The goal of cleft lip repair is an anatomic re-creation of the normal lip elements with no vertical discrepancy between the affected and normal sides of the central philtral element. Frequently, the repaired lip appears short in the vertical dimension despite careful preoperative measurements and intraoperative maneuvers. Some may be due to postoperative scar contraction, but some may be due to a failure to consider the internal surface when reconstructing the lip. Much literature has been dedicated to marking and repairing the skin and muscle of the lip; however, scant consideration has been given to careful reapproximation of the mucosal surface. The present study sought to review the literature, regarding mucosal reapproximation in unilateral cleft lip repair and to better describe closure of the mucosal surface to minimize tension and provide adequate lip length.