The bilateral cleft lip and nasal repair has remained a challenging endeavor. Techniques have evolved to address concerns over unsatisfactory features and stigmata of the surgery. We present a novel approach to this complex clinical problem that modifies traditional repairs described by Millard and Manchester. The senior author has evolved this technique with over 25 years of surgical experience dealing with the bilateral cleft lip. This staged lip and nasal repair provides excellent nasal projection, lip function, and aesthetic outcomes. Lip and velar repair is performed at 3 months of age. Palatal repair and columellar lengthening is performed at approximately 18 months of age. A key component of this repair focuses on reconstruction of the central tubercle. A triangular prolabial dry vermilion flap is augmented by lateral lip vermilion flaps which include the profundus muscle. This minimizes lateral lip segment sacrifice and provides improved central vermilion fullness, which is often deficient in traditional repairs. This approach decreases tension across the upper lip, augments the tubercle, and improves the proportion between the upper and lower lip. We present the surgical technique and our outcomes.