Instructions after Cleft Lip Repair

Important information about cleft lip repair:

During cleft lip repair surgery, the surgeon will close your child’s cleft lip and attach the major muscles within the upper lip. The repair will leave a scar on the lip that will fade, but not disappear, with time.

Some children are treated with nasoalveolar molding (NAM) before surgery to narrow the cleft. Some wide clefts will need to be repaired with 2 surgeries. The first surgery is called a lip adhesion. This pulls the tissue into better position for the final repair, which is done a few months later.

Appearance

When you see your child for the first time after surgery, you may think they look different. You have become used to the cleft which is now repaired with small stitches. We may use blue sutures that need to be removed by the surgeon in the office about 5 days after surgery, or we may use sutures that dissolve on their own in about 2 weeks.

There may be bruises on your child’s face and swelling around the lip and tip of the nose. Sometimes there is some yellow or brown soap on your child’s face, but this will be washed off soon after the surgery. There is usually a small amount of bloody drainage from the lip during the first day.

We may place a small piece of plastic tubing in one or both nostrils at the time of lip repair, called stents or conformers. They will stay in place for up to six weeks after surgery and then removed in the office by the surgeon. The purpose of these nasal stents is to help the nasal tip keep its shape.

Patient instructions after surgery:

Drinking and eating

  • Your child may be fussy or asleep after the surgery. When your child wants to eat, they can eat the same way as before surgery. Babies may breastfeed or bottle feed after surgery. Older children may drink from a cup. When your child is ready, they can start eating a soft diet.

  • If your child uses a pacifier, ask your surgeon when it is safe to use again after surgery.

Safety

  • Keep hands and toys away from your child’s mouth.

  • Your child will have to wear No-Nos® (elbow splints) or a CozeeCoo® wearable blanket at all times for 2 weeks after surgery to keep their fingers away from their mouth. Remove the No-Nos every 2 hours while your child is awake. Bend their elbow back and forth to ensure range of motion. The No-Nos should not be wrapped too tight. Look at your child’s arm skin often to make sure there is no redness from the No-Nos. You may remove the No-Nos when you are watching your child closely.

Lip care with skin stiches

  • Gently clean the stitches several times a day with water especially after feeding. It is important to prevent “crusts” from forming and to keep the area free of infection. A nurse will show you how to take care of your child’s lip before going home. Although it may make you nervous at first, you will be able to do this easily. Simply take warm water and a clean washcloth or gauze to gently wipe the area.

  • Your child may have Steri-strips™ (small pieces of paper tape) over the incision. Leave these in place until your surgeon removes them or they fall off on their own. If your child does not have Steri-strips you may apply a thin layer of antibiotic ointment to the incision with a cotton swab 2 or 3 times a day. If your child does have Steri-strips in place, you should wait until these are removed or fall off to apply the antibiotic ointment.

  • Keep your child away from direct sunlight to the lip for several months after the surgery, as sun exposure can affect the healing of the scar.

Care of the nasal conformer

If your child has a nasal conformer, wipe around the conformer/nostril with water and a cotton swab when you are doing lip care. Apply a thin layer of antibiotic ointment around the bottom of the conformer, near the lip. Check to make sure the skin in between the nostrils does not look discolored. If you have questions or concerns about the conformers, contact your surgical team.

Pain management

  • Typically, cleft lip repair is not a very painful surgery, and your child will only need over-the-counter pain medicines. You may give your child acetaminophen (Tylenol®) liquid every 4 hours as needed for pain. Follow the dosing instructions on the label.

  • During surgery, we will place long-acting pain medicine in the surgical sites to make these areas less painful after surgery. This medicine lasts 6 to 12 hours after surgery. Your child may have numbness and tingling at the surgical sites because of this medication.

Discharge

  • When you have learned lip care and your child is feeding well by mouth, you may take your child home. This may occur on the day of surgery or the day after, depending on your child’s medical history.

  • Make a follow-up appointment for 4 to 5 days after the surgery to have the stitches removed. If dissolvable sutures are used, your child will be seen in 2-4 weeks.

Complications

As in any surgery, rare problems can occur which include bleeding, infections, breakdown of the repair, and reactions to medicine. At times, for unknown reasons, the lip repair will pull apart a couple of days after the surgery and will need to be repaired again a few months later. These problems are uncommon, and most of the time lip repair surgery has positive results.

Contact your CHOP surgical team with questions, concerns or if:

  • Your child has signs of dehydration, including:

  • They will not drink. We expect children to have slightly decreased oral intake on the day of surgery, but they typically go back to normal feeding patterns within 24 hours of surgery.

  • They are wetting fewer diapers or urinating less often. Infants under 6 months of age should not go longer than 4 to 6 hours without urinating.

  • They are difficult to soothe or appear weak

  • Producing few or no tears when crying

  • Your child has difficulty breathing or has long pauses of breathing when sleeping

  • Your child has pain that does not get better after taking acetaminophen, ibuprofen and oxycodone

  • Your child has signs of infection:

  • Temperature is 101ºF (38.3° C) or higher under the arm or 102ºF (38.8° C) or higher rectally

  • Swelling or redness on lip

  • Yellow/green drainage from lip incision

  • Purple or deep red discoloration on the skin between the nostrils if your child has a nasal stent

Division of Plastic, Reconstructive and Oral Surgery

Monday through Friday, 8 AM -5 PM

215-590-2208

Evenings, weekends, and holiday, call 215-590-1000 and ask to speak with the plastic surgery resident or fellow on call

Reviewed March 2026 by Kelsey Reilly, CRNP, Nancy Folsom, RN