Understanding operations

It’s your body and it’s important that you have a say in what happens to it. You do not have to have any operations which you don’t want to have.

However, some operations are very important for your health and wellbeing. If you don’t have them when they’re offered, you may not be able to have them later, and you may regret it.

For example, an Alveolar Bone Graft operation is important to make sure your adult teeth can come through properly. If you don’t have this operation at the right time, it can affect your dental health for the rest of your life.

Talk to your cleft team about why they have recommended you have an operation, the benefits and risks, and what will happen if you say no.

It’s normal to be worried about operations, but there is lots of support and help available from CLAPA and your cleft team.

If your cleft team offer an operation which can change how you look, it’s up to you whether or not you go ahead with it.

Your cleft team want you to know about all the options available. This doesn’t mean you have to choose them. The most important thing is feeling happy and confident in yourself.

If you’re not sure, you could ask for an appointment with the Clinical Psychologist in your Cleft Team. Part of their job is to support people with these kinds of decisions.

It’s important that your expectations of an operation fit with what your surgeon things is possible. Make sure you take the time to fully understand what will happen and what you can expect.

See below for questions you might want to ask at appointments.

There are some operations and treatments which can change or ‘revise’ how your lip scar looks. This can mean making them less red, less lumpy, or changed to blend in better with the skin around them.

But your scar will probably be more noticeable for a while after the operation, and there’s no treatment which can make it go away completely.

If your scar is bothering you, you can talk to your surgeon about what is possible.

Remember, sometimes the problem with a scar isn’t how it looks, but rather how we feel about it. It could be that your scar is the first thing you see when you look in the mirror, but other people are more likely to look at your eyes or your whole face. You might be surprised to learn that there are lots of people who don’t notice your scar at all, or just see it as a part of your face just like a mole or freckles.

See below for more support if you’re concerned about how your scar looks.

It’s very normal to be worried about operations, even if you’ve had operations in the past.

It can help to talk to friends or family about this.

You will have at least one appointment with your Cleft Team to help you prepare for the operation. If there is something in particular you are worried about, bring this up at the appointment. Write down any questions you have before the appointment so you don’t forget.

You might also want to ask your Cleft Team if you can talk to the Clinical Psychologist before your operation. They can help you to talk through any difficult feelings you might be having.

Your nose will naturally grow as a teenager, and it can start to look different as you become a young adult. Breathing can also become a little difficult if the nose bends on the inside.

Your Cleft Team will probably ask you about your nose when you have check-ups with them. They will want to know how you feel about how it looks and also about breathing and whether anything has changed.

You can also usually ask for a separate appointment with the Clinical Psychologist if you would like to discuss any other concerns.

Nose surgery may be able to change:

• how wide your nose is
• how much your nose sticks out from your face
• the shape of your nostrils
• the shape and straightness of your septum (the bit between your nostrils)
• how easy it is to breathe through your nose

Not every issue can be ‘fixed’ with an operation, so it’s important that you talk about it in detail with your Cleft Team. They will help to make sure that you understand exactly what is possible so that you have the right expectations before having the operation.

There are a few different kinds of rhinoplasty depending on what the aim is. If you want to know more about exactly what will happen to you, ask your surgeon.

This operation is almost always done under general anaesthetic (where you are completely asleep and can’t feel anything) and usually involves one or two nights in hospital.

Your Cleft Team will tell you exactly what you can expect after your operation, so remember that the information here is general only.

After the operation, you may wake up with a splint on your nose. Your nostrils may be packed with gauze or supported with a silicone splint inside your nose. The splints may stay for between 5 days and 3 weeks.

When the splits come off, your nose will be swollen and you may have bruising around your nose and eyes. The nose is quite often spotty, but this soon settles. The skin of the nose will be red and shiny for a few weeks, and it may be numb. Breathing may feel different for a while until the swelling goes down.

It can take about 6 months for the nose to settle to its final appearance. In around 1 in 4 cases, people who have had rhinoplasty will go back for other minor adjustments. If you’re concerned about the outcome, you can talk to the Cleft Team and they can tell you whether any additional operations would be possible or helpful.

There are several different operations which aim to make less air come through your nose when you talk.

These include:

• pharyngeal flap
• buccinator flap
• pharyngoplasty
• palate re-repair

You might have had one of these already when you were younger.

If your voice sounds nasal and unclear, it could be that the soft palate is letting too much air through your nose while you’re talking. These operations aim to make it so less air escapes through your nose. This can make your voice sound less nasal and help you make some sounds more clearly.

A Speech and Language Therapist together with your surgeon may recommend an operation if they think it’s right for you.

It’s up to you whether this operation is something you want to go through with. Some people are very concerned with how their voice sounds, and others don’t mind so much. If you’re not sure if you want to go through with the operation, ask if you can talk to the Clinical Psychologist to help you make the decision.

This depends on which operation you have.

Pharyngeal Flap: A square flap is taken from the lining at the back of the throat and attached at one end to the soft palate.

Buccinator Flap: Part of the inside lining of the cheek is moved to make the soft palate longer.

Pharyngoplasty: Two pieces are taken from the sides of the throat and joined together to make a ‘bulge’ on the back or sides of the throat.

Palate re-repair: The original cleft palate repair is opened, the muscles are realigned, and the palate is repaired once more.

These operations help to block excess air from going into the nose, but still allow you to breathe normally.

You will be asleep during the operation, and will usually be able to go home one or two days later.

Your Cleft Team will give you more detail on what you can expect after the operation and what the recovery will be like.

You will usually need to take around two weeks off to properly recover, and you’ll need to stick to a soft diet for 2-3 weeks as well as follow other recommendations from your Cleft Team.

The inside of your mouth will be swollen after the operation, and it may take a little while before you can clearly tell if there has been a change in your voice. How long depends on the procedure.