Obstructive sleep apnea is a multifactorial medical condition with a complex pathophysiology. Surgery becomes a primary treatment option when anatomical factors causing airway narrowing are identified at specific or generalized levels of the pharyngeal airway. Surgical procedures are targeted at the underlying anatomical structures to achieve maximum effectiveness. Key factors in selecting appropriate surgical interventions include body weight, the Mallampati score, and tonsil grade. Surgical weight reduction, maxillomandibular advancement (MMA), and pharyngeal soft tissue surgeries are considered for patients with obesity, maxillomandibular retrognathism, and tonsillar hypertrophy, respectively. A comprehensive craniofacial assessment, including cephalometry and facial aesthetics, is essential for developing an optimal surgical plan for MMA in patients with varying facial patterns. The surgical objective should ideally balance the patient’s airway needs, aesthetic considerations, and normal occlusion.