Introduction: Orthognathic surgery has steadily developed since its establishment in 1849, and is characterized by consistent collaboration with orthodontics. Materials and Methods: Computer-based operation planning, that also takes resulting changes in soft tissue into account, can now be carried out through three-dimensional X-ray imaging, face scans and powerful data processing. This procedure can also be used to produce individualized osteosynthesis material and osteotomy templates, which in combination even enable orthog-nathic surgery without the use of an occlusal wafer. Piezo surgery represents a minimally invasive alternative to conventional methods for the osteotomy. As an alternative to titanium, resorbable polymers can also be used as osteosynthesis material. Conclusion: Due to modern orthodontics and computer-based operation planning, the surgery-first concept enables orthognathic surgery without prior orthodontic treatment for eligible cases. The effects of orthognathic surgery on the upper airway must be considered during planning. In addition to treating dysgnathia, orthognathic surgery expands the upper airway and has become established as a treatment option for obstructive sleep apnea. Keywords: computer-based surgery planning, effects on the upper airways, iindividualized osteosynthesis material, piezosurgical osteotomies, prediction of soft tissue changes, resorbable osteosynthesis material, surgery first