The V-Y advanced composite ap is designed following two lines: the inferior curved line following the lower border of the alar cartilage (line of the marginal incision) and the superior line located at the intercartilaginous border in both sides. The marginal line starts from the intercartilaginous border laterally and nishes before the medial wall of the nasal vestibule (Fig.8.36). The intercartilaginous line is performed in continuity with the lateral side of the marginal marking and follows the intercartilaginous border (limit between the upper and lower lateral cartilages of the nose) until its medial end (before the internal nasal valve) (Fig.8.37). Both markings are creating a V form advanced composite ap, and this triangular ap is easily designed observing the change of color; above the marginal line is red and below is the same color as the nasal skin. The lateral Z plasty is designed using two transpositional branches located at the lateral end of the V composite ap. This lat­eral design continues with the lip marking through the alar base. The main benet of the lateral Z plasty is the prevention of lateral scar contractures. These markings are performed in both sides in bilateral cleft lips (Fig.8.38). Finally, an additional marking is performed at the base of the columella, a Z plasty is designed bilaterally, the lower arm is composed by lateral prolabium aps, and the upper arm is located at the lateral side of the base of the columella (Fig.8.39). This Z plasty helps to enhance the angle between the lip and columella.