New York City is home to the world's largest cleft charity: The Smile Train, an organization founded in 1999 that has been providing free corrective surgery for children born with cleft lip and palate in more than 80 developing countries around the world. With massive support from doctors and other medical professionals, The Smile Train has helped over 750,000 children since it first started out.

Brian Mullaney, an advertising executive who worked with cosmetic surgeons, observed that many families could not afford to have their children undergo their services. He then began a program to address this need with the help of doctors and other professional connection. Fund-raising activities provided the necessary operating expenses, and as of 2012, The Smile Train has established partnerships with 1,100 hospitals all over the planet, mostly focusing on the poorest nations where cleft lip and palate operations are more of an economic rather than a medical problem.

The Smile Train believes that since cleft lip and palate is an easily solvable condition, every child in the world who has it should have the opportunity to live a life without the stigma that comes with it. To date, The Smile Train provides over 120,000 free cleft surgeries annually, holds 1,400+ medical conferences, and has more than 2,300 surgeons working with them, supported by some 2.3 million donors from around the world.

Aside from providing free services, The Smile Train also trains skilled medical workers in innovations in cleft lip and palate technologies and techniques. Currently headed by Robert T. Bell, Executive Director, The Smile Train's structure and operations have made the organization one of the most notable charities worldwide, seeing a growth rate of 15% yearly in their programs, and according to the foundation's reports, it has been consistent in accomplishing its goals over the years.