“Having a visible difference allows us to be more accepting of others and I know I wouldn’t have overcome some of the hurdles I’ve been faced with if it wasn’t for the processes I’ve been through with my cleft lip.”

Roannah, 20

If you’ve had a cleft lip repair, chances are you will have a visible scar that makes you look a little different to other people. You may also have an irregular nose or a ‘flat’ profile, and if you were born with a cleft that affects your gums you may have noticeably irregular teeth. We call this a visible difference.

There is no right way to feel about having a visible difference. Some people see it as a fundamental part of who they are and would never want to change it. Others are very self-conscious about it and find it negatively affects their self-esteem. This isn’t necessarily to do with how ‘extreme’ or ‘obvious’ a visible difference is – sometimes, people with quite minor scarring can be the most self-conscious about it, and people with very clear differences can cope exceptionally well.

More about self-image and society

How You Can Get Help

There are two main treatment options open to adults who are concerned about their appearance:

  1. Surgical, dental and/or orthodontic treatment which covers both functional and appearance-related concerns
  2. Therapeutic input from the Cleft Clinical Psychology Team (see ‘Self-Image and Society’)

Surgical Treatment

Treatment options may have changed since the last time you accessed cleft care, and adults with a cleft should always be welcome to have an initial appointment at a Cleft Centre (with a referral from their GP or dentist) to discuss any treatment options that might be open to them. Treatments deemed necessary for issues caused by your cleft should always be free under the NHS, no matter your age.

If you’re interested in surgical or dental procedures, you’ll be seen individually with the relevant medical professional to discuss your needs and circumstances. What procedures are appropriate for someone depends on many different factors such as medical history, age, previous surgeries, etc., and a decision about offering further treatment depends on these, not just on the desires of the patient. Please keep this in mind when thinking about asking for further treatment, and understand that a procedure you want might not be offered to you by the medical team if they do not think it is appropriate.

Examples of surgical treatment include:

Scar Revision

Surgery can sometimes improve the appearance of scars by changing the shape or position, making it less lumpy, or loosening up the skin so it moves better. Surgery will create a new scar that could take up to two years to improve in appearance. Other non-surgical options include Skin Camouflage creams and powders, or laser therapy to flatten the scar or reduce redness.

Orthognathic Surgery (Osteotomy)

This is surgery to correct the position of the jaws. It can improve the appearance of a flat nose and upper lip, and help to correct an underbite (where your top teeth sit behind your bottom teeth). It involves breaking and re-setting one or both of your jaws, so it’s a serious procedure that requires a lot of preparation, as well as ongoing orthodontic work and possibly speech therapy. Teenagers are usually offered this procedure at 16-18 years old once their facial bones have stopped growing, but some people have it later in life. Read More.


This surgery aims to change the shape of your nose, and sometimes it helps to improve breathing. There are many different kinds of rhinoplasty which aim to change different aspects of your nose, but not all issues can be fixed surgically, so it’s important to consult with your Cleft Team about what’s right for you.

Abbe Flap

A procedure that aims to reconstruct a patient’s top lip using tissue from the bottom lip. This is used mostly when a bilateral cleft lip repair has left the top lip looking thin and tight.

Lip Fillers

These are injections which can be used to increase the volume and definition of the lips. The effects can be temporary or permanent, depending on the type of filler.

Further Support:

Changing Faces

Changing Faces is an organisation which supports and represents people who have conditions or injuries which affect their appearance. They offer a range of services, including support groups, self-help resources and Skin Camouflage clinics where you can learn to apply special cover creams and powders.

Peer Supporters

Peer Supporters are adults with a cleft who are trained by CLAPA to support others one-on-one over the phone or email. If you’re considering further treatment and want to talk to someone about it, get in touch with CLAPA so we can link you up with a Peer Supporter.

Adult Facebook Group

Our Facebook Group for adults with a cleft has almost a thousand members and is growing all the time. Here you can find others like you to share stories and experiences.

Adult Voices Council

CLAPA’s Adult Voices Council is made up of adults with a cleft from around the UK who meet up four times per year to discuss issues brought up by others, themselves or by CLAPA which are relevant to adults with a cleft. This can be anything from the content of new leaflets to the implications of new research. If you have an issue you would like Adult Voices to discuss, please do get in touch with them.


Published: November 2015

Next Review: February 2017

Source(s): Range of existing literature from CLAPA, including a leaflet produced by the Royal College of Surgeons in association with CLAPA. Various studies concerning the experiences of adults with a cleft were also used. Stories and suggestions from adults born with a cleft have been included throughout. Information from Changing Faces was also consulted. This information has been reviewed by cleft health professionals as well as CLAPA’s Adult Voices Council.

If you have a comment or question about the information in this page, or would like to know more about the sources of this information, please contact Communications & Information Manager Anna Martindale at [email protected] or 020 7833 4883.


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