Adult Secondary Cleft Lip Revision: Operative Patterns and Exploratory Patient-Reported Outcomes.

BACKGROUND

Residual cleft lip deformities may persist into adulthood despite childhood repair and contribute to aesthetic, functional, and psychosocial concerns. Adults undergoing isolated cleft lip revision remain underreported. This study characterized operative patterns, patient motivations, clinical outcomes, and exploratory patient-reported outcome trends after isolated secondary cleft lip revision.

METHODS

A retrospective cohort study was performed of adults undergoing isolated secondary cleft lip revision between 2020 and 2024 at two tertiary craniofacial centers. Patients undergoing concomitant rhinoplasty or other cleft procedures were excluded. Demographic, operative, clinical, and patient-reported outcome data were reviewed retrospectively. PROM analyses were limited to paired responders because follow-up timing and questionnaire completion were nonstandardized.

RESULTS

One hundred eight adults underwent isolated cleft lip revision (mean age, 22.8 years). Scar excision was performed in 80.6%, orbicularis reconstruction in 59.3%, philtral reconstruction in 47.2%, and vermilion revision in 35.2%. Educational, occupational, or marital transition concerns were the most common motivation for revision (41%). No complications requiring hospital admission or reoperation occurred. Residual irregularities remained present in 31% of patients, most commonly vermilion notching and hypertrophic scar formation. Among paired PROM responders, postoperative scores were generally higher across psychosocial and appearance-related domains, although interpretation is limited by incomplete follow-up and nonstandardized assessment intervals.

CONCLUSIONS

Adult secondary cleft lip revision often required combined reconstruction of scar, muscular, vermilion, and philtral deformities. Because reconstructive maneuvers were commonly combined, technique-specific outcome effects could not be determined. Among patients with available longitudinal follow-up, postoperative PROM scores were generally higher across psychosocial and appearance-related domains.