This article describes the treatment of an adult patient with a Class II skeletal malocclusion, with significant skeletal asymmetry. Two treatment alternatives were presented to the patient; one alternative involved the surgical correction of skeletal asymmetries in conjunction with orthodontic treatment, and the second alternative involved only surgically assisted palatal expansion and orthodontic camouflage of the existing skeletal problems. The patient’s desires, financial limitations, and the ability to satisfy treatment objectives without exceeding the parameters of sound orthodontic treatment are discussed. World J Orthod 2003;4:55–60.