Young woman with a destructive underbite secondary to manipular retrusion. Associated with a short face and asymmetry of the face and jaw. Correction involved leveling the upper jaw (maxilla) and lengthening it anteriorly. In addition the mandible was advanced and leveled. The chin was also advanced and made longer. The residual asymmetry in the mandible was corrected by contouring the lower jaw (mandible) by removing the excess bone. This was done at one time. The jaws were fixed with internal titanium plates and screws and no inter maxillary fixation was used. Orthodontics was performed concomitantly.