Show notes

Cleft palate rhinoplasty is one of the most technically demanding operations in rhinoplasty — and one of Dr Dan’s favourites. In this episode, he explains why these cases require extensive rhinoplasty experience, how unilateral and bilateral cleft deformities differ, and why reconstructing a stable septal framework is central to his approach.

The discussion focuses particularly on unilateral cleft rhinoplasty: the potential need for rib cartilage, complete removal of existing structural components where appropriate, osteotomies, and a substantial septal replacement graft rather than relying on a simple extension graft. Dr Dan also discusses the limitations of tensioning, his strong opposition to primary alar base reduction on the cleft side, and selective premaxillary augmentation.

These are the surgeon’s clinical views and operative preferences, rather than universal treatment rules. Individual anatomy and prior treatment determine surgical planning.

Key topics

Why cleft rhinoplasty is exceptionally difficult

Unilateral versus bilateral cleft nasal deformity

Rib cartilage and rebuilding structural support

Full explantation, osteotomies and the limitations of tensioning

Large septal replacement grafts versus extension grafts

Why Dr Dan avoids alar base reduction in primary unilateral cases

When cleft-side premaxillary augmentation may be considered