This video shows the pre-operative visit, surgical correction, and immediate post-operative result of a rare and difficult cleft surgery. This child has a bilateral cleft palate with a unilateral cleft lip. The combined defect leaves the nose very widely splayed and creates a significant deficiency in the lip soft tissues. The surgery was performed by Dr. Evan Ransom and a colleague, Dr. Joseph Rousso, during the Healing the Children mission to Ica, Peru, in April 2014. Sensitive viewers are advised that the intra-operative footage is graphic. For more information, or to make a charitable donation, please visit www.htcne.org.