Bilateral Cleft Lip Repair With and Without Primary Rhinoplasty: Comparing Two-Year Aesthetic and Anthropometric Outcomes.

ObjectiveTo compare aesthetic outcomes in patients with bilateral cleft lip treated with concurrent primary rhinoplasty (PR) versus non-primary rhinoplasty (NPR), using layperson and anthropometric assessments.DesignRetrospective review of patients undergoing bilateral cleft lip repair between 2008 and 2024.SettingSingle tertiary care institution.Patients/ParticipantsSeventy-five children (mean age = 6.1 ± 3.6 months) who underwent bilateral cleft lip repair.InterventionsPR performed in 55 patients (73.3%) and non-PR in 20 patients (26.7%). Preoperative cleft severity was graded with the Bilateral Cleft Lip Severity Index (BCLSI; grades 1-3). Presurgical nasoalveolar molding (NAM) and nasal stenting were also evaluated.Main Outcome MeasuresLayperson perception surveys (pairwise comparison and Likert scale) and anthropometric analyses of nasal appearance.ResultsLower BCLSI scores predicted superior aesthetic ratings. Lip adhesion after NAM failure correlated with inferior ratings (p < .001). Overall, PR did not yield superior nasal appearance compared with NPR. In subgroup analysis, PR patients in the BCLSI3 group had higher layperson scores (p = .036). PR with nasal stenting ≥21 days was associated with greater Goode's ratio (p < .001). Increased columellar-labial angle correlated with inferior nasal appearance (p = .029).ConclusionsThese data highlight the impact of presurgical NAM on oronasal outcomes and preoperative cleft severity to guide personalized surgical approaches in this patient population.