A repaired cleft lip often heals with a vertically oriented scar that cuts across the natural moustache line. In men, that hair‑free strip is conspicuous even when the surgical repair itself is technically excellent. The gap not only draws the eye, it brands the wearer as “different”—a stigma many patients have lived with since infancy.
Modern follicular‑unit hair transplantation (FUT/FUE) offers a deceptively simple but highly effective camouflage: repopulating the scar with living, growing hair so the moustache once again forms an uninterrupted ribbon.
The technique occupies a unique niche—it is neither a routine cosmetic cover‑up nor a major reconstruction but the final aesthetic step that “erases” the tell‑tale sign of a congenital deformity.
Table of Contents
Medical Background
Epidemiology and Pathogenesis
Cleft lip with or without cleft palate (CL±P) affects roughly 1 in 1,050 U.S. births—about 4,440 newborns every year, according to the Centers for Disease Control and Prevention estimates. (OHSU)
The defect results from the failure of the medial nasal and maxillary processes to fuse between the fourth and seventh gestational weeks. Early primary cleft lip reconstruction (cheiloplasty), typically performed at three to six months of age, restores function and gross form but inevitably leaves a scar.
Evolution of Scar-Management Strategies
Mid‑20th‑century surgeons tried Z‑plasty, W‑plasty, and even full‑thickness scalp grafts. Outcomes were unsatisfying: new scars traded places with old, and plug‑style grafts looked “doll‑like.”
Over the last two decades, refinements such as Fisher’s anatomical‑subunit closure, fractional lasers, dermabrasion, steroid or 5‑FU injections, and autologous fat grafting have markedly softened cleft lip scars, making. Yet none of those modalities can restore hair follicles to the barren strip.
That final limitation became the catalyst for borrowing scalp and beard restoration science for cleft after‑care, thus leading us to where we are today in facial hair restoration for cleft lip.
Hair‑Transplant Techniques Adapted to Cleft Lip Scars
Why Follicular‑Unit Extraction (FUE) Dominates
For the small graft numbers (100–300) typical of a unilateral scar, FUE—harvesting follicles individually with a 0.8–0.9 mm punch—avoids a visible donor scar and provides fine single‑hair units ideal for the narrow philtral column in moustache hair transplants. Strip FUT can also work, but is now reserved for special cases (e.g., concurrent scalp work).
Donor‑hair selection—scalp vs. beard
| Attribute | Scalp donor | Beard donor | Clinical takeaway |
| Caliber & curl | Usually finer, straighter | Thicker, matches moustache | Beard preferred when available |
| Color match | May be lighter | Nearly identical | Blend drives choice |
| Survival in scar | ~90 % in most series | 70–85 % reported | Slightly higher attrition is offset by texture match |
Key Technique Tips for Planting Hairs Into the Scar
- Angle. Each slit is made almost flat to the skin—about a 10‑ to 15‑degree tilt—so the new hairs lie down and follow the natural moustache direction. If a graft sticks straight out, it will attract attention.
- Spacing. On the first pass, the surgeon leaves roughly 2 millimetres between grafts. That breathing room lets every follicle pick up enough blood supply inside the scar. Extra hairs can be added later once circulation has improved.
- Instruments. Ultra‑fine blades or Choi implanter pens (0.6–0.8 mm) slide the grafts in with minimal trauma and help avoid “cobblestone” bumps.
- Healing boosters. Many teams inject platelet‑rich plasma at the time of surgery or “prime” the scar a few months earlier with a small fat graft. A 2018 study in Plastic & Reconstructive Surgery showed that combining these boosters pushed graft survival past 90 percent and left patients highly satisfied.
Growth Timeline
Shedding of transplanted shafts occurs at 2–3 weeks; new hair emerges around month 4, densifies by month 6, and typically matures by month 9–12. Rajput’s 18‑patient series documented full coverage at six months with only 7–10 % follicle loss. (Lippincott Journals)
Patient Case Study: Roger Grabman
Background
Roger Grabman, born in 1951 with a unilateral cleft lip, went through roughly twenty surgical repairs before finishing high school. As an adult, he could grow a full beard—except for one glaring, hair-free strip right through the old lip scar. The gap bothered him for decades.
Why He Chose a Hair Transplant
In 2008, Roger discovered that the U.S. tax code treats procedures to correct congenital deformities as medically necessary, meaning he could use his flexible-spending account to cover a transplant. Finding the right surgeon proved harder: cleft-lip specialists rarely perform hair work, and most hair surgeons focus on the scalp. After several consultations, he chose Dr John Cole in Atlanta, known for facial-hair FUE.
Pre-Operative Planning
Dr Cole and Roger mapped out two donor zones:
- Back of the scalp for its high graft survival rate.
- Under-chin beard for a perfect color and texture match.
Roger shaved the beard area three days before surgery, so actively growing follicles were easy to spot. The procedure would be done entirely under local anesthetic—no general anesthesia, no hospital stay.
The Surgery
Using a 0.8 mm punch, the team harvested about 180 single-hair grafts. Each recipient slit in the lip scar was cut almost flat—10–15 degrees to the skin—so the new hairs would lie naturally with the rest of his moustache. The whole session took roughly five hours; Roger described the only real discomfort as the initial numbing injections.
Early Recovery
For the first day and a half, his upper lip looked puffy, and pinpoint scabs dotted the implant sites. Those scabs—and similar ones in the donor areas—fell away by the end of the first week. One night, he accidentally scratched his lip; a simple bandage stopped the bleeding, and he wore a light dressing at night for the remainder of the week.
Results at Six Months
By month four, new hairs began to sprout, and at six months, Roger’s moustache looked continuous for the first time in his life. The tiny FUE dots under his chin and on the scalp healed into spots too small to notice. Roger says the change isn’t dramatic to strangers—but to him, it closes a decades-long chapter: “Unusual, but worth it.”
Risks and Considerations
| Category | Details | Mitigation |
| Early post‑op | Transient edema, pinpoint scabbing, rare folliculitis | Saline soaks, topical antibiotic, gentle hygiene |
| Infection (<1 %) | Introduced bacteria during implantation | Pre‑op antisepsis, prophylactic oral antibiotic in high‑risk patients |
| Graft failure | Scar hypovascularity → lower take (10–30 %) | Moderate first‑pass density; consider fat/PRP priming; stage procedures |
| Cobblestoning | Papular skin irregularity if grafts placed too superficially | Micro‑blades, careful depth control; treat late bumps with CO₂ laser |
| Mis‑angulation | “Porcupine” hairs divert attention instead of hiding scar | Surgeon experience; replace errant grafts electively |
| Cosmetic mismatch | Color/texture difference, inadequate density, patient expectations | Donor‑hair matching, pre‑op digital mock‑ups, counsel that a touch‑up may be required |
Crucially, the procedure does not erase the scar; it obscures it. Patients who intend to shave clean should be advised that the scar will again be visible when hair is removed.
Expert Overview
Professionals generally favor facial hair as a donor source for cleft lip scars due to superior aesthetic compatibility.
The 20‑patient Akdağ study cited earlier provides Level IV evidence that pre‑graft fat‑transfer plus FUE yields durable results with minimal morbidity. PubMed
Another case series from Fortune Journals demonstrated the successful use of FUE hair transplantation combined with Platelet Rich Plasma (PRP) injections to camouflage the scar and improve the surrounding skin texture. As the study states:
“In all the cases, there was a good survival rate of the healthy hair follicles, accompanied by improvement in the texture of the surrounding skin.”
Long‑term follow‑up (≥5 years in several series) confirms that transplanted follicles behave like their donor source, unaffected by androgenetic alopecia patterns in the native moustache region. Grooming needs are identical to natural facial hair—trimming, waxing, or styling as the patient prefers.
Conclusion
Hair transplantation has progressed from a fringe idea to a mainstream, evidence‑based adjunct in comprehensive cleft‑lip rehabilitation. When executed with modern FUE instrumentation, judicious graft density, and thoughtful donor matching, it reliably converts a conspicuous hairless scar into an afterthought—often in a single outpatient session under local anesthesia. Complications are minor and reversible; psychological dividends are outsized.
Key takeaways for candidates
- Indication: stable, mature cleft‑lip scar in a patient willing to maintain a moustache.
- Donor choice: beard > scalp for texture; scalp remains a dependable fallback.
- Expectations: 70–90 % graft survival, visible improvement at 4–6 months, full density by 9–12 months. A second session may be needed for perfection.
- Expertise matters: enlist a surgeon fluent in both facial aesthetic subunits and hair‑restoration micro‑techniques
For men who have already endured multiple surgeries, a few hundred carefully angled hairs can be the final, confidence‑restoring flourish—proof that in reconstructive surgery, sometimes the smallest details make the largest human difference.
Ready to take the next step toward a more confident you? Learn how Forhair, led by Dr. John P. Cole in Atlanta and New York City, can help restore natural-looking hair to cleft lip scars.
Discover your options today
Sources:
- Centers for Disease Control and Prevention. Facts about Cleft Lip and Cleft Palate (latest data update 2024).
- Bhattacharya S, et al. “Cleft Lip: The Historical Perspective.” Indian Journal of Plastic Surgery.
- Dempsey R, et al. “Revisional Techniques for Secondary Cleft Lip Deformities.” Seminars in Plastic Surgery (2021).
- Fisher D. “Anatomical Subunit Approximation Repair for Unilateral Cleft Lip.” Plastic & Reconstructive Surgery.
- Akdağ O, et al. “Camouflaging Cleft Lip Scar Using FUE Hair Transplantation Combined with Autologous Fat Grafting.” Plastic & Reconstructive Surgery (2018).
- Rajput R S. “Moustache Restoration after Cleft Lip Repair.” Journal of Cleft Lip Palate & Craniofacial Anomalies (2015).
- Hollier L H Jr., et al. “Secondary Deformities in Cleft Lip and Palate: A Review.” Plastic & Reconstructive Surgery.
- Verma V, et al. “Beard and Moustache Reconstruction.” Indian Journal of Plastic Surgery (2021).
- Garg, Suruchi , et al. “Follicular Unit Extraction (FUE) Hair Transplantation in Combination with Platelet Rich Plasma for the Treatment of Scarring Alopecia: A Case Series.”
