Stephen B. Baker, MD, DDS, FACS

Professor and Program Diector

Department of Plastic Surgery

Georgetown University Hospital



Cleft lip-follow up one week after surgery for suture removal

Cleft palate-follow-up three weeks after palate repair

Alveolar bone graft-follow three weeks after surgery

WHAT TO EXPECT          

Right after surgery your child may be fussy or asleep.  You may think that he or she looks so different since you became                                                                                      accustomed to seeing the cleft.   You may see bruising and/or swelling of the face, around the lip and nose.  Sometimes the remains of a brown or yellow soap is on the face.  This will be washed off soon after surgery.  Also, there may be a little                                                                            bloody discharge from the sutured area and the nose.

Expect changes in your child’s sleeping, eating, and playing routine after surgery.

For 2 weeks after surgery your child may need extra attention and understanding.  Remember that this situation is temporary                                                                               and that his or her regular routine will return. 

 Don’t worry about spoiling your child during this time.

 After cleft palate repair, or maybe some bleeding through the nose. This is normal.

After bone graft there may be some hip discomfort. Activity is limited as tolerated however the patient is instructed  to avoid a bathtub for approximately 10 to 14 days.


 Cleft lip patients will usually go home with after surgery.

Cleft palate patients will stay until they are able to take fluids by mouth and control their pain with oral medications. This typically takes two days.

Alveolar bone graft patients usually go home the next day.


Your child’s lip has been repaired with many layers of sutures and a layer of tissue glue over the skin.  The sutures will be removed in the office 5-7 days after surgery.  Do not put any antibiotic ointment on the lip because it will dissolve the tissue glue.  Your doctor will tell you if and when antibiotic ointment should be used.  The tissue glue seals the wound to minimize crusting. If the tape over the sutures becomes loose, then use any medical tape to hold the ends down until seen in the doctor’s office.  Your surgeon will tell you how to take care of the wound at the time of suture removal. A small amount of bloody discharge  from the sutured area  is normal.  If a large amount of blood occurs, call your doctor. 

 There is typically no wound care necessary for alveolar bone graft or cleft palate operations.


Antibiotics are not used routinely postoperatively.  A liquid pain medicine may be used for pain control.  A prescription will be given to you before hospital discharge.  Irritability related to pain should improve in about 3 days

RESTRAINTS-cleft lip and palate only

Your child should wear No-Nos for three weeks postop.  Avoid letting anything hard and/or sharp near the sutured area.  Teach other children not to put anything near your child’s mouth.  Arm restraints may be removed during bathing for a short time, however, close supervision is needed.  Throughout the day, check your baby’s arms for skin irritation and circulation.  Baby powder may ease any irritation that occurs.  Notify your doctor is it does not go away.   

 Patients who are adopted typically older and therefore do not No nose after surgery.


Careful positioning is required so that he does not rub his face and damage the sutured areas.  Baby may sleep on his/her back avoid                   rubbing the sutures.  You may prefer keeping baby in an infant car seat or baby swing.  Sometimes elevating the head of the bed will reduce the  swelling.  When carrying your baby, make sure that you do not bump the   lip area on anything or rub the face against your shoulder.  Facing your baby away from you will help prevent accidents.    


After lip repair:  resume normal feeding, whether that is bottle, breast.  The baby may use pacifier. 

You may need to feed your child more often as the soft diet may not satisfy their hunger as a regular diet with solid foods.

Drooling may be seen 1-2 weeks after surgery.  This is normal.  Offer liquids frequently to replace fluids lost. 


 Use stuffed, soft animals without button eyes. 


During routine office hours contact (202)444-9302.  After hours call the Georgetown Hospital operator and have them page the plastic surgery resident on-call. Swelling is normal and will take months to completely resolve, but the majority of the swelling should go down after several weeks.

Fevers less than 100.5 degrees are not uncommon after surgery.  If a fever persists beyond 3 days or is greater than 100.5 degrees, call your doctor    to let him know.  Do not take oral temperature. 

Call your doctor immediately if your child develops:  excessive swelling, excessive redness, heat, fever, severe pain, drainage (green or yellow), red streaks, unusual bleeding, poor feeding and fewer than 6 wet diapers per day.  For unknown reasons, it is                                                                   possible that the wound will separate and need to be repaired at a later date. This is extremely rare.  Typically, the baby will have excellent surgical results.  

Information on scarring after cleft lip repair

The scar progresses through a maturation process.  It may appear red and thick by the third week after surgery, but will continue to improve with time.  As the scar matures, the lip may contract a little.  This is no cause for concern.  The scar will relax over time and the lip will return to its normal position.  After six weeks or so, the scar will begin to mature and will continue to do so for the next 4 months.  It will soften and the redness will go away.  Some children have scars that take a little longer to mature.

Eventually, most scars become a soft flat white line.  After surgery avoid the sun and tanning.  The sun will increase the redness and firmness of the scar.  The scar will always be present but should blend well into the normal skin creases of the lip and not be too noticeable. 

The only topical antiscar agent that has been shown to be effective is topical silicone gel. Studies have shown Mederma and vitamin E do not help scars and vitamin E has actually shown to result in adverse skin reactions. 

Hypertrophic scar:  scars where the redness and firmness do not go away but the scar always remains within the area of the original surgery.  The doctor may use intra lesional steroids or massage to help this type of scar.

Begin massaging the scar approximately 4 weeks after surgery. This can be done by gently moving the fingers over the scar during feeding or other times in the baby is sleeping. Sometimes it helps to pull up the Vaseline on the fingertip to smooth the rubbing action and cause less discomfort to the child.