The achievement of an “optimal” aesthetic and functional result in the corrective surgery of the cleft nose is a formidable undertaking. There are significant differences between the goals of conventional rhinoplasty and this for patients with cleft deformities. In as much as in conventional rhinoplasty the tasks are usually related to reduction, definition and balance the goals in cleft nose are mainly correction of severe asymmetries and functional disturbances. It is also more common than not to encounter multiply operated previously nose and it is uncertain what the surgeon will find while operating on it. Deficiency of skeletal support, dysmorphic and iatrogenically affected morphology, scarring and deficit of healthy mucosa are amongst the most common problems in this patient population. What should be the goal of the surgeon? Is it to achieve a resemblance of “normalcy” or to create a “beauty”? What are the means to achieve these elusive goals? The author’s personal philosophy and techniques will be presented. Triumphs as well as bitter disappointments will be illustrated.

Conflict of interest: None declared.