Cleft Lip & Cleft Palate
Common questions from parents about cleft conditions, diagnosis, and treatment.
Cleft lip is often detected during a routine prenatal ultrasound, typically between 18–22 weeks of pregnancy. Cleft palate alone (without cleft lip) is more difficult to detect on ultrasound and may not be diagnosed until after birth. If a cleft is detected prenatally, we encourage families to schedule a consultation so we can discuss the treatment plan and answer questions before the baby arrives.
Cleft lip repair is typically performed around 3–6 months of age, following the traditional "Rule of 10s" — the baby should be at least 10 weeks old, weigh at least 10 pounds, and have a hemoglobin of at least 10 g/dL. Some centers perform nasoalveolar molding (NAM) before surgery to align the cleft segments and improve surgical outcomes. Dr. Chaiyasate will determine the optimal timing based on your child's individual health and anatomy.
Cleft palate repair is typically performed between 9–18 months of age, ideally before the child begins developing speech (around 12 months). Early repair helps ensure normal speech development. The timing balances the need for early repair (for speech) with allowing the palate to grow sufficiently for a successful closure.
Most children with cleft lip and/or palate require a series of surgeries and treatments over time. A typical timeline includes: • 3–6 months: Primary cleft lip repair • 9–18 months: Cleft palate repair • 5–7 years: Speech surgery (if needed) — pharyngoplasty or pharyngeal flap • 8–12 years: Alveolar bone grafting (if the cleft involves the gum line) • Teenage years: Rhinoplasty (nose refinement) and possible jaw surgery (orthognathic surgery) Not all children need every procedure. Dr. Chaiyasate works with a multidisciplinary team to create an individualized treatment plan for each child.
Babies with a cleft lip only can often breastfeed successfully, though it may require some adaptation. Babies with a cleft palate (with or without cleft lip) typically have difficulty creating the suction needed for breastfeeding. Special bottles — such as the Pigeon bottle, Haberman feeder, or Dr. Brown's Specialty Feeding System — are designed for babies with cleft palate and allow feeding without suction. Our team includes feeding specialists who work with families from birth to ensure proper nutrition.
With timely palate repair and appropriate speech therapy, the majority of children with cleft palate develop normal or near-normal speech. About 20–30% of children may develop velopharyngeal insufficiency (VPI) — where the palate doesn't close completely against the back of the throat during speech, causing nasal-sounding speech. VPI can be corrected with secondary speech surgery (pharyngoplasty or pharyngeal flap). Our multidisciplinary team includes speech-language pathologists who monitor your child's speech development from an early age.
Cleft lip and palate result from incomplete fusion of facial structures during early pregnancy (weeks 4–12). In most cases, the exact cause is unknown — it is believed to be multifactorial, involving a combination of genetic and environmental factors. Risk factors include family history of clefting, certain medications during pregnancy (such as anti-seizure drugs), maternal smoking, diabetes, and folic acid deficiency. Having a child with a cleft does not mean parents did anything wrong.
There is a genetic component to clefting, but most cases occur in families with no history of cleft. If one parent has a cleft, the risk of having a child with a cleft is about 2–4%. If one child has a cleft and neither parent does, the risk for subsequent children is about 2–5%. If both a parent and a child have a cleft, the risk for subsequent children increases to about 10–15%. Genetic counseling is available for families who want to understand their specific risk.
Craniosynostosis
Questions about premature skull fusion, diagnosis, and surgical treatment.
Craniosynostosis is a condition in which one or more of the fibrous joints (sutures) between the bones of a baby's skull close prematurely, before the brain has fully grown. This can restrict brain growth, increase intracranial pressure, and cause an abnormal head shape. It affects approximately 1 in 2,000–2,500 live births.
Craniosynostosis is typically diagnosed by physical examination — an experienced craniofacial surgeon can often identify the characteristic head shape changes. A CT scan with 3D reconstruction confirms the diagnosis by showing which sutures are fused. In some cases, craniosynostosis is detected prenatally on ultrasound. Early diagnosis is important because treatment is most effective when performed in the first year of life.
There are two main surgical approaches: 1. Endoscopic strip craniectomy — A minimally invasive procedure performed through small incisions, typically done before 3–4 months of age. The fused suture is removed endoscopically, and the baby wears a custom molding helmet for several months afterward to guide skull growth. 2. Open cranial vault remodeling — A more extensive procedure performed between 6–12 months of age. The skull bones are removed, reshaped, and repositioned to create a normal skull shape. This provides immediate correction without the need for a helmet. Dr. Chaiyasate will recommend the best approach based on your child's age, the type of craniosynostosis, and the severity of the condition.
Yes, untreated craniosynostosis can lead to increased intracranial pressure (ICP), which can affect brain development, vision (due to papilledema), and cognitive function. Even in cases where ICP is not elevated, the abnormal head shape can have significant psychosocial effects. Treatment is recommended for all cases of craniosynostosis.
Positional plagiocephaly (flat head syndrome) is a common condition caused by external pressure on the skull — from sleeping position, time in car seats, etc. It does NOT involve premature suture fusion and is NOT craniosynostosis. Positional plagiocephaly is treated with repositioning and sometimes a molding helmet, but does not require surgery. An experienced craniofacial surgeon can distinguish between the two conditions through physical examination and, if needed, imaging.
Craniofacial Syndromes
Questions about Apert, Crouzon, Treacher Collins, and other conditions.
Dr. Chaiyasate treats the full spectrum of craniofacial conditions, including: • Apert syndrome • Crouzon syndrome • Treacher Collins syndrome (mandibulofacial dysostosis) • Hemifacial microsomia (Goldenhar spectrum) • Pfeiffer syndrome • Saethre-Chotzen syndrome • Muenke syndrome • Pierre Robin sequence • Facial clefts (Tessier classification) • Fibrous dysplasia • And other rare craniofacial conditions Each condition requires an individualized, multidisciplinary treatment plan.
Children with craniofacial syndromes typically require multiple staged surgeries over many years. The exact number depends on the specific syndrome and severity. For example, a child with Apert syndrome may need: • Cranial vault remodeling in infancy • Midface advancement in childhood • Hand surgery for syndactyly (fused fingers) • Jaw surgery in adolescence • Rhinoplasty and other refinements Dr. Chaiyasate works with families to create a long-term surgical plan that addresses each issue at the optimal age, minimizing the total number of procedures while achieving the best outcomes.
A craniofacial team is a group of specialists who work together to provide comprehensive care for children with craniofacial conditions. The team typically includes: • Craniofacial surgeon (Dr. Chaiyasate) • Neurosurgeon • Pediatrician • Orthodontist/dentist • Speech-language pathologist • Audiologist • Ophthalmologist • Geneticist • Psychologist/social worker • ENT (otolaryngologist) • Anesthesiologist • Nurse coordinator This team approach ensures that all aspects of the child's care are coordinated and that each specialist's recommendations are integrated into the overall treatment plan.
Mohs Defect Reconstruction
Questions about facial reconstruction after skin cancer removal.
In many cases, reconstruction can be performed the same day as Mohs surgery or within a few days. Dr. Chaiyasate works closely with Mohs surgeons to coordinate the timing. Same-day reconstruction is ideal when possible, as the wound is fresh and the anatomy is undistorted. For complex cases requiring general anesthesia or staged procedures, reconstruction may be scheduled within 1–2 weeks.
All surgery produces scars, but Dr. Chaiyasate uses advanced techniques to minimize their visibility. Scars are placed along natural skin creases, facial subunit boundaries, and relaxed skin tension lines — where the eye expects to see natural transitions. Scars continue to mature and fade for 12–18 months after surgery. Scar management techniques (silicone sheets, sun protection, massage) further improve the final result. Most patients are very satisfied with the cosmetic outcome.
A skin graft is a piece of skin that is completely detached from its blood supply and transplanted to the defect site, where it must establish a new blood supply from the wound bed. Grafts are thinner and may have a different color or texture than surrounding skin. A flap is tissue that maintains its own blood supply (through a pedicle or reconnected blood vessels). Flaps provide better color and texture match, more bulk for contour restoration, and more reliable healing. Dr. Chaiyasate prefers flaps for most facial reconstructions because they produce superior aesthetic results.
Many Mohs reconstructions are completed in a single procedure. However, some techniques — particularly for larger defects — are staged (performed in 2–3 procedures): • Paramedian forehead flap (for large nasal defects): 2–3 stages over 3–6 weeks • Abbe cross-lip flap (for lip defects): 2 stages over 2–3 weeks • Complex reconstructions may benefit from a secondary revision procedure 3–6 months later for scar refinement or flap thinning Dr. Chaiyasate will discuss the expected number of procedures during your consultation.
Yes, facial reconstruction after Mohs surgery for skin cancer is considered a medically necessary reconstructive procedure and is covered by virtually all insurance plans, including Medicare and Medicaid. This is not cosmetic surgery — it is reconstruction after cancer treatment. Our office staff will verify your insurance coverage and obtain any necessary pre-authorizations before your procedure.
Microvascular Reconstruction
Questions about free tissue transfer and complex reconstruction.
Microvascular free tissue transfer (free flap surgery) involves transplanting tissue — which may include skin, fat, muscle, bone, or a combination — from one part of the body to another. The tiny blood vessels (arteries and veins, typically 1–3mm in diameter) are reconnected under a microscope to blood vessels at the recipient site. This allows reconstruction of complex defects that cannot be repaired with local tissue alone.
Microvascular free flap surgery typically takes 6–12 hours, depending on the complexity of the reconstruction. The procedure involves three main phases: (1) preparing the recipient site, (2) harvesting the flap from the donor site, and (3) connecting the blood vessels under the microscope and insetting the flap. Patients are under general anesthesia throughout the procedure.
In experienced hands, the success rate of microvascular free tissue transfer is 95–99%. Dr. Chaiyasate has performed over 3,500 microvascular cases and has been recognized with 6 ASRM Best Case and Best Save awards. Flap monitoring in the first 48–72 hours after surgery is critical — if a blood vessel clot is detected early, the flap can often be salvaged by returning to the operating room.
Recovery after microvascular surgery typically involves: • 5–7 days in the hospital for flap monitoring and recovery • Flap checks every 1–2 hours for the first 48 hours • Gradual increase in activity over 2–4 weeks • Return to normal activities in 4–8 weeks • Donor site healing over 2–4 weeks • Follow-up visits at 1 week, 2 weeks, 1 month, 3 months, and 6 months The specific recovery depends on the type of flap used and the location of the reconstruction.
General & Practical Questions
Insurance, appointments, preparation, and what to expect.
For your first consultation, please bring: • Photo ID and insurance card • Referral letter from your physician (if required by your insurance) • Any relevant medical records, imaging (CT scans, X-rays), or previous surgical reports • A list of current medications and allergies • A list of questions you'd like to ask • For children: bring the child's immunization records and growth charts • For Mohs reconstruction: the pathology report and photos of the defect from your Mohs surgeon The consultation typically lasts 30–60 minutes. Dr. Chaiyasate will examine the patient, review imaging, discuss the diagnosis and treatment options, and answer all questions.
Dr. Chaiyasate accepts most major insurance plans. Craniofacial surgery, cleft repair, and reconstruction after cancer removal are medically necessary procedures covered by insurance. Our office staff will verify your coverage and obtain pre-authorization before any procedure. Please call our office at (947) 274-8300 to verify your specific plan.
Preparing your child for surgery involves both practical and emotional preparation: Practical: • Follow all pre-operative instructions (fasting guidelines, medication adjustments) • Arrange for time off work — plan to stay with your child during the hospital stay • Prepare the home for recovery (soft foods, medications, comfortable sleeping area) Emotional: • For older children, explain the surgery in age-appropriate terms • Tour the hospital or surgical center if possible • Bring comfort items (favorite toy, blanket) to the hospital • Our team includes child life specialists who help children cope with medical procedures Dr. Chaiyasate's team will provide detailed pre-operative instructions specific to your child's procedure.
Dr. Chaiyasate is affiliated with: • Corewell Health (formerly Beaumont Health) — a leading healthcare system in Michigan • Trinity Oakland — providing comprehensive surgical services • Children's Hospital at Troy — specialized pediatric care for children with craniofacial conditions These affiliations provide access to state-of-the-art operating rooms, pediatric anesthesia teams, intensive care units, and multidisciplinary specialists.
Absolutely. Dr. Chaiyasate welcomes patients seeking second opinions and regularly provides them. A second opinion is especially valuable for complex craniofacial conditions, revision surgery, or when a patient has been told that nothing can be done. Dr. Chaiyasate's dual fellowship training and extensive experience allow him to offer treatment options that may not be available elsewhere. Many of his patients were told by other surgeons that their condition could not be treated — and Dr. Chaiyasate was able to help.
Yes, we offer telemedicine consultations for patients who are unable to travel to our office for an initial evaluation. This is particularly helpful for out-of-state patients, international patients, or families seeking a second opinion. During a virtual consultation, Dr. Chaiyasate can review photos, imaging, and medical records to provide an initial assessment and discuss treatment options. An in-person visit will be needed before any surgical procedure.
Still Have Questions?
Every patient's situation is unique. If you have questions that aren't answered here, we encourage you to schedule a consultation with Dr. Chaiyasate. He takes the time to thoroughly explain your condition and all available treatment options.
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