Predictive Factors for Lip Revision Following Unilateral Cleft Lip Repair
Alexander M. Kolodychak, B.S.1, Albert S. Woo, M.D.2
1Warren G. Alpert Medical School of Brown University; 2Department of Plastic Surgery, Rhode Island Hospital
Background & Aims
The primary goal of unilateral cleft lip repair is to achieve functional restoration and long-term aesthetic symmetry1. Despite advancements in surgical techniques, a significant subset of patients requires secondary revision surgery to address persistent asymmetry, functional impairment, or aesthetic dissatisfaction2. Currently, there is a lack of objective, early-postoperative data to help surgeons predict which patients will eventually require these secondary procedures. Identifying early anthropometric red flags and surgical risk factors is essential for refining primary repair strategies and improving patient counseling regarding the likelihood of future surgeries3. This study seeks to bridge that gap by utilizing digital morphometry and machine learning to identify specific clinical and surgical predictors of lip revision.
Methods
•Study Design: Retrospective review of 139 patients treated by a single surgeon.
•Data Collection: Standardized frontal photographs were captured at specific intervals: preoperative, immediate postoperative, 1-month postoperative, and long-term (minimum 1-year follow-up).
•Digital Morphometry: Serial morphometric measurements were performed using ImageJ software to quantify vertical lip height and asymmetry.
•Outcome: Lip revision was defined as any subsequent surgical intervention intended to improve the form or function of the lip following the primary repair (n = 24, 17%).
•Statistical Analysis: LASSO (Least Absolute Shrinkage and Selection Operator) regression was utilized to identify the most significant predictors of revision while controlling for multiple variables (AUC = 0.83).
Results
Figure 1: LASSO Regression Model – Predictors of Lip Revision. The LASSO model (AUC = 0.83) identified four key clinical and surgical variables that significantly influence the likelihood of a secondary lip revision. The use of an inferior pennant flap was the only significant protective factor, reducing the odds of revision by 50%. Conversely, the Noordhoff technique and vertical height asymmetry—measurable as early as one month post-operatively—were identified as the primary drivers of secondary surgical intervention.
Conclusions
This study demonstrates that the necessity for secondary lip revision is not random but rather is significantly influenced by early postoperative morphology and the specific surgical techniques employed during primary repair. By identifying vertical lip height asymmetry as a reliable predictor as early as one month postoperatively, surgeons can more accurately identify patients at high risk for suboptimal long-term outcomes. Furthermore, the data suggests that technical modifications, specifically the inclusion of an inferior pennant flap, may actively reduce the odds of revision by 50%. These findings provide a data-driven framework for improving surgical planning, refining primary repair techniques, and setting realistic expectations for families during early postoperative counseling.
References
1.Rogers, A., & Tse, R. (2025). Cleft Lip. Clin Plast Surg, 52(2), 137-155. https://doi.org/10.1016/j.cps.2024.10.003
2.Sarrami SM, Skochdopole AJ, Ferry AM, Buchanan EP, Hollier LH Jr, Dempsey RF. Revisional Techniques for Secondary Cleft Lip Deformities. Semin Plast Surg. 2021 May;35(2):65-71. doi: 10.1055/s-0041-1728673. Epub 2021 Jun 8. PMID: 34121941; PMCID: PMC8186990.
3.Lo, A. L., Haley, C. T., Jones, C. M., Brooke, S. M., Long, R. E., Jr., Samson, T. D., & Mackay, D. R. (2024). The Severity of Initial Unilateral Cleft Lip and Nasal Deformity Predicts Long-Term Postoperative Esthetic Outcome. J Craniofac Surg. https://doi.org/10.1097/scs.0000000000010082.
