1. Long-term outcome of simultaneous repair of bilateral cleft lip and nose (a 15 year experience) 
Tatsuo Nakajima, Hisao Ogata, Hisashi Sakuma 
British Journal of Plastic Surgery 
Volume 56, Issue 3, Pages (April 2003)
DOI: /S (03)

2. Figure 1
Our initial operative procedure (first eight years). (A) Skin design is small triangular flap method. (B) A triangular flap at the columellar base is rotated 90° to create well defined columella-Labial angle. (C) Nasal dome cartilages are sutured together and lifted to opposite lateral cartilage through rim incisions. (D) Lip and nose repair is completed.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

3. Figure 2
(A) Patient with bilateral symmetric complete cleft lip and palate. Operation is performed 50 days after birth. (B) Seven years postoperative shape of Cupid's peak looks like a mountain (frontal view). (C) Profile, columella base is shifted caudally. At the age of 12 years, he underwent red lip revision and base of columella is moved cranial position using VY plasty. (D) 15 years after primary lip and nose operation (frontal view). (E) Profile.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

4. Figure 2
(A) Patient with bilateral symmetric complete cleft lip and palate. Operation is performed 50 days after birth. (B) Seven years postoperative shape of Cupid's peak looks like a mountain (frontal view). (C) Profile, columella base is shifted caudally. At the age of 12 years, he underwent red lip revision and base of columella is moved cranial position using VY plasty. (D) 15 years after primary lip and nose operation (frontal view). (E) Profile.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

5. Figure 3
(A) Patient with complete bilateral symmetric cleft lip and palate. Primary lip and nose repair is performed by triangular flap method at 1 month. At the age of eight, he underwent lip revision without nose correction. (B) 13 years after the primary operation. (C) Profile.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

6. Figure 4
(A) Deviated premaxilla. (B) Bandage traction for moving the maxilla toward the center. (C) Two weeks after the traction.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

7. Figure 5
(A) Design for repair of bilateral symmetric complete cleft lip. (B) Distance resulting suture lines are 4 mm. (C) Red lip of prolabium is used to cover the oral vestibule (flap A). Cleft margin of lateral red lip are sutured zig-zag fashion to form the oral vestibule (flap B). Muscle suture is limited upper half of the white lip. (D) Tension reducing suture of the white lip.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

8. Figure 6
Nose correction. (A) Inverted trapezoid suture plus cartilage lifting. (B) Inverted trapezoid suture is placed at four point.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

9. Figure 7
(A) After the lip closure. (B) After the nose correction. (C) Wound surface is covered by clear polyurethane tape. (D) This sleeved long retainer is inserted into the nostril and fixed to the dorsum of the nose. It prevents pressure sores after this fixation. (E) Sleeved long retainer.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

10. Figure 8 Design for repair of bilateral asymmetric complete cleft lip.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

11. Figure 9
(A) Patient with bilateral complete symmetric cleft lip and palate. (B) Seven years postoperative (frontal view). (C) Worm's eye view. (D) Profile.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

12. Figure 10
(A) Patient with complete bilateral symmetric cleft lip and palate. (B) Seven years postoperative (frontal view). (C) Worm's eye view. (D) Profile.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

13. Figure 11
(A) Patient with complete bilateral asymmetric cleft lip and palate. (B) Seven years postoperative (frontal view) vertical scar above the vermillion is visible. (C) Worm's eye view. (D) Profile.
British Journal of Plastic Surgery  , DOI: ( /S (03) )

14. Figure 12
(A) Patient with complete bilateral asymmetric cleft lip and palate. (B) Six years postoperative (frontal view). (C) Worm's eye view. (D) Profile.
British Journal of Plastic Surgery  , DOI: ( /S (03) )