This chapter explores the conceptual rationale, surgical planning, and technical execution of box osteotomies for the treatment of orbital hypertelorism in patients with Apert syndrome. A hallmark craniofacial feature of Apert syndrome, hypertelorism, poses significant reconstructive challenges due to its variable skeletal and soft tissue components. The box osteotomy, first introduced by Tessier in 1967, remains the gold standard for medializing the orbits while preserving the medial canthal tendon. This chapter outlines the evolution of the box osteotomy and compares it with alternative techniques—such as the monobloc facial bipartition—emphasizing its superior soft-tissue-to-bone movement ratios, greater anatomical preservation, and reduced complication rates. Surgical planning, timing within a comprehensive craniofacial algorithm, and intraoperative technique are described in detail. A comparative analysis of outcomes between box osteotomies and facial bipartitions demonstrates the box osteotomy’s efficacy, safety, and versatility in achieving aesthetic and functional correction. The procedure’s role in reducing the number of staged interventions in patients with Apert syndrome is also discussed. This chapter provides an in-depth, evidence-based framework for surgeons managing hypertelorism in complex Apert craniofacial dysmorphology.