Patients with repaired cleft lip and palate often require orthognathic surgery and rhinoplasty to achieve better aesthetics and function. Conventionally, rhinoplasty is performed as a staged procedure after orthognathic surgery. An online search by the author through PubMed and Google Scholar revealed one article describing simultaneous Lefort I osteotomy and rhinoplasty for a bilateral cleft lip and palate patient. This paper reports on a case of simultaneous Lefort I osteotomy, mandibular bilateral saggital split, genioplasty and rhinoplasty for a repaired unilateral cleft lip and palate patient. It also touches on certain operative considerations for the surgeon performing this operation.