Dr. Nico Sierra, cleft lip and palate surgeon

Cleft lip and palate surgery and the treatment of craniofacial conditions is a highly specialised discipline in which the surgeon's experience directly influences the results. In most cases, a person born with a cleft lip and palate will need a limited number of operations to reach a harmonious facial appearance with full function. Each surgery is a single opportunity to achieve the best possible result. Surgical precision and quality determine function, growth and facial appearance for life. Several studies have shown that patients treated by surgeons with a specific dedication to this field and a high caseload obtain better functional and aesthetic results and, often, need fewer revision surgeries over their lifetime. With a practice dedicated exclusively to cleft lip and palate surgery and other craniofacial conditions, Dr. Nico Sierra guides patients of all ages every year, from newborns to adults, through every stage of the reconstructive process, from primary surgery to the most complex secondary reconstructions. This experience makes it possible to plan each operation with a long-term view: to preserve growth, optimise function and achieve natural, lasting results. The aim is not to achieve the best possible result with the fewest operations. Achieving it requires experience, careful planning and precise technique.</p>

Cleft lip and palate surgery and the treatment of craniofacial conditions require highly specialised training that goes far beyond the medical specialty. Fellowship programmes represent the highest level of clinical and surgical training, providing intensive preparation in reconstructive surgery, multidisciplinary care and comprehensive patient management, from birth to adulthood. Dr. Nico Sierra completed a Fellowship in Craniofacial Surgery and Cleft Lip and Palate in the Department of Plastic Surgery at the Federal University of Paraná (UFPR), Brazil, one of the centres accredited by the Associação Brasileira de Cirurgia Crânio-Maxilo-Facial and internationally recognised for its excellence in this discipline. The programme combines intensive surgical activity with training within a highly specialised multidisciplinary team, taking part in hundreds of complex reconstructive procedures and in the comprehensive treatment planning of patients with cleft lip and palate and other craniofacial conditions. In addition, for almost a decade Dr. Sierra worked alongside Dr. Lluís Tresserra Llauradó, regarded as the historic reference in cleft lip and palate surgery in Spain. As a disciple and close collaborator, Dr. Sierra learned first-hand the reconstructive philosophy, the surgical technique and the commitment to excellence that characterised Dr. Tresserra's entire career. Today he continues that legacy as Medical Director of Clínica Tresserra, providing continuity of care for his patients and keeping alive the principles that defined a school of reference in our country.

Between 2019 and 2024, Dr. Nico Sierra was Chief Consulting Surgeon and Medical Director of the Comprehensive Cleft Care Centre of Mobile Surgery International (MSI) in Oaxaca, Mexico, a non-profit organisation dedicated to widening access to cleft lip and palate surgery in areas with limited resources. During that period, the centre treated more than 700 patients and performed more than 550 reconstructive surgeries aimed at treating and preventing the disabilities associated with cleft lip and palate. Dr. Sierra led the multidisciplinary team, coordinated the clinical and surgical programmes, and took part in training local and regional professionals.

The advanced, minimally invasive techniques used in modern reconstructive surgery make it possible to restore function and facial harmony while respecting the tissues as much as possible, supporting faster recovery and healthy facial growth. In addition, Dr. Nico Sierra's team uses evidence-based perioperative care protocols to minimise the impact of surgery, reduce pain, swelling and recovery time, and provide the greatest possible safety and comfort in every procedure. Each treatment is planned individually, choosing the most suitable technique according to the age, anatomy and specific needs of each patient. The aim is to achieve natural, lasting results through surgery that is as precise and gentle as possible, preserving growth, optimising function and improving the experience of the patient and their family.

The aesthetic and functional after-effects of earlier suboptimal or incomplete treatment, or of the complexity of the cleft itself, can have a significant impact on quality of life. Visible scars, asymmetries of the lip or nose, speech difficulties, and problems with breathing or feeding can persist or become more noticeable with growth, affecting function, facial appearance, self-esteem and social integration. Revision surgery aims to correct these after-effects and restore function and facial harmony. These are highly complex reconstructive procedures that require an individual assessment, meticulous planning and broad experience in surgery for the after-effects of cleft lip and palate. Dr. Nico Sierra specialises in treating patients of all ages who wish to improve the result of previous surgery. Each case is studied in a personalised way to identify the most suitable treatment options and design a plan adapted to the needs, expectations and stage of life of each patient. Revision surgery does not seek only to improve facial appearance. Its aim is to reduce the disability associated with the after-effects of cleft lip and palate, restore function and help each patient reach their full functional, social and emotional potential. It is never too late to improve. Even small changes can lead to better function, greater facial harmony and a significant impact on confidence, quality of life and wellbeing.

Dr. Nico Sierra sees patients from Barcelona, from the rest of Spain and from anywhere in the world who are looking for highly specialised care in cleft lip and palate surgery and craniofacial conditions. To make access easier for families and patients who live outside Barcelona, the team offers an adapted care model: the first consultation can be done remotely by telemedicine, with remote review of studies and images and personalised treatment planning. Surgery takes place in an accredited centre, and postoperative follow-up, in person or remotely when indicated, depends on each case, as does the length of stay. This model helps avoid unnecessary journeys, makes the best use of treatment time and supports continuity of care before, during and after surgery, wherever the patient lives. Distance should not be an obstacle to specialised care.

Dr. Sierra takes an active part in a range of projects to advance, teach and share knowledge so that more patients can benefit from high-quality care. As a member of the Paediatric Maxillofacial Surgery Unit at Vall d'Hebron University Hospital, one of the reference centres in Europe, Dr. Nico Sierra takes part in training resident doctors and specialists in cleft lip and palate surgery and craniofacial conditions, contributing to the development of the next generation of surgeons. His commitment to education goes beyond the hospital. As an international volunteer with Operation Smile, he helps train surgeons and multidisciplinary teams in different countries, contributing to better reconstructive surgery in regions with limited resources. Dr. Sierra regularly speaks at national and international congresses, advises organisations dedicated to the global development of cleft care, such as Transforming Cleft and Circle of Cleft Professionals, and is a member of the Organising Committee of the European Cleft Palate and Craniofacial Congress (ECPCA Barcelona 2027). His academic work also includes publishing scientific articles, co-authoring and editing specialist books, and collaborating on international research and innovation projects aimed at improving care for patients born with cleft lip and palate.