Leaflet modification is a necessary element in the armamentarium of the structural interventionalist and will remain an area of active investment in the future. Although leaflet splitting is proven, there are limitations in certain extreme cases. Although intraleaflet techniques are emerging and potentially have more broad applicability, there remain safety concerns with these techniques. The proposed systematic algorithms on aortic and mitral leaflet modification procedures can serve as a guide to structural operators when selecting the appropriate approach on the basis of anatomy, pathology, and procedural goals.