Surgery of the cleft lip nasal deformity presents a challenging problem for the facial plastic and reconstructive surgeon. The nasal deformity involves abnormalities in all layers, including skin, cartilage, vestibular lining, and skeletal platform. If not repaired, these deformities tend to accentuate as nasal growth continues. In the past, primary cleft lip repairs have not focused on aesthetic improvement of the nose. Primary tip rhinoplasty, with early repositioning of the nasal tip cartilages, can result in a less severe secondary nasal deformity. Secondary, or definitive, nasal reconstruction is best performed through an open rhinoplasty approach, which allows better diagnosis and treatment of cleft nasal deformities. The open approach also has the advantage of accurate placement of cartilaginous grafts that provide both structure and support. This article outlines the deformities associated with unilateral and bilateral cleft lips and outlines a treatment plan for these deformities including both primary and secondary repair. Surgery of the cleft lip nasal deformity presents a challenging problem for the facial plastic and reconstructive surgeon. The nasal deformity involves abnormalities in all layers, including skin, cartilage, vestibular lining, and skeletal platform. If not repaired, these deformities tend to accentuate as nasal growth continues. In the past, primary cleft lip repairs have not focused on aesthetic improvement of the nose. Primary tip rhinoplasty, with early repositioning of the nasal tip cartilages, can result in a less severe secondary nasal deformity. Secondary, or definitive, nasal reconstruction is best performed through an open rhinoplasty approach, which allows better diagnosis and treatment of cleft nasal deformities. The open approach also has the advantage of accurate placement of cartilaginous grafts that provide both structure and support. This article outlines the deformities associated with unilateral and bilateral cleft lips and outlines a treatment plan for these deformities including both primary and secondary repair.