Revisional velopharyngeal dysfunction surgery is most commonly indicated for either hyponasality and obstructive sleep apnea or persistent velopharyngeal dysfunction. A thoughtful approach to revisional surgery is necessary to achieve optimal speech outcomes and to minimize complications. A variety of revisional techniques have been described, and treatment should be individualized to each patient’s unique anatomy and function. Physical examination, speech evaluation, and velopharyngeal imaging are helpful in formulating this surgical management plan. Secondary revisional VPD surgery can be more challenging due to scar tissue and tissue distortions, but careful planning can achieve a competent mechanism in many cases. Long-term follow-up is essential to monitor for obstructive sleep apnea.