Looking for answers after evaluation of the long-term outcomes using conservative methods, I decided to use a different technique to improve my work. Many of the primary cleft rhinoplasty techniques were used initially for secondary cases, and the V-Y advancement combined with lateral Z plasty was used with success in our sec­ondary cases. Therefore, I decided to use this well-known method primarily expecting better outcomes even when the technique is more aggressive and the risk of complica­tions is higher. It is clear now that this is not a true innovation since the technique has been currently used for secondary nose deformities and combines two previously described methods: Potter’s and Berkeley’s techniques [7, 8]. The technique was pub- lished in 2017, as the V-Y-Z cleft rhinoplasty for primary unilateral cleft lip nose repair observing good long-term outcomes after its initial use [20, 21]. The V-Y advanced composite ap was described by Potter in 1954 for secondary nasal defor­mities associated with unilateral cleft lip. The method is an effective form of nasal tip correction; however, it is not addressing the lateral vestibular web, and also the risk of lateral scar contracture is higher. This is the reason why the technique has been used in combination with lateral Z plasty (a technique previously described by Berkeley). The combination of these two techniques produces an expansion of the vestibule of the nose in a similar form as the presurgical orthopedic (NAM) is doing nonsurgically (however the effect of the orthopedics is temporary; that is why the surgery is always necessary); therefore the method was published by the author as the “surgical nasoal­veolar molding” [10]. Its use by the author in primary cleft rhinoplasty is an innova­tive proposal that allows good outcomes after long-term follow-up [21]. The method is indicated for complete unilateral cleft lip nose cases because it is preventing the scar contracture developed by using a continuous incision from the nose to the lip in these cases. This lateral incision creates frequently a lateral web, and the lateral Z plasty prevents its development. We published a study comparing three methods, Mc Comb, Potter’s, and V-Y-Z techniques, and observed increased risk of synechia using Potter and more nose deformity relapse and lateral web development after Mc Comb’s method [9]. However, considering the extended incisions along the nasal vestibule, the use of postoperative nasal conformers is mandatory. If there is not option for their use, this method should not be used because of the risk of scar contracture and syn­echia. A total collapse of the nasal vestibule may be developed because of scar con­tracture if the patient does not follow the instructions and uses regularly the postoperative nasal conformer. The rotation composite ap method can be used as alternative if the use of nasal conformers cannot be guaranteed after surgery.