Previous studies have documented the stability of Class III surgical procedures in the first postsurgical year and during a postsurgical period > 2 years. To evaluate long-term changes, postoperative cephalometric radiographs at 1 year and ≥ 5 years were digitized for 79 patients who had received either a bilateral sagittal split osteotomy for mandibular setback, a Le Fort I maxillary advancement, or a combination of the 2 procedures. From 1 year to longest follow-up, the mean changes were quite small. Eighty-five percent of the maxillary advancement group and the mandibular setback group and 80% of the bimaxillary surgery group showed less than 4 mm of postsurgical change from 1 year to ≥ 5 years. Long-term, the mandibular setback alone was more stable than when combined with maxillary surgery. This is opposite of what was observed during the first postsurgical year. Bimaxillary surgery in Class III patients improved the stability of the mandibular setback short-term and the maxillary advancement in the short and long term if the maxilla was also moved down during surgery. This study also suggests that bimaxillary surgery in Class III patients is more stable than bimaxillary surgery in Class II patients.On questionnaires that evaluated patient perception, 92% of patients reported satisfaction with healing since surgery. Eighty-nine percent thought their experience was positive and were happy with the surgical results. The predominant problems were altered feelings in the face or mouth (68%) and surprise at the length of their recovery (41%).