Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the upper lip and alveolus reconstruction. Preserving the blood supply, the lip and alveolus was successfully separated and reconstructed to create the labial vestibule. Pre-maxillary setback was done using Paul Black technique. Following surgery and suture removal there was good healing. The boy’s appearance, speech and eating improved significantly. The boy and his family were very happy with the defect correction and went back to their hometown and they are to return for further cleft management.