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Correction of secondary deformities of the midface can happen even for the most experienced surgeons due to inadequate reduction. This chapter categorizes the correction of secondary defects based on the initial fracture patterns and deformity of midface caused by medial canthal deformity, orbitozygomaticomaxillary complex (OZMC) fractures and Le Fort fractures. The secondary correction of the central midface will be covered briefly in the context of Le Fort II and III fractures. Medial canthal correction can be done by osteotomy or epicanthoplasty techniques. Complications of OZMC fractures include poor 3-dimensional reduction resulting in residual cosmetic deformities and an increase in orbital volume with subsequent enophthalmos or dystopia. This can be corrected by onlay of bone or other materials if there are no associated ocular findings and reconstruction of the internal orbit. OZMC osteotomy is the optimal technique to address orbital volume, dystopia and projection, and width of the face. The key fit of the bony fractures at the zygomaticofrontal sutures, orbital rim, and lateral buttress of the maxilla are lost in delayed repair due to bone remodeling. Hence techniques such as intraoperative navigation, imaging, preoperative surgical cutting, and repositioning guides are of value. The most common maxillary defects encountered after Le Fort fractures are midface retrusion, decreased midfacial height, and anterior open-bite. Patients with Le Fort II or III fractures would benefit from reestablishing the old fractures and mobilization to help correct the orbital rim position and the malocclusion at the same time. Often recreation of the Le Fort II or III fractures may not help obtain the desired occlusion due to remodeling and associated soft tissue changes. In such situations, the Le Fort I osteotomy should be completed at the same time. The technique is similar to that of the Le Fort I osteotomy performed in orthognathic surgery, utilizing dental models and surgical splints.