Cleft Lip and Palate: surgery that changes not just a face, but an entire childhood

There are surgeries that correct a malformation. And then there are surgeries that accompany a child as they learn to eat, speak, smile, and look at themselves in the mirror without feeling different. Cleft lip and palate surgery works precisely in this space: where reconstruction concerns not only the face, but also quality of life, self-confidence, and relationships with others throughout growth and development.

Because a cleft lip and palate condition does not end in the operating room. It involves the family, extends through childhood, and reaches adolescence, when scars, appearance, and identity begin to carry much greater emotional weight.

Explaining this is Alessandro Giacomina, a plastic surgeon at the Pisa University Hospital, who works on the cleft lip and palate treatment pathway together with Smile House.

«The Pisa school has been treating cleft lip and palate since the late 1960s – Giacomina explains – Today we continue this work with a multidisciplinary and highly specialized approach».

Early intervention to improve growth and functionality

In the treatment of cleft lip and palate, timing is essential. «There are different schools of thought regarding techniques and timing – the surgeon explains – but what is universally recognized is that early intervention greatly improves functional recovery».

In Pisa, surgeries are scheduled within the first months of life. «We operate on the lip at around three months and on the palate at around six months», says the surgeon.

The goal is to allow the child to develop essential functions such as feeding, breathing, and speech in the most natural way possible. «Early intervention allows us to restore anatomy and functions that are not fully developed at birth», he adds.

Alongside functional recovery, there is another aspect that will accompany the patient for years to come: aesthetics. «The quality of aesthetic healing also has an enormous impact on the patient’s future life».

A department built around families

For Giacomina, cleft lip and palate treatment is never only about the child.

Since 2016, Pisa Hospital has had a ward entirely dedicated to these patients and their families. «It is a department designed exclusively for children with cleft lip and palate and for their parents. On May 22 we will celebrate ten years since the opening of the dedicated cleft lip and palate unit at Pisa Hospital — a unique project in Italy that we will celebrate together with Revée and the families who have shared this journey with us over the years».

The spaces, the surgeon explains, were designed to make hospitalization as humane and as non-traumatic as possible. «We even have a dedicated terrace where families can spend time with their children. During Covid, it was essential».

But the true center of the work remains the human relationship. «We are entrusted with the most precious thing two parents have». For this reason, the surgeon explains, the process cannot be limited to the technical aspect alone. «It is not only about treating a condition, but about accompanying an entire family».

Humanitarian missions: “they see you like a superhero”

Over the years, Giacomina has participated in numerous humanitarian missions in South America, especially in Brazil and Paraguay, collaborating with organizations such as Operation Smile and Smile House.

He describes these experiences as deeply formative. «You find yourself working in places where there is often no access to specialized surgery for facial malformations». In those settings, the impact of the operations is enormous. «Families see you arriving almost like a superhero for their children».

Many young patients are finally able to speak better or reintegrate more easily into social life. «Giving these children back both function and appearance is something extremely rewarding».

According to Giacomina, however, one of the most important goals remains local training. «We must do more and more to share what we have learned and expand on-site training».

Growing up with a scar: the weight of adolescence

The most delicate phase of the journey often arrives during adolescence. «We cannot completely erase scars and surgical aftereffects». It is during these years that deep psychological vulnerabilities emerge. «There can be bullying or social exclusion, and these are aspects we must consider very carefully».

For this reason, psychological support is also included in the treatment pathway. «In the early stages, the support mainly involves the family; later, it directly involves the patient».

Today, Giacomina explains, constant exposure to personal image makes everything even more complex. «We live in the era of selfies and constant exposure of one’s face».

For many teenagers, some procedures become true symbolic milestones. «Many patients wait until they are 16 or 18 years old to undergo definitive rhinoplasty».It is not only about breathing better. «For them, it also means feeling more confident about their appearance».

And this is perhaps one of the deepest aspects of pediatric reconstructive surgery: helping a child not only regain a function, but also build their identity peacefully and confidently as they grow.