Nasal deformity, a common occurrence in unilateral and bilateral cleft lip and cleft palate patients, is a formidable challenge for the cleft surgeon. The underlying abnormal anatomy, aggravated by tissue scarring and loss of facial planes after primary procedures, makes secondary rhinoplasty a difficult procedure for even the most experienced. Over the past years, numerous techniques for secondary cleft rhinoplasty have been described in literature. Regardless of the technique adopted, the fundamental goal of cleft rhinoplasty is to achieve a nose that would be esthetically accepted in society as well as functionally accepted by the patient. The correction of nasal deformity can be performed with a closed or an open technique. This article highlights the open technique used for secondary rhinoplasty for a challenging case of unilateral cleft lip nasal deformity in an adult patient.