Plastic Surgery and a Child’s Smile

When most of us think of plastic surgery, we tend to think of nose jobs, breast implants, face-lifts, and tummy tucks. But plastic surgery does all that and more. Plastic surgery tackles reconstruction and repairs that go way beyond popular notions.

We will talk a bit about a remarkable non profit group called The Smile Train that provides plastic surgery for cleft plates and lips all over the world.

But first lets find out about cleft lips and palates and how cosmetic dentistry and plastic surgery works for these maladies.

Cleft lip or cleft palate result from tissues that form the upper lip or the roof of the mouth that fail to grow together. The cleft may be so pronounced that teeth are growing outside the mouth. Sometimes cleft lip and cleft palate occur together. No one is sure what causes them but the present theory is that a genetic predisposition combines with environment al factors–the mother smoking, for example-to cause a cleft.
Clefts seem to run in families, which would indicate a strong genetic component.

Depending on your source, cleft palate or cleft lip occurs in one in 500, 600, or 700 babies. Whatever the exact number, these statistics mean that allot of the world’s children have cleft lip or palate. Correcting these clefts isn’t done just for cosmetic reason, although children endure teasing and ostracism based on their disfigured appearance. Children with clefts have difficulty eating and drinking, have problems with their teeth, hearing, and speech, and, because they are teased and shunned, they have difficulty with normal psychological development. In the United States, plastic surgeons recommend a Cleft Team consisting of a plastic surgeon, a pediatrician, a dentist, a speech and language specialist, an eye, ear, nose, and throat specialist, a nurse, psychologist, social worker, and genetic counselor!

Plastic surgery repairs cleft lip by correcting the asymmetry it causes. One side of the mouth and nose does not match the other side. The surgery is performed when the baby is about 10 weeks old. The surgeon makes an incision on each side of the cleft from the mouth into the nostril. Then the outer portion of the cleft is pulled down and the muscles and skin pulled together to close the separation so that muscle function and normal lip shape are restored. The nostril deformity that is often associated with cleft lip may be repaired at this time or it may be done later.

The baby can leave the hospital in one to two days. She is sent home with non-aspirin pain medication and muscle restraints are applied to her elbows so that she can’t rub the area of her surgery. The scar initially gets bigger and redder and then fades to be almost invisible.

Plastic surgeons work on cleft palates when the infant is 9 to 18 months old and more able to tolerate a more extensive operation. The surgeon will make and incision along both sides of the cleft, moving tissue from each side to the center of the mouth or the mouth ridge. This provides enough length so that the child can eat and talk. At first an IV will be used to get liquids into the child. The ear, nose, and throat specialist may recommend that a small ventilation tube be put into the eardrum for proper drainage and airflow.

When the child is older, she may have further surgery to fine-
tune the shape and function of the lip, nose, gums, and palate.


In 1999, in China, two surgeons operated on a child with cleft lip. This was the start of the Smile Team; a group dedicated to eliminating cleft lip and cleft palate from the world. They say that children suffer, not because they have cleft lip or cleft palate but because their families are too poor to get plastic surgery for them.

Plastic surgeons from the United States and other countries volunteer their time and expertise in poor areas to do surgeries on clefts and to train local doctors to do surgeries. Areas of the United States are included. They have their most major efforts in China and in India because these are the two most populous areas in the world and therefore have the most children with clefts. China’s children have more clefts than is proportional to their population. For some reason, clefs are more common among Asians and Native Americans. Doctors in both countries are dedicated and eager to be trained to do plastic surgery on clefts.

The Smile Team has 10 principals:
1. Insure patient safely is our #1 priority
2. Focus exclusively on the problem of clefts
3. Foster self-sufficiency through free training and education
4. Provide free surgery for children who can’t afford it
5. Invest in research to find a way to prevent clefts
6. Embrace an interdisciplinary team approach
7. Leverage technology to accelerate learning results
8. Partner with other cleft organizations & share results
9. Operate the most cost-efficient cleft organization in the world
Work ourselves out of a job

Team Smile puts 100% of all donations into helping children. They are able to do this because the grants of the founding donors provide for their tiny staff of 11.

Hundreds of educational and training programs such as symposiums, clinics, training missions, and workshops are done. The Smile Team has also developed software training programs and has cleft education materials on the Internet. They support and partner with most of the world’s leading research efforts where the focus is on cause, prevention, and improving safety and quality of cleft treatments.

Here are some very interesting numbers:

1999 year Smile Train began
135,765 the number of children treated to date
25,005 children Smile Team will help this year
4,901 doctors Smile Team will train this year
$250 average cost per surgery
45 minutes to repair a one sided cleft lip
2,975 Smile Team donors
11 Smile Team employee
189 partners and projects
3,580 in Smile Train programs
32 countries that have Smile Teams programs

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