Surgical management of velopharyngeal incompetence (VPI) aims at improving voice resonance and correcting nasal air escape by restoring a competent velopharyngeal sphincter. Assessment of VPI requires the examination of multiple variables. The dynamic study of movements of the velopharyngeal port during speech and the quantification of the closure gap, using flexible videonasoendoscopy and/or videofluoroscopy, is essential. Autologous fat injection represents a minimally invasive alternative to major surgery in the management of mild to moderate VPI that minimizes the risk of complications and sequelae, and can be performed without modifying the anatomy of the velopharyngeal port.