First 7 Days After Cleft Lip Surgery: What to Expect

The first 7 days after cleft lip surgery are the most critical period both for the baby's recovery and for the family's management of the process. When wound care, feeding routine, and follow-up appointments are planned correctly during this time, healing progresses quite smoothly in most babies.

What does the first 24–48 hours after surgery look like?

Noticeable swelling and mild bruising around the mouth in the first hours after surgery are completely normal. These findings are part of the natural response of the tissues to surgical intervention; they typically peak on the second or third day and then gradually subside. Parents being aware of this appearance in advance largely prevents unnecessary panic.

During the first 24 hours, the baby is usually kept under observation in a ward or intensive care unit. Pain management is provided with analgesics determined by the physician; excessive crying can both strain the wound and increase swelling. For this reason, calm environments, soft music, or a pacifier (used carefully while arm restraints are in place) can help soothe the baby. Restraint devices that prevent the arms from bending at the elbow stop the baby from bringing their hands to the wound; wearing these devices typically continues for several weeks from discharge in most cases.

When does discharge usually take place?

In cases with no complications, discharge typically occurs the day after surgery or on the second day. However, every baby's situation is different; your team will assess the timing of discharge. At the time of going home, the family should have discharge instructions, emergency contact numbers, and information about the first follow-up appointment.

How should wound care be performed?

Sutures used in cleft lip surgery are mostly self-dissolving and do not need to be removed. However, the suture area requires daily and regular cleaning. Unless recommended by the physician, commercial antiseptic solutions should be avoided; gentle cleaning with sterile saline solution or a moist cotton-tipped swab is sufficient in most cases.

After cleaning, applying a thin layer of antibiotic ointment prescribed by the physician both keeps the area moist and minimizes crust formation. When crust formation is not prevented, the risk of scarring may relatively increase; therefore, regular use of the ointment is important. If the baby's saliva or formula residue comes into contact with the wound area during the day, gently cleaning the area and reapplying the ointment is appropriate.

When should sun protection begin?

To prevent the scar tissue from darkening, the wound area should not be exposed directly to sunlight. If the baby is outdoors, a hat and shade are sufficient; applying sunscreen directly to a freshly closed wound is not recommended without physician approval. Asking about this at the follow-up visit will ensure you receive clear guidance.

How is feeding and oral hygiene maintained?

Post-operative feeding is the area families find most challenging. To prevent a bottle nipple or breast nipple from pressing on the lip wound, special post-operative bottles or soft-tipped feeding devices can be used. The feeding method approved by your physician will be demonstrated to you at discharge; it is natural for the baby to go through a slow adaptation period during the first few feedings.

Cleaning the inside of the mouth and around the lip after each feeding prevents formula residue from accumulating at the suture site. A soft gauze pad moistened with sterile saline solution can be used for this cleaning; firm pressure should absolutely be avoided. Some babies may suckle less or keep feedings short during the first few days; it is important to share this with your physician, as adequate nutrition directly affects both overall recovery and wound healing.

Can breast milk be given?

Breast milk is preferred when possible, as it is valuable for immunity. If direct breastfeeding is not possible, expressing milk and giving it through an appropriate feeding device is a viable option in most cases. Evaluating this together with your surgeon and the baby's pediatrician will make it easier to determine the most suitable approach for your baby.

When and how should follow-up appointments be scheduled?

The first follow-up appointment is usually planned 5–7 days after discharge. At this visit, the surgeon evaluates wound healing, checks the condition of the sutures if necessary, and decides whether to continue the ointment. Photographing the wound area and monitoring it before the appointment can contribute to the surgeon's assessment.

During the first week, if you notice any of the following, it is recommended that you call your clinic without waiting for the appointment: significant redness or discharge at the suture site, the baby's temperature exceeding 38°C, complete refusal to feed, or the impression that the sutures have separated. These findings do not always indicate a serious problem; however, early evaluation in most cases either dispels unnecessary concern or expedites necessary intervention.

If you would like to obtain general information about cleft lip and palate, you can refer to our article where we cover the subject in detail. If you are curious about how this condition develops and the big picture of the treatment process, you can benefit from our article explaining the causes and treatment of cleft lip and palate. What families need to do during the pre-operative preparation period is also covered comprehensively in a separate article.

To get general information about lip and palate clefts or to make an appointment to consult with Prof. Dr. Mithat Akan, you can book an appointment. For additional questions that come to mind during the post-operative process, you can also refer to our dedicated Q&A article.