The Class III malocclusion with mandibular prognathism and open bite can be a result of excessive mandibular growth, underdevelopment of the maxilla, environmental factors, and trauma to the jaws. Correction of this malocclusion can involve an orthodontic or a combined orthodontic-orthognathic approach. Skeletal asymmetries can complicate this situation, making treatment more difficult. This skeletal Class III deformity with skeletal open bite case presentation involves treatment with a combined orthodontic-bimaxillary orthognathic approach following rhinoplasty. In addition, the patient’s postoperative skeletal and dental stability was well-maintained after 1 year postoperation. World J Orthod 2009;10:57–66.