Indentation clefting of the nose means there is a split, groove, or deep notch in the nose, often in the midline, that can range from a shallow dimple at the nasal tip to a visible cleft that involves cartilage and bone. In the congenital form (Tessier-0, “median cleft”), the tip can look “bifid” (two-peaked) and the columella may be broad or split; it can occur alone or with broader midline facial differences (sometimes called frontonasal dysplasia). In acquired cases, “indentation” often comes from scar tissue after injury, surgery, infection, or skin disease, pulling the skin inward and narrowing the nasal valves so airflow feels blocked. Diagnosis is clinical (what the nose looks like and how it works), sometimes supported by imaging/endoscopy to see cartilage, septum, and airway. Congenital midline clefts are rare and relate to how the median nasal prominences fuse during early development; severity varies from subtle to complex. NCBI+2Children’s Hospital of Philadelphia+
Congenital midline clefting reflects incomplete midline fusion of embryologic nasal structures and can be part of the frontonasal dysplasia spectrum (often with wide nasal bridge, hypertelorism, and a midline cleft of the bony dorsum). Acquired indentations usually arise from trauma, surgery, infection, or scar biology (hypertrophic/keloid tendencies), which remodel collagen and can tether skin inward. Management focuses on airway function, cosmesis, scar modulation, and—when needed—staged rhinoplasty with cartilage grafts and soft-tissue balancing. PMC+1
An indentation or cleft of the nose means there is a visible groove, split, or “gap-like” notch along the midline (center) or just to one side of the nose. In mild cases it looks like a shallow midline dent in the nasal tip or bridge; in stronger forms the nose can look split in two (often called a bifid nose). When the split follows the true middle line, doctors call it a median (midline) nasal cleft—this belongs to the group of rare craniofacial clefts described in the Tessier system (number 0 for the midline). When the split sits slightly off the center, it can be a paramedian cleft (Tessier 1 or 2). Some people are born with it (congenital). Others develop a sunken or indented bridge later in life after injury, infection, autoimmune cartilage damage, or drug injury—this is usually called a saddle-nose deformity, which is a depression rather than a true “cleft,” but to families it can look like a central indentation. Medscape+4Children’s Hospital of Philadelphia+4The Plastics Fella+4
Other names
Doctors and articles may use one or more of these terms (some are very close, some are “related but not identical”—your team will clarify which one fits your child/patient):
Median nasal cleft / midline nasal cleft / Tessier 0 cleft – a split exactly in the middle, sometimes with a bifid (split) nasal tip. NCBI
Bifid nose (cleft nose) – the nose appears divided into two halves; severity ranges from a small groove at the tip to a complete split. Often seen in frontonasal dysplasia. Genetic Rare Diseases Center
Paramedian nasal cleft (Tessier 1 or 2) – the split sits just to one side of the midline. Orpha.net
Craniofacial cleft – broader family name that includes midline, paramedian, and lateral facial clefts. The Plastics Fella+1
Saddle-nose deformity – a related but different condition with a sunken bridge from loss of cartilage/bone; it can mimic a central indentation but is not a true cleft. Cleveland Clinic
Types
By position
Midline (median): the groove or split runs through the center (Tessier 0). The Plastics Fella
Paramedian: slightly off the center on one or both sides (Tessier 1–2). The Plastics Fella
By depth and extent
Surface-only: a skin-level notch or groove at the tip/columella.
Soft-tissue and cartilage: the columella, lower cartilage, or septum are split or duplicated.
Bone involved: the split reaches the nasal bones or the premaxilla (often syndromic).
By association
Isolated (limited to the nose) or syndromic (part of a pattern such as frontonasal dysplasia or craniofrontonasal syndrome). MedlinePlus+1
Causes
Congenital (present at birth)
Failure of fusion of the medial nasal processes — in early fetal life, tissues that should meet in the center do not fully join, leaving a midline notch or cleft. This embryology underlies median nasal clefts. The Plastics Fella
Frontonasal dysplasia (FND) — a rare condition; facial features can include a midline nasal cleft or bifid tip, wide nasal root, and increased eye distance. Specific gene changes can cause subtypes (see below). Genetic Rare Diseases Center
ALX3 gene changes (FND type 1 / frontorhiny) — ALX3 is a development gene for the frontonasal region; variants can produce midline nasal clefting. PMC
ALX4 gene changes (FND type 2) — another transcription factor affecting craniofacial patterning; variants can lead to frontonasal malformations. MedlinePlus
ALX1 gene changes (FND type 3) — loss-of-function variants disrupt neural crest cell behavior and can cause severe facial clefting including nasal clefts. PMC+1
Craniofrontonasal syndrome (EFNB1 variants) — an X-linked disorder; females are often more severely affected, and bifid nasal tip or nasal clefting can occur. PubMed+1
Acromelic frontonasal dysostosis (ZSWIM6 variants) — combines nasal clefting or bifid tip with limb/brain differences. PMC+1
Paramedian nasal cleft (developmental defect) — a unilateral/bilateral “coloboma” of the nostril wing (alar region) due to local failure of fusion next to the midline. Orpha.net
Nasal dermoid sinus/cyst with overlying midline groove — a congenital tract in the midline can tether skin and create a visible central line or dimple; important because some tracts connect to the skull. JAMA Network
Holoprosencephaly spectrum and midline facial anomalies — broader forebrain midline disorders sometimes include nasal midline differences (ranging from single nostril to midline clefts). (General midline association noted in dysmorphology texts.)
Retinoic acid signaling disturbances in early development — both too much and too little RA signaling in animal models disrupt midfacial fusion and can cause midline clefts or cleft palate. (Human counseling: avoid non-prescribed retinoids in pregnancy.) PubMed+1
Maternal diabetes (pre-gestational) — increases overall risk of craniofacial anomalies; mechanism includes oxidative stress affecting neural crest development. PLOS+1
Prenatal alcohol exposure (FASD) — classically causes midface changes (smooth philtrum, short nose); while not a “cleft” itself, significant midline underdevelopment may accentuate a central groove. AAP Publications
Acquired (develops later; looks like an indentation)
Nasal trauma — fractures or cartilage loss can collapse the bridge and create an indented/saddle profile. Medscape
Untreated septal hematoma with cartilage necrosis — after injury, blood trapped in the septum kills cartilage; later the bridge sinks (saddle-nose). (Described widely in ENT practice.)
Granulomatosis with polyangiitis (Wegener’s) — autoimmune vessel inflammation destroys septal cartilage causing a midline depression. (ENT/Medscape reviews include this among saddle-nose causes.) Medscape
Relapsing polychondritis — recurrent cartilage inflammation weakens nasal support and can indent the bridge. Rhinoplasty Archive
Cocaine-induced septal perforation and collapse — vasoconstriction + ischemia erode the septum and can produce a saddle-like indentation. Wikipedia
Syphilis (congenital or tertiary) — late destructive lesions can collapse the bridge and mimic a central cleft/indentation (classic saddle-nose). Mayo Clinic
Leprosy (Hansen’s disease) — chronic infection may destroy septal/turbinate cartilage leading to saddle-nose and central indentation. PubMed+1
Common symptoms
A visible groove or split at the nasal tip or bridge (cosmetic concern). In midline clefts it can look like two halves of a tip. Genetic Rare Diseases Center
Nasal asymmetry (one side looks different from the other).
Blocked nose or trouble breathing through one or both sides, especially with colds or allergies.
Snoring or noisy sleep if airflow is reduced.
Mouth breathing because the nose feels closed.
Crusting and dryness inside the nose (airflow turbulence and dryness).
Frequent runny nose or sinus infections, especially if the anatomy narrows drainage paths.
Nosebleeds from irritated or exposed areas.
Hyponasal speech (sounds “nasal blocked”) or, if a cleft palate is present too, sometimes hypernasality; speech therapy often helps.
Feeding difficulties in infants if breathing through the nose is hard while sucking.
Reduced smell (hyposmia) when airflow to the smell area is limited. Objective smell tests can measure this. PMC
Headaches or facial pressure during infections or allergy flares.
Hearing issues/ear infections if a related palate problem affects the Eustachian tube; newborns are screened with AABR (an automated brainstem hearing test). AAP Publications
Sleep apnea risk in some with severe obstruction; a sleep study can check.
Psychosocial stress (self-image, teasing); supportive counseling can help while planning care.
Diagnostic tests
A) Physical examination
Full facial and nasal inspection – the clinician looks for a midline groove or true cleft, checks the width of the nasal root, symmetry, and associated features (wide-set eyes, bifid tip) that suggest a Tessier 0/frontonasal pattern. Children’s Hospital of Philadelphia
Anterior rhinoscopy (light and speculum) – a close look inside the nostrils to see septum shape, valve area, crusting, or perforation.
Palpation of the nasal bones and cartilages – gentle feel for steps, gaps, or loss of support (helps distinguish congenital split vs post-traumatic “saddle”).
One-side occlusion airflow check – you breathe through each side while the other is closed; the examiner notes airflow difference (simple screening).
Craniofacial survey – checks the lips, palate, teeth and bite, eye spacing, forehead, and hairline for syndromic clues (e.g., frontonasal dysplasia). Genetic Rare Diseases Center
B) Manual bedside maneuvers
Cottle maneuver – the cheek skin is gently pulled sideways to open the internal nasal valve; if breathing suddenly improves, a valve problem contributes. Evidence is mixed: it can be suggestive but is not perfectly reliable alone. E-CEO+1
Modified Cottle maneuver – a small instrument supports either the internal or external valve to predict which repair helps; some studies show it can predict outcomes of functional rhinoplasty. PubMed
Cotton-wisp/feather test at the nostrils – visualizes airflow direction and strength during quiet breathing (quick, noninvasive).
Fogging-mirror test – a cool mirror held under the nose shows fog pattern from each side—uneven fog suggests asymmetry.
Manual alar lift or sidewall support – the clinician gently lifts or braces the nostril rim; improvement cues external valve weakness that can accompany a cleft-like notch.
C) Laboratory & pathological tests
Chromosomal microarray – looks for submicroscopic changes when a syndromic pattern is suspected. (General genetics standard in craniofacial anomalies.)
Targeted gene testing panels – include ALX1, ALX3, ALX4, EFNB1, ZSWIM6 when features or family history suggest frontonasal or craniofrontonasal syndromes. MedlinePlus+2PubMed+2
Karyotype – used less often now, but can detect large chromosomal problems if suspected.
Pathology of any excised tract/mass – if a nasal dermoid sinus/cyst is removed, the specimen confirms the diagnosis; imaging plus pathology guide complete treatment. JAMA Network
D) Electrodiagnostic/physiologic tests
Automated Auditory Brainstem Response (AABR) – part of universal newborn hearing screening; helpful when cleft palate or syndromic features raise hearing-risk. AAP Publications
Overnight polysomnography (sleep study) – tracks airflow, oxygen, and brain activity to detect sleep apnea if obstruction is suspected.
Objective nasal patency tests – rhinomanometry measures airflow/pressure and acoustic rhinometry measures cross-sectional area; both give numbers to follow over time. JA CI Online
E) Imaging tests
Low-dose CT or Cone-Beam CT (CBCT) – maps the bony nose, septum, and maxilla; widely used in cleft-care planning and airway measurements. craniofacialinstitute.org
MRI of the face/brain – best to check soft tissue and to exclude an intracranial connection if there is a midline nasal pit/tract (dermoid). MRI is more accurate than CT for detecting intracranial extension. MDPI
Prenatal ultrasound ± fetal MRI – in expert hands, a wide midface or bifid nose sign can be seen before birth; fetal MRI adds detail when syndromes are suspected. Genetic Rare Diseases Center
Non-pharmacological treatments (therapies & others)
Nasal saline irrigation (isotonic rinse/neti pot)
Description & purpose: Rinsing the nose with sterile saltwater gently clears mucus, crusts, allergens, and dust. It reduces irritation and makes breathing easier, especially when swelling or crusting worsens valve narrowing around an indentation. Mechanism: Saline thins secretions, flushes debris, and helps cilia (the tiny hair-like cleaners) move better. It also moistens dry lining so it heals more comfortably after procedures. Key safety: Always use boiled-then-cooled, distilled, or sterile water; clean the device regularly. Evidence: Cochrane reviews suggest saline can modestly reduce symptom severity in rhinitis and sinusitis with a good safety profile. Cochrane Library+2Cochrane Library+2Humidification and steam inhalation (safe method)
Description & purpose: Adding humidity (room humidifier) or brief warm mist inhalation reduces nasal dryness and crusting that can exaggerate a notch or internal narrowing. Mechanism: Moist air prevents thick crusts, reduces friction on tender mucosa, and supports cilia. Tip: Keep humidifiers clean to avoid mold or bacteria. Evidence: Supportive in airway dryness; often advised as part of conservative care alongside saline (clinical practice guidance). (General supportive measure; pairs with Cochrane-supported saline.) Cochrane LibraryNasal valve support taping (external)
Description & purpose: Skin-safe tape gently splints the sidewalls outward, reducing collapse where an indentation narrows airflow. Mechanism: Mechanical lifting widens the internal/external valve angle, easing airflow during inspiration. Use: Temporary daily support; useful before or after surgery and during exercise or sleep. Evidence: Nasal valve obstruction care emphasizes valve support; physical tests like the (modified) Cottle maneuver explore response to lateral support, though diagnostic reliability is debated. Frontiers+2PubMed+2Nasoalveolar molding (NAM) for infants with cleft features
Description & purpose: For babies with cleft lip/nose patterns, a custom intraoral plate and soft nasal stents are used before surgery to gently shape gums and nose, improving symmetry and reducing surgical tension. Mechanism: Continuous gentle molding repositions cartilage and soft tissues during the early, more “plastic” months of life. Evidence: Reviews show NAM can improve short- to mid-term symmetry and reduce defect width; certainty varies and bias exists, but overall benefits are supported. PubMed+2Nature+2Silicone gel or sheeting on scars
Description & purpose: Clear silicone sheets or gels worn daily help flatten, soften, and lighten raised scars that pull the nose inward. Mechanism: Occlusion and hydration alter collagen signaling in the healing scar, reducing thickness and symptoms like itch. Evidence: RCTs and systematic reviews suggest benefit, though study quality varies. Safe, non-invasive, and widely used. PMC+2PMC+2Scar massage and pressure therapy
Description & purpose: Gentle daily massage with clean fingers (or a pressure splint designed by your clinician) helps scars remodel and become more flexible. Mechanism: Mechanical forces align collagen fibers and improve pliability, decreasing tethering that creates notches. Evidence: Common in scar protocols; often combined with silicone and, when needed, intralesional therapies. American Academy of Family PhysiciansBreathing retraining and nasal breathing drills
Description & purpose: Simple drills (slow nose-first inhalation, diaphragmatic breathing) reduce mouth breathing and train gentle airflow patterns, which may lessen dryness and crusting around an indentation. Mechanism: Behavioral. Keeps airflow laminar and encourages nasal conditioning of air. Evidence: Supportive/adjunct in nasal obstruction care; pairs with valve support strategies. FrontiersAllergen avoidance & home triggers control
Description & purpose: Reducing dust mites, pet dander, smoke, and strong scents prevents mucosal swelling that can worsen a narrow notch. Mechanism: Less allergic inflammation = wider functional airway. Evidence: Standard in allergic rhinitis care alongside saline and intranasal steroids when appropriate. Cochrane LibraryUV protection for scars (sunscreen, shade)
Description & purpose: Sun can darken and stiffen scars, making a nasal indentation more noticeable. Mechanism: UV avoidance reduces hyperpigmentation and abnormal collagen cross-links during remodeling. Evidence: Standard scar-care advice; complements silicone and massage. PMCWound-care hygiene after procedures
Description & purpose: Keeping incisions clean and moist (per surgeon’s protocol) lowers infection and hypertrophic scarring risk that can deepen notching. Mechanism: Infection prevention and moisture-balanced healing lead to finer scars. Evidence: Core surgical aftercare principles; complements antibiotic stewardship and follow-up. American Academy of Family PhysiciansNasal stents/splints (custom)
Description & purpose: Soft internal stents maintain shape and airway after molding or surgery. Mechanism: Temporary scaffolding for cartilage/soft tissue until stable. Evidence: Routine in cleft rhinoplasty pathways; chosen by surgeon based on anatomy. Children’s Hospital of PhiladelphiaMicropore taping of tip/columella after rhinoplasty
Description & purpose: Short-term taping reduces edema and supports tip projection to prevent early collapse in notched areas. Mechanism: Gentle external support during early healing. Evidence: Standard post-op practice. Children’s Hospital of PhiladelphiaSpeech-feeding counseling in syndromic infants
Description & purpose: Early guidance improves feeding and speech when clefts affect lip/nose structures. Mechanism: Positioning, pacing, and specialized bottles reduce airway stress. Evidence: Part of multidisciplinary cleft care. Children’s Hospital of PhiladelphiaPsychosocial support and expectation setting
Description & purpose: Counseling helps families plan staged care and understand realistic outcomes, which reduces distress and supports adherence. Mechanism: Education + coping strategies. Evidence: Embedded in cleft teams. Children’s Hospital of PhiladelphiaPhysical exam-guided valve maneuvers (office trials)
Description & purpose: Temporary lateral cheek lift (Cottle/modified Cottle) shows whether external support helps breathing; it can predict benefit from splints or surgery. Mechanism: Manual widening of nasal valve. Evidence: The maneuver is widely used but has mixed reliability; results should be interpreted cautiously. PubMed+2PMC+2Lifestyle hydration & room air hygiene
Description & purpose: Adequate water intake and clean indoor air (no smoke) keep mucosa healthy, lessening crusts that “catch” on notched skin. Mechanism: Mucosal conditioning. Evidence: Supportive airway care. Cochrane LibraryGentle skin care over the indentation
Description & purpose: Non-fragrant emollients limit irritation and micro-inflammation that can thicken scars. Mechanism: Barrier repair and reduced itch/scratch cycle. Evidence: Scar programs often pair emollients with silicone. PMCPosture and sleep adjustments
Description & purpose: Slight head elevation can reduce nighttime congestion that worsens valve narrowing. Mechanism: Less venous pooling = less mucosal swelling. Evidence: Common supportive advice for nasal obstruction. FrontiersPeri-operative cold-then-warm compress cycles (per surgeon)
Description & purpose: Helps swelling and bruising settle more evenly after rhinoplasty or scar revision. Mechanism: Vasoactive effects on edema; comfort. Evidence: Routine aftercare guidance. Children’s Hospital of PhiladelphiaAvoid unapproved “stem-cell” or exosome injections
Description & purpose: Some clinics market unapproved regenerative shots for scars or nasal shape. These can be ineffective or harmful. Mechanism: FDA has warned most such products are not approved for these uses. Action: Avoid outside regulated trials. U.S. Food and Drug Administration+1
Drug treatments
Acetaminophen (paracetamol) — Analgesic/antipyretic
What/why: First-line pain reliever after procedures or when indentations feel tender. Mechanism: Central prostaglandin modulation to lower pain/fever. Dose/time: Per FDA label (weight-based in children; max daily dose limits to protect liver). Purpose: Comfort without bleeding risk of some NSAIDs. Side effects: Liver toxicity if overdosed or combined with multiple acetaminophen products. Label: FDA labeling details dosing and hepatotoxicity warnings. FDA Access DataIbuprofen — NSAID
What/why: Pain and inflammation control short-term after trauma/surgery. Mechanism: COX inhibition lowers prostaglandins. Dose/time: Per age/weight; avoid if surgeon prefers acetaminophen only early after rhinoplasty. Side effects: Stomach upset, bleeding risk, renal caution. Label: FDA OTC/ Rx ibuprofen labeling. FDA Access DataAmoxicillin-clavulanate (AUGMENTIN®) — Antibiotic
What/why: If there’s a true skin/soft tissue infection around a scar or post-op wound risk, clinicians may choose this broad oral agent. Mechanism: Amoxicillin kills susceptible bacteria; clavulanate blocks beta-lactamases. Dose/time: Per FDA label; adjust for renal function; pediatric forms available. Side effects: GI upset, allergy, yeast overgrowth; stewardship important. Label: Current FDA label. FDA Access DataCephalexin — First-generation cephalosporin
What/why: Common for uncomplicated skin infections when indicated. Mechanism: Cell-wall synthesis inhibition. Dose/time: Per label, 2–4 times daily. Side effects: GI upset, allergy (esp. with penicillin history). Label: FDA cephalexin labeling (skin/soft tissue infections). FDA Access DataMupirocin 2% ointment — Topical antibiotic
What/why: Short courses for localized infected crusts or to reduce Staph colonization around stitches (per clinician). Mechanism: Inhibits bacterial isoleucyl-tRNA synthetase. Side effects: Local irritation; avoid prolonged unsupervised use. Label: FDA mupirocin labeling. FDA Access DataFluticasone propionate nasal spray (FLONASE®) — Intranasal corticosteroid
What/why: Reduces allergic swelling that worsens functional narrowing at a notch. Mechanism: Local anti-inflammatory steroid effect. Dose/time: Once daily typical; onset builds over days. Side effects: Local dryness/epistaxis; rare cataract/glaucoma risks noted in label. Label: FDA FLONASE labeling. FDA Access Data+1Mometasone furoate nasal spray — Intranasal corticosteroid
What/why: Similar to fluticasone; chosen by availability/tolerance. Mechanism: Local steroid anti-inflammation. Dose/time: Per label; daily use. Side effects: Similar local effects; monitor if prolonged. Label: FDA mometasone nasal labeling. FDA Access DataOxymetazoline 0.05% nasal spray (short-term only) — Topical decongestant
What/why: Brief rescue for severe congestion that narrows valves in colds/allergies; not for infants; limit to ≤3 days to avoid rebound. Mechanism: Alpha-agonist vasoconstriction shrinks swollen mucosa. Side effects: Rebound congestion if overused; caution in cardiovascular disease. Label: FDA/DailyMed warnings (3-day rule). DailyMed+1KOVANAZE® (tetracaine + oxymetazoline) nasal spray (procedural anesthesia)
What/why: Used by clinicians to numb upper teeth and nearby nasal tissues for certain minor procedures in adults—not a home medication. Mechanism: Local anesthetic + vasoconstrictor combination via nasal route. Risks: Label-specific contraindications and precautions. Label: FDA product labeling. FDA Access DataTopical lidocaine (clinic use) — Local anesthetic
What/why: For suture care or small in-office scar procedures. Mechanism: Sodium channel blockade. Side effects: Rare systemic toxicity if excessive. Label: FDA local anesthetic labeling. FDA Access DataTriamcinolone acetonide (intralesional steroid for hypertrophic/keloid scars)
What/why: Clinic injections into a raised, tethering scar can flatten it and reduce inward pull. Mechanism: Potent local anti-proliferative effect on fibroblasts/collagen. Schedule: Spaced sessions per specialist. Side effects: Skin thinning, hypopigmentation, telangiectasia if superficial. Evidence: Considered a mainstay of non-surgical scar management; used with silicone/pressure. PMC+1Cetirizine or loratadine — Second-generation oral antihistamines
What/why: For allergy-driven swelling without sedation that worsens a narrow valve. Mechanism: H1 receptor blockade. Dose/time: Once daily typical. Side effects: Drowsiness (less than diphenhydramine). Label: FDA antihistamine labeling. FDA Access DataPseudoephedrine (oral decongestant; adults)
What/why: Short-term relief of nasal swelling; avoid at night if it causes jittery feeling; check drug interactions and BP. Mechanism: Alpha/beta agonist decongestion. Side effects: Insomnia, palpitations, BP rise. Label: FDA OTC decongestant guidance. FDA Access DataOndansetron (post-op nausea)
What/why: If anesthesia or pain meds cause nausea after nasal surgery, ondansetron can help. Mechanism: 5-HT3 antagonism. Side effects: Headache, constipation; QT caution. Label: FDA ondansetron labeling. FDA Access Data
(Note: Your clinician may select other agents—e.g., clindamycin/doxycycline when indicated, or short topical antibiotic courses—based on cultures, allergies, age, and local guidelines. Always use decongestants and steroids exactly as labeled and prescribed.)
Dietary molecular supplements
Vitamin C (ascorbic acid)
What it does: Supports collagen synthesis, cross-linking, and antioxidant defense during wound healing. Typical doses: 500–1000 mg/day in adults for short healing periods (adjust for GI tolerance). Function/mechanism: Cofactor for prolyl/lysyl hydroxylase in collagen; scavenges reactive oxygen species. Notes: Can cause GI upset; very high doses may increase kidney stone risk.Zinc
What it does: Aids DNA synthesis and cell proliferation in healing tissues. Typical doses: 15–30 mg elemental zinc/day short-term; avoid long high-dose courses (copper deficiency risk). Mechanism: Cofactor for many enzymes in tissue repair; supports immune function.Protein (with arginine)
What it does: Supplies amino acids for tissue building. Typical amounts: Aim for 1.2–1.5 g/kg/day protein during active healing (per clinician/dietitian). Mechanism: Arginine fuels nitric-oxide-mediated collagen deposition and wound tensile strength.Omega-3 fatty acids (EPA/DHA)
What it does: Modulates inflammation; may help comfort and swelling after procedures. Typical doses: 1–2 g/day combined EPA+DHA if not on anticoagulants. Mechanism: Competes with arachidonic acid pathways to form less pro-inflammatory mediators.Bromelain (pineapple enzyme)
What it does: May reduce post-op swelling/bruising when used carefully. Typical doses: 200–400 mg, 1–3×/day for a few days post-procedure if your surgeon agrees. Mechanism: Proteolytic modulation of edematous exudates. Caution: Possible interactions with anticoagulants; allergy to pineapple.Quercetin
What it does: Flavonoid with antihistamine-like properties that may ease seasonal triggers of nasal swelling. Typical doses: 250–500 mg/day. Mechanism: Mast-cell stabilization and antioxidant effects. Caution: Limited clinical data for nasal outcomes; adjunct only.Curcumin
What it does: Anti-inflammatory antioxidant that may support comfortable healing. Typical doses: 500–1000 mg/day with piperine (enhances absorption). Mechanism: NF-κB pathway modulation; antioxidant activity. Caution: Drug interactions; discuss before surgery.Hyaluronic acid (oral)
What it does: Hydration support for skin/mucosa, potentially aiding comfort. Typical doses: 120–240 mg/day in supplements. Mechanism: Water-binding glycosaminoglycan; supports extracellular matrix moisture.Orthosilicic acid (silicon)
What it does: Trace mineral supporting collagen/elastic fiber integrity. Typical doses: Per product; often 5–10 mg elemental silicon/day. Mechanism: May influence hydroxylation and cross-linking in connective tissue.Probiotics
What it does: Gut support during/after antibiotic courses; may reduce GI side effects. Typical doses: Vary by strain (e.g., Lactobacillus, Bifidobacterium) for 1–2 weeks after antibiotics. Mechanism: Microbiome support to limit dysbiosis-related diarrhea.
(Supplements are adjuncts; quality varies. Stop all non-essentials 1–2 weeks before surgery unless your surgeon approves.)
Immunity-booster / regenerative / stem-cell” drugs
There are no FDA-approved stem-cell or “regenerative shots” to correct nasal clefts/indentations. Autologous fat, PRP, or stem-cell-labeled products advertised for scars or cosmetic nasal reshaping are unapproved for these uses outside research; the FDA has issued consumer alerts because of harms from unapproved regenerative interventions. What is used legitimately are clinician-delivered techniques during surgery (e.g., cartilage grafts) rather than “stem-cell drugs.” Below are common clinic-delivered biologic/adjacent options and the safety reality:
Platelet-rich plasma (PRP) (procedural adjunct, not an FDA-approved drug for scars) — Autologous platelets concentrate growth factors that may assist wound quality when used by specialists; cosmetic evidence is mixed; not a cure for clefts. (Discuss risks/benefits.) U.S. Food and Drug Administration
Autologous fat grafting (with/without stromal vascular fraction) — Surgeons sometimes use fat to soften contour defects; adding “stem-cell fractions” is not FDA-approved and has safety/regulatory concerns. U.S. Food and Drug Administration+1
Tissue-engineered cartilage (research stage) — Lab-grown cartilage scaffolds are promising but remain investigational for nasal reconstruction. Avoid commercial “stem-cell” offers outside trials. U.S. Food and Drug Administration
Silicone/porous polyethylene implants (materials, not drugs) — Sometimes used structurally; risks include infection/extrusion; chosen carefully by facial plastic surgeons. (Implants are devices selected within regulated practice.)
Intralesional triamcinolone (Kenalog) for keloid/hypertrophic scar — This is a real, guideline-supported therapy that can reduce scar pull contributing to notching. It is not a stem-cell therapy but is regenerative-adjacent by modulating collagen. PMC
Avoid unapproved “stem-cell/exosome” injections — FDA warns most marketed products are illegal and potentially dangerous; stick to board-certified surgeons and IRB-approved trials. U.S. Food and Drug Administration+1
Surgeries (procedures & why they’re done)
Primary cleft rhinoplasty (infant/child as part of cleft pathway)
Procedure: In cleft patterns, surgeons reshape lower lateral cartilages, reposition the alar base, and support the tip/columella; often staged with lip repair and later revisions. Why: Improve symmetry, airway, and contour early, then refine during growth. Children’s Hospital of PhiladelphiaOpen septorhinoplasty with cartilage grafting (adolescent/adult)
Procedure: Through a small columellar incision, the surgeon straightens the septum, reinforces the internal/external nasal valves, and uses grafts (spreader, batten, rim) to stabilize weak or notched areas. Why: Restore function and aesthetics in congenital or scar-related indentations. FrontiersAutologous cartilage onlay/strut grafts (septal/auricular/costal)
Procedure: Sculpted grafts support the dorsal line, tip, and alar rims to correct a visible cleft or notch. Why: Long-term structural support and symmetry. PMCScar revision (e.g., Z-plasty, W-plasty, geometric broken-line)
Procedure: Re-excise and rearrange scar lines to release tethering and camouflage notches; sometimes add fat or dermal graft for volume. Why: Reduce inward pull and improve contour.Adjunctive laser/dermabrasion after structural repair
Procedure: Fractional laser or dermabrasion softens surface irregularity after shape is corrected. Why: Texture and color blending to finish the reconstruction.
Preventions
Prenatal care and folate sufficiency; avoid alcohol/smoking during pregnancy (general congenital risk reduction).
Protect the nose from trauma (sports masks, seatbelts).
Early wound care for any nasal cut (clean, moist healing, follow-up).
Sun protection on healing scars to prevent dark, stiff scars.
Manage allergies (saline, allergen avoidance, steroid sprays when appropriate). Cochrane Library
Avoid overuse of topical decongestants (no more than 3 days). DailyMed
Don’t pick crusts; use saline and soft ointments per clinician.
Keep humid air at home in dry seasons.
Choose board-certified surgeons and evidence-based care—avoid unapproved “stem-cell” offers. U.S. Food and Drug Administration
Keep follow-up appointments to catch early scar thickening (so it can be treated with silicone, massage, or steroid injection). PMC
When to see doctors
Baby with a midline nasal groove, bifid tip, or other facial differences.
Any breathing noise, mouth-breathing, snoring, feeding trouble, or recurrent crusting/bleeding.
A new notch after injury/surgery that seems to deepen over weeks.
Signs of infection: redness, warmth, pus, fever.
Worsening allergies making breathing hard despite saline/avoidance.
Considering surgery: get a facial plastic surgeon or cleft team opinion early. Children’s Hospital of Philadelphia
Foods: what to eat & what to avoid
Eat more:
Lean proteins (eggs, fish, poultry, legumes) for collagen building.
Vitamin C-rich fruits/veg (citrus, kiwi, berries, peppers).
Zinc sources (pumpkin seeds, beans, seafood).
Omega-3s (fatty fish, walnuts).
Hydrating broths and water-rich foods (soups, fruits).
Limit/avoid:
- Alcohol (impairs healing, increases bleeding risk around surgery).
- Smoking/vaping (vasoconstriction = poorer healing).
- Ultra-processed high-sugar foods (inflammation, glycation).
- High-salt meals (fluid retention/swelling).
- Herbal/botanical “blood thinners” before procedures (e.g., large doses of garlic, ginkgo) unless your surgeon says it’s okay.
FAQs
1) Can medicines “fix” a nasal cleft/indentation?
No. Medicines reduce pain, infection, and swelling, but structural correction needs molding and/or surgery. Children’s Hospital of Philadelphia
2) Is a midline nasal cleft always part of a syndrome?
Not always. It can be isolated or part of frontonasal dysplasia; evaluation rules out associated issues. PMC
3) What age is best for surgery?
Cleft teams plan staged care—early molding/repairs in infancy, refinements later when facial growth allows stable results. Children’s Hospital of Philadelphia
4) Will silicone gel really help my scar?
It often softens and flattens scars over weeks to months; evidence shows benefit but quality varies. Consistent use matters. PMC+1
5) Are steroid injections safe for thick scars on the nose?
When done by experts, intralesional triamcinolone can flatten scars; risks include skin thinning or light spots if too superficial. PMC
6) Do neti pots work?
Saline irrigation can reduce symptom severity in rhinitis/sinusitis and keep the nose clean—use sterile water and proper hygiene. Cochrane Library
7) Is the Cottle maneuver a diagnosis?
It’s a quick office test to see if lateral support helps airflow, but reliability is debated; it’s only one piece of assessment. PubMed+1
8) Can over-the-counter decongestant sprays help?
They can for 1–3 days, but longer use risks rebound congestion—follow labels strictly. DailyMed
9) Are “stem-cell injections” for scars a good idea?
No—most marketed products are unapproved and have caused harm. Seek only IRB-approved trials or standard care. U.S. Food and Drug Administration+1
10) How do surgeons rebuild a notched rim or cleft tip?
With cartilage grafts and suturing to balance shape and support airflow; sometimes staged. PMC
11) Will allergy control really improve breathing through a notched nose?
Yes—less swelling means a relatively wider valve and smoother airflow. Intranasal steroids have strong evidence in allergic rhinitis. FDA Access Data
12) Can diet or supplements replace surgery?
No. Nutrition supports healing quality but doesn’t move cartilage or close a cleft.
13) How long do silicone sheets take to work?
Often 8–12 weeks of near-daily wear to see softening; many continue several months. PMC
14) Why are staged surgeries common?
Faces grow. Early steps improve function/looks, and later refinements fine-tune once structures are larger and stable. Children’s Hospital of Philadelphia
15) Who should manage this?
A multidisciplinary team: cleft/craniofacial surgeons, facial plastic surgeon (ENT or plastics), pediatrician, orthodontist/orthodontic therapist, speech and feeding specialists. Children’s Hospital of Philadelphia
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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: October 24, 2025.
Cleft Nasal Bridge
