Episode 22 – Bilateral Cleft Rhinoplasty: Rebuilding Nasal Projection

In this episode of Doctor Dan Behind the Scalpel, Dr Dan Robinson explores bilateral cleft rhinoplasty, one of the most technically challenging procedures in facial plastic surgery.

While bilateral cleft rhinoplasty is an extremely complex operation, Dr Dan explains why it can paradoxically be somewhat easier than unilateral cleft rhinoplasty.

The central challenge is restoring nasal projection. Understanding this fundamental issue is essential to achieving a successful reconstruction.

Dr Dan discusses his surgical approach, including the use of rib cartilage, extensive septal reconstruction and the challenges of establishing a stable structural foundation.

Topics covered:

• Why bilateral cleft rhinoplasty differs from unilateral cleft reconstruction
• The importance of restoring nasal tip projection
• The role of rib cartilage and complete septal reconstruction
• Extended spreader grafts and nasal bone osteotomies
• The challenge of finding a reliable anchoring point on the premaxilla
• Large septal replacement grafts, extension techniques and tensioning

Key takeaway: Successful bilateral cleft rhinoplasty depends on restoring adequate nasal projection through robust structural reconstruction. Understanding the anatomy, establishing stable support and using advanced grafting techniques are fundamental to achieving a successful result.