Borgos is a nice boy, 24 years old. That he needs some combined surgical orthodontic treatment is obvious. The boy insisted all should be done in one operation. Ultimately the surgical plan was as follows: Le Fort I advancement. This was a considerable advancement. (8-10mm advancement). To fit the bite he needed as well a widening of the upper jaw (2-3mm) in order  to end up with a stable transversal bite. Since the midface deficiency was extending  (as always in those cases) to the high cheekbone area and infra orbirtal rim area, we offered Borgos to built those regions up extending the same incisional Lefort I approach. We did this with non-resorbable Hydroxyapatite (Bio os)  and a human glue named Tisseel. We did not touch the lower jaw, although there was a slight transversal canting. We preferred in our planning to focus on the transversal stability with the smile distractor.