Le Fort III osteotomy is a subcranial procedure aimed at correcting midfacial retrusion, inverted bite, and exophthalmos, with a demonstrated positive effect on obstructive sleep apnea syndrome. In our unit, most patients with Apert syndrome benefit from a two-step protocol involving an early frontofacial monobloc advancement followed by a Le Fort III osteotomy using combined internal and external distraction, performed as late as possible based on respiratory monitoring. This two-step protocol has satisfactory respiratory and morphological results even if relatively low patient numbers do not allow formal quantitative assessments. Furthermore, the association of facial bipartition and transversal maxillary expansion with Le Fort III osteotomy seems to be a reliable tool for the correction of the specific orbito-palpebral anomalies of Apert syndrome, without significant added morbidity.