of the skull sutures, asymmetric jaw growth, orbital and mid face differences, and syndromic patterns. These need imaging, a growth aware plan and often more than one specialty in the room.
Nothing here is improvised. At the first consultation you are given the whole sequence in writing, so you know what happens at six months and what happens at ten years.
Cleft specific feeding advice, weight tracking, hearing screen and photographs. The full staged sequence is explained and handed over in writing.
Millard or Fisher repair restoring the lip, the muscle ring and the nostril base in one operation, with the nose set up for later refinement.
Two flap palatoplasty with intravelar veloplasty to rebuild the muscle sling, the operation that decides speech. Grommets are placed if the ears need them.
Formal speech evaluation. If nasal air escape persists, secondary palate or pharyngeal surgery is planned rather than waiting for school to expose it.
Bone from the hip fills the gum cleft so the canine can erupt, done alongside orthodontic expansion and timed to the tooth, not the birthday.
Cleft rhinoplasty, lip scar revision and, where the bite demands it, orthognathic correction, once facial growth is essentially complete.
Timing is set by the baby weight, feeding and general health rather than by the calendar alone.
Weight, haemoglobin and chest are cleared. Markings are drawn awake so the plan is measured, not improvised, and photographs are recorded.
A dedicated paediatric anaesthetist manages the airway and temperature throughout, the single biggest safety factor in infant surgery.
Skin, muscle and lining are separated and rejoined as layers. The philtral column and Cupid's bow are reconstructed, and the nostril base is set.
Fine absorbable sutures inside, non absorbable on the lip skin. Arm splints prevent the child reaching the repair for the first ten days.
The child is woken with the family present and started on spoon or cup feeds the same evening, with pain kept ahead of the clock rather than chased.
Swelling peaks and settles. Cup or spoon feeding only, arm splints on, discharge once feeding is reliable.
Lip sutures removed around day 5 to 7. Splints come off at ten days. Soft diet continues; no dummies or hard toys in the mouth.
Wound fully healed and normal diet resumed. Scar massage and silicone begin, and speech follow up is scheduled.
Scar softens and fades. Review for symmetry, nasal shape, hearing and speech progress; any next stage is dated from here.
The lip will look and move much closer to usual, though a scar line remains from the lip up towards the nostril. It is red and firm for the first months, then softens and pales over a year or two. The nose usually stays a little uneven and is often refined in later childhood. Speech depends far more on the palate and on therapy than on the lip. Regular reviews continue as the face grows.
Cleft surgery is safe and routine in trained hands, but no operation is risk free and you deserve the real list before you consent.
The repair is delicate for the first few weeks, so protect it from rubbing, stretching and dried milk.
A cleft forms very early in pregnancy from a mix of inherited and chance factors, and in most families no single cause is ever found.
The scar fades and softens over the first year or two, but a fine line stays. Massage and sun protection help it settle.
Speech comes mainly from the palate and from speech therapy. Lip repair helps with a few sounds only.
Palate repair, ear and hearing checks, speech reviews, dental work and often nose surgery follow over the years.
New parents need feeding help and a clear map of the years ahead, and that is what the first consultation is built around.
Images published with documented parental consent and generalised for age, in line with advertising norms applicable to medical practitioners in India.
Bands below are for Surat and cover surgeon, anaesthesia, theatre and the standard hospital stay. A quote changes with the width of the cleft, whether both sides are involved, the child's weight and whether speech surgery or grafting is added.
Cleft lip, cleft palate and alveolar bone grafting are listed functional procedures under Ayushman Bharat PM JAY, and children are screened under RBSK. We give a written estimate before admission, no revision after the operation.
These are the questions asked in almost every consultation. Anything else, ask directly. You will speak to the team, not a call centre.
Ask your question →Between three and six months, once the baby weighs about 5 kg, feeds well and has adequate haemoglobin. Repairing earlier does not improve the result and increases anaesthetic risk; repairing much later means the family lives with feeding and social difficulty for no clinical gain.
Most children with a complete unilateral cleft need two primary operations, lip and palate, plus alveolar bone grafting in late childhood. Around one in five needs speech surgery, and some choose a rhinoplasty or scar revision in the teens. That is three to four planned procedures over roughly fifteen years.
Most children reach normal or near normal speech when the palate is closed by eighteen months and speech therapy is followed through. A minority develop nasal air escape and need a secondary procedure, usually assessed at four to five years by a speech therapist and surgeon together.
Yes for eligible families. Cleft lip repair, cleft palate repair and alveolar bone grafting are listed functional procedures under PM JAY, and RBSK screening also refers children for treatment. Our team prepares the documentation and confirms approval before the admission date.
One night for a lip repair, and two to three nights for a palate repair, where feeding and airway are watched more closely.
The lip scar is placed along the philtral column, where the natural shadow of the lip falls. It is red and firm for two to three months, then fades over nine to twelve months with silicone, massage and sun protection. Most adults' scars are visible only at close conversational distance.
Send photographs, birth details and any imaging on WhatsApp. You will get a staged plan, expected hospital stay and cost band in writing before travelling, and investigations scheduled for the day you arrive so the visit is not wasted.
Each technique below has its own page explaining how it works and when it is chosen.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
