Despite advances in surgery and technology, velopharyngeal dysfunction (VPD) persists as a relatively common sequela of cleft palate repair. Why does palate reconstruction sometimes fail despite improvements in cleft care overall? To answer that question, it is imperative to understand modern embryological concepts and reconstructive principles. This chapter emphasizes the value of the double opposing buccal flap palatal lengthening procedure and stresses the importance of assessing tissue deficiencies. There are three learning objectives for this chapter: (1) to enhance the reader’s understanding of modern embryological concepts; (2) to describe how fundamental reconstructive principles can be used in cleft palate reconstruction; and (3) to provide readers with guidance on performing the double opposing buccal flap palatal lengthening procedure.