Dermofat Graft as a Dual Solution: Lip Revision and Cleft Rhinoplasty in Secondary Cleft Surgery

Abstract

Introduction: Cleft lip and palate remain among the most common congenital craniofacial anomalies. Secondary deformities frequently require additional surgery due to scarring, asymmetry, and cartilage deficiency. Dermofat grafting has re-emerged as a promising reconstructive option, offering stable volume, natural contour, and lower donor-site morbidity compared to traditional grafts or implants.

Case Illustration: An 8-year-old girl with a history of bilateral cleft lip repair and alveolar bone grafting presented with lip asymmetry, vermilion retraction, coloboma, and nasal deformity, resulting in aesthetic concerns and psychosocial impact. The patient underwent single-stage secondary lip revision and cleft rhinoplasty. Lip revision followed Mulliken’s technique with scar and coloboma excision, orbicularis oris release and reorientation, and white-roll augmentation using a dermofat graft harvested from the gluteal fold. Cleft rhinoplasty was performed using Tajima’s reverse-U incision, with repositioning of the lower lateral cartilages, and dermofat graft placement along the dorsum and tip.

Discussion: Dermofat grafting provided durable soft-tissue volume and enhanced contour, addressing vermilion asymmetry, white-roll deficiency, and nasal projection. This single-stage approach reduced donor-site morbidity, minimized the need for staged procedures, and offered psychosocial benefits by improving facial aesthetics during critical developmental stages.

Conclusions: Dermofat grafting is a safe, versatile, and cost-effective autologous option for secondary cleft lip and nasal reconstruction. It represents a practical strategy in resource-limited settings, while offering both aesthetic and psychosocial outcomes.