The present study evaluate the effect of immediate fat gragting with primary repair of cleft lip by modified millard technique by comparing the esthetic outcome between modified millard with fat injection and modified millard without fat injection.The study was conducted on twenty patients (7 females and 13 males), their age at time of presentation ranged between two to six months complaining of unilateral complete cleft lip ,selected from the outpatient clinic of department of plastic pediatric surgery department,the specialized pediatric hospital Faculty of Medicine cairo universityThe twenty patients were randomized in to two groups 10 in each group Study group : treated with modified millard technique with immediate fat grafting at time of repair Control group : treatred with modified millard technique without fat injectionThe patients were evaluated at 1 week, 3 months and 6 months and photos were taken to be analysed by Image J software to measure alar base and philtrum ridge length and compare measures with non cleft side.The results showed significant difference in the esthetic outcome in the study group which was treated by modified millard with immediate fat grafting.We did not find any complications in both groups, no complaint from the mothers regarding the function of the mouth during feeding through follow up periods after the operation.