A severe Class III malocclusion with maxillary transverse and anteroposterior deficiency, mandibular prognathism, and excessive lower facial height is presented. The malocclusion was treated with a combination of orthodontics and a 2-stage surgical treatment: a surgically assisted rapid palatal expansion prior to a sagittal mandibular and chin reduction and Le Fort I osteotomies. The patient exhibited excellent stability 6 years after treatment. The controversy regarding one surgery or a 2-stage surgical approach is discussed briefly. (Int J Adult Orthod Orthognath Surg 2001;16:200-;206)