How technology is transforming cleft rhinoplasty and revision surgery in the UK

By Mr Shaheel Chummun, Consultant plastic, reconstructive and aesthetic surgeon

Before the 1990s, cleft lip and palate repair in the UK was performed by a broad range of surgeons, often with limited specialist training.

While many achieved excellent results, the lack of national standards meant some patients were left with functional and aesthetic challenges that lasted well into adulthood.

Today, the landscape is dramatically different. Cleft care is now centralised and highly regulated, delivered by multidisciplinary teams in designated centres of excellence.

Yet, as a consultant plastic surgeon specialising in nasal reconstruction, I still see the legacy of those earlier decades, adults who underwent primary repair as children and now present with complex nasal deformities requiring cleft rhinoplasty or revision surgery.

Modern advances in imaging, surgical planning, and tissue engineering are allowing us to restore both form and function with a level of precision that was previously impossible.

The Evolution of Cleft Care

In the past, cleft lip and palate procedures were carried out by general or oral surgeons, ENT specialists, and plastic surgeons alike.

There were no formalised training pathways or multidisciplinary structures. As a result, outcomes varied widely.

By the early 1990s, growing evidence around speech, breathing, and facial development outcomes prompted significant NHS reform.

The Clinical Standards Advisory Group (CSAG) recommended the centralisation of cleft services, a landmark change that has improved surgical consistency and long-term results for patients born with cleft conditions.

However, for many adults who had surgery before these reforms, residual nasal asymmetry, airway restriction, and scar-related differences remain common.

These patients now seek specialist cleft rhinoplasty, a highly complex procedure that aims to correct both aesthetic imbalance and functional breathing difficulties.

Technology in Cleft Rhinoplasty: From Intuition to Innovation

Modern cleft rhinoplasty combines artistry with engineering.

The nose is a three-dimensional, asymmetrical structure, already challenging to reshape in standard rhinoplasty, but even more so in post-cleft cases, where anatomy has been altered by scarring and prior surgery.

Today’s technology-driven approach allows surgeons to plan, predict, and perform with remarkable accuracy:

• 3D imaging and simulation enable precise preoperative analysis of nasal asymmetry, airway dimensions, and tissue volume. This digital mapping forms the blueprint for each stage of correction.
• Virtual surgical planning (VSP) and 3D-printed models allow surgeons to visualise deformities from multiple angles and even practice or plan graft placement before entering the theatre.
• High-resolution endoscopic systems enhance intraoperative visualisation, particularly when addressing internal nasal valve collapse or septal deviation (issues common in post-cleft patients).
• Cartilage grafting techniques, supported by imaging guidance, now allow reconstruction of nasal tip and dorsum architecture with millimetre precision.

Together, these innovations mean that cleft rhinoplasty today is not only safer but capable of delivering both structural and aesthetic harmony.

The Role of Imaging and Functional Assessment

Functional outcomes are central to every cleft rhinoplasty.

Advanced airflow analysis tools, such as acoustic rhinometry and rhinomanometry, are now routinely used to measure nasal obstruction and guide surgical planning.

Intraoperative navigation systems, once limited to neurosurgery, are increasingly being adapted for facial reconstructive work.

These technologies help align surgical manoeuvres to digital plans in real time, minimising error and improving postoperative symmetry.

Postoperative imaging and AI-assisted outcome tracking are also emerging, enabling long-term data collection that can refine future cleft care protocols.

Challenges in Revision Surgery

Revision cleft rhinoplasty remains one of the most technically demanding operations in facial plastic surgery.

Scar tissue, distorted cartilage, and limited donor graft material complicate every step.

For these patients, precision is everything.

The introduction of patient-specific graft templates, high-definition magnification, and digital photography comparison software allows for exact replication of preoperative planning.

Ultimately, technology amplifies, rather than replaces, the surgeon’s judgment. It provides clarity, predictability, and a platform for creativity rooted in data.

Restoring Confidence, Function, and Identity

Cleft rhinoplasty is more than reconstruction, it’s restoration.

For patients, the procedure often represents the final chapter in a lifelong journey. Advanced technology helps us not only correct anatomy but also restore identity and confidence.

Every successful reconstruction blends innovation with empathy.

By integrating imaging, navigation, and biologic principles, surgeons can deliver results that honour both the science of precision and the art of human expression.

Looking Forward

The future of cleft rhinoplasty lies in the integration of AI-assisted surgical planning, machine learning outcome prediction, and biologic tissue regeneration.

These tools will allow us to anticipate healing patterns, personalise graft design, and potentially engineer tissue tailored to the individual patient.

For those of us working at the intersection of aesthetic and reconstructive surgery, the goal remains the same: to refine, restore, and rebuild, not only appearance but also comfort, function, and confidence.

Author Bio

Mr Shaheel Chummun is a Consultant Plastic, Reconstructive and Aesthetic Surgeon and Co-Founder of Emendo Surgical Group, specialising in facial surgery, body and breast surgery as well as specialist expertise in cleft rhinoplasties.

He is passionate about precision, safety, and patient-centred innovation in reconstructive care.