Cleft lip and palate repair

What is cleft lip and palate repair?

A cleft is a gap that happens when parts of a baby's face and mouth do not fully join during early pregnancy. A cleft lip is a gap in the upper lip; a cleft palate is a gap in the roof of the mouth. A baby can have one or both, on one or both sides. It is one of the most common conditions a baby can be born with, and it is no one's fault.

In the UK, cleft care is not a one-off cosmetic operation. It is a long-term pathway run by specialist NHS cleft teams. There are nine NHS cleft services across the UK, each with a multidisciplinary team (MDT) — including cleft surgeons, a specialist nurse, speech and language therapists, orthodontists, paediatric dentists, audiologists (hearing), and clinical psychologists — who support a child and family from before birth, through childhood, and into adulthood.

Surgery is a central part, but only part, of this care. The first operations repair the lip and the palate in infancy. Over the years, a child may also need help with feeding, hearing (the palate affects the ear), speech, the position of teeth and jaws, and sometimes further surgery in later childhood or as a young adult. The goals are a well-functioning palate for speech and eating, good hearing, healthy teeth, balanced facial growth, and a natural appearance.

Types & techniques

There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.

Options at a glance

These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.

Preparing for your surgery

• If the cleft is found at the 20-week scan, a cleft nurse specialist usually contacts the family before birth to explain the pathway and offer support.
• Before the baby's surgery, the team checks the baby is fit and well and explains the operation and aftercare.
• Feeding support is arranged early — special bottles or teats help many babies feed well before and after surgery.
• Tell the team about any other health concerns, as a cleft is sometimes part of a wider syndrome that is screened for.
• Plan for time off and support at home, as feeding and settling a baby after surgery takes extra care.
• Ask about pain relief, feeding after the operation, and arm splints sometimes used to stop the baby touching the repair.
• Make sure newborn hearing screening and any planned hearing tests are kept up, as the palate affects the ears.

What happens

Cleft surgery is carried out by a specialist cleft surgeon under general anaesthetic. For a lip repair, the surgeon carefully realigns the muscle, skin and lining of the lip — and often the base of the nose — and closes it with fine stitches to create a balanced lip. This commonly takes around one to two hours.

For a palate repair, the surgeon closes the gap in the roof of the mouth in layers and repositions the muscles so the palate can lift and seal for speech and feeding. This usually takes around two hours. Grommets may be placed in the ears during the same anaesthetic if hearing is affected.

Afterwards the baby is cared for on a children's ward, usually for a night or two. Feeding is restarted carefully, pain relief is given, and the team checks the repair before discharge. Soft arm splints are sometimes used for a short time to stop the baby rubbing the stitches.

Is this operation right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Anaesthetic choices

The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.

The biggest things to understand are that cleft care is a long journey, not a single fix, and that some children need more than one operation — for the palate to seal well enough for speech, for a small hole (fistula) that can form, or to refine the lip, nose or jaw as the child grows. Hearing must be watched closely because the palate affects the ears. The NHS cleft team plans and monitors all of this; ask them what to expect at each stage and what support is available for feeding, speech and hearing.

Published figures to discuss

Outcomes depend on the type and severity of the cleft, the child's growth and the stage of care, so single figures are not very meaningful and the team will give individualised advice. Some children need further surgery for the palate to seal well for speech, or for a small hole (fistula) that can form, and these are best discussed in the child's specific context rather than as fixed percentages.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

Recovery — what to expect, and when

After each operation there is a short recovery while the baby or child heals and feeding settles. But the wider picture is years of regular follow-up by the cleft team, watching speech, hearing, teeth and facial growth and stepping in when needed.

• Swelling and a healing scar on the lip in the first weeks
• Temporary changes to feeding while the repair settles
• A baby who is unsettled for a few days after surgery
• Episodes of glue ear and changing hearing during childhood
• Speech that develops with support and is checked at set ages

Aftercare

• Follow the team's feeding advice closely after surgery, using the recommended bottles or teats.
• Give pain relief as advised and keep the baby calm and comfortable.
• Keep fingers, dummies and hard objects away from the healing lip or palate.
• Use any prescribed wound care and keep the lip repair clean as directed.
• Keep all hearing, speech and dental appointments, even when things seem fine.
• Watch for signs of infection or feeding difficulty and contact the team if worried.
• Attend the regular cleft-team reviews that track speech, hearing, teeth and growth.
• Ask about psychological support for the child or family if it would help at any stage.

• Recommended feeding bottles/teats and feeding plan ready
• Pain relief and any prescribed wound care to hand
• Soft arm splints if the team has advised them
• Time off and support at home for after the operation
• Hearing, speech and dental appointments noted
• Cleft team's contact number saved
• Knowledge of warning signs that need urgent help

Scars and how they heal

Lip repair leaves a scar on the upper lip and at the base of the nose. Skilled cleft surgery places this along the natural lines of the lip so it is as discreet as possible, and the scar usually fades and softens over the first year and beyond, though it does not disappear entirely. The lip and nose can be refined with further surgery in later childhood or as a young adult if needed. Palate repair is inside the mouth and leaves no visible scar.

⚠ Get urgent help if…

• Difficulty breathing after palate surgery — seek urgent help
• The baby not feeding or becoming dehydrated (fewer wet nappies, sunken soft spot, no tears)
• Bleeding from the mouth or lip that does not settle
• Spreading redness, swelling, heat or discharge at the lip repair (signs of infection)
• A high temperature or a baby who is floppy, very drowsy or hard to rouse
• The repair appearing to come apart or a new hole appearing in the palate

Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your surgeon gives you.

Results & realistic expectations

Modern cleft surgery gives most children a well-functioning palate for speech and eating, good hearing with monitoring, and a natural-looking, balanced lip and nose, though a fine scar remains and some children need further surgery along the way. Results are judged over years, not weeks, because speech, hearing, teeth and facial growth all develop with time. The NHS cleft team measures and supports these outcomes throughout childhood. No surgeon can promise a perfect, single-operation result, and honest teams set expectations stage by stage.

A repaired lip and palate are lifelong repairs, but a cleft affects growing structures, so some children need further treatment as they develop — for example orthodontics, a bone graft, speech surgery, or jaw or nose surgery in the teenage years. Most people are discharged from the cleft team as young adults with a good, stable result, and can return to the NHS cleft service later through their GP or dentist if a cleft-related concern arises.

Combining with other procedures

Cleft care brings together many treatments over time: surgery, feeding support, hearing care (including grommets), speech and language therapy, orthodontics and dentistry, and psychological support, all coordinated by the cleft team. Some operations are deliberately timed together — for example grommets during palate surgery — while others, such as the bone graft or jaw surgery, are timed to a child's dental and facial growth.

Follow-up & long-term care

Follow-up is built into the NHS cleft pathway, with set review points (for example full team assessments around ages 5, 10 and 15) and regular speech, hearing and dental checks in between. The team decides if and when further surgery is needed and supports the family throughout. Children are usually discharged as young adults, with a clear route back if a cleft-related issue comes up later.

• Keep up regular dental care and orthodontic reviews as the teeth develop
• Attend scheduled hearing and speech assessments through childhood
• Follow the cleft team's plan for any later surgery (bone graft, speech, jaw or nose)
• Return to the NHS cleft service via a GP or dentist if a cleft-related concern arises in adulthood

Revision and secondary surgery reality

• Some children need further palate surgery if speech shows the palate is not sealing well enough.
• A small hole (fistula) in the palate can form and sometimes needs another operation.
• Lip and nose refinement is commonly done in later childhood or as a young adult.
• Jaw (orthognathic) surgery may be needed once facial growth finishes if there is a marked underbite.

Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.

What good aftercare looks like

• Coordinated care by a named NHS cleft multidisciplinary team with a clear point of contact.
• Structured feeding support before and after each operation.
• Scheduled speech, hearing and dental reviews with timely action when problems arise.
• Access to clinical psychology support for the child and family throughout the pathway.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• In the UK this care is NHS-funded; the points below would only apply to any private element
• The surgeon's fee and the type and complexity of each operation
• General anaesthetic and the theatre or facility fee, with a children's inpatient stay
• The many years of multidisciplinary input — speech therapy, orthodontics, dentistry, hearing care, psychology
• Any later procedures such as a bone graft, speech surgery or jaw or nose surgery
• Long-term follow-up appointments across childhood

• Confirmation of whether care is being provided within the NHS cleft pathway
• If any private element: the surgeon's fee and the facility/theatre fee
• Paediatric anaesthetic fee and any inpatient stay
• Which multidisciplinary services (speech, hearing, orthodontics, psychology) are included
• How later-stage procedures and follow-up are arranged and funded
• Who to contact for problems and how aftercare is provided

On the NHS? In the UK, cleft lip and palate care is specialist NHS care delivered by regional cleft teams from before birth into adulthood; it is a medical pathway rather than a private cosmetic procedure.

You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a surgeon safely

• Check your surgeon is on the GMC Specialist Register for this area.
• Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
• You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
• Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including aftercare and any revision — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good surgeon will welcome every one of these.

• What type of cleft does my child have, and what does our care pathway look like over the years?
• When will the lip and palate be repaired, and what does each operation involve?
• How will feeding be supported before and after surgery?
• How and when will hearing and speech be checked, and what help is available?
• Is my child likely to need a bone graft or further surgery later, and when?
• What psychological and practical support is available for our family?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the surgeon who carries out my operation, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this operation not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified surgeon for cleft lip and palate repair

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Cleft lip and palate CLAPA (Cleft Lip and Palate Association) — About NHS cleft services CLAPA — Cleft treatment timeline CLAPA — How is cleft treated? NHS England — Cleft lip and palate services (specialised commissioning)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.