The Tessier No. 7 cleft is the most common atypical facial cleft. The deformity is a lateral facial cleft that includes a varying combination of macrostomia, perioral and lateral facial muscular diastasis, and bony abnormalities of the lateral facial skeleton. Macrostomia and lateral facial soft tissue defects are universal to the deformity, and are ideally primarily repaired in infancy (similar to the time frame in which a cleft lip would conventionally be repaired). The goals of macrostomia repair are both functional and aesthetic. Specifically, one should aim to (1) create a symmetric oral aperture with anatomic, natural appearing commissures, (2) ensure functional perioral musculature while maintaining existing muscular insertions to ensure symmetric animation and an adequate oral sphincter for speaking and feeding, and (3) minimize external scar. Multiple reports of surgical technique for macrostomia repair exist, with numerous variations described for muscular and soft tissue closure. Herein we report a straight-forward, anatomical technique for repair of a bilateral Tessier No. 7 cleft. After review of this video, viewers should be able to describe the steps in planning and execution of a Tessier No. 7 cleft repair and explain details of the repair that require attention to optimize aesthetic and functional results.