Dr. Rachel A. Ruotolo, MD, FACS

Parents should understand that many changes occur to the lip, nose, and scar during the months and years following cleft repair. The lip often remains pink and firm for months. The scar may contract, causing shortening of the lip, which can sometimes make it appear as if the cleft is recurring. Patience and time are essential for the lip and nose to soften and settle. While some changes may require operative intervention, others simply need time and observation.

Dr. Ruotolo's approach involves meticulous intra-operative markings, including the alar bases, collumellar base, oral commissures, and the red line. She emphasizes the importance of anatomically aligning the wet and dry vermilion to prevent chronic crusting. She carefully marks the white roll to determine Cupid's bow peak and trough and Nordhoff's point. The procedure involves drawing rotation, C, and advancement flaps, ensuring the advancement flap does not extend beyond the alar base. Medial and lateral mucosa flaps are used to align the nasal floor and line the piriform aperture-relaxing incision, respectively. A Z-plasty release of the upper lip frenulum is also performed to aid medial segment rotation. She uses rulers for horizontal and calipers for vertical measurements, and may include a vertical triangular wedge excision to shorten the lip if needed, especially in incomplete clefts which can counterintuitively end up too long.

Dr. Ruotolo features actual patients with real results on her website and social media. Informed consent is always obtained directly from the patient or their parents for the use of these images.