Rehabilitation for the post-cleft nasolabial stigma.

The post-cleft central facial stigma is a psychologically crippling deformity that challenges the reconstructive surgeon's imagination. Rewarding improvements can be achieved through a combination of an "elephant trunk" open approach and restoration of existing structural elements with addition of a central cartilage or bony columellar strut capped by cartilage to provide nasal tip projection. The entire deformity must be considered and, if needed, maxillary or lip revisional surgery must be done to obtain optimal results.