Hypopharyngeal obstruction in terms of tongue obstruction during sleep has been demonstrated as the second common site of airway obstruction in obstructive sleep apnea (OSA) patients and the commonest cause in the failure of uvulopalatopharyngoplasty for OSA. Assessment of tongue obstruction evolves from oropharyngeal examination, cephalometry, nasopharyngoacopy to drug-induced sleep endoscopy (diagnostic and interventional). Important findings in the dynamic lateral image of drug-induced sleep CT scan showed that obstruction of the tongue not only emerges at tongue base but evenly at tongue base, body with base, and tongue body. Many hypopharyngeal procedures have been used in multilevel surgery to improve success rate that include lingual tonsillectomy (robotic or non-robotic), tongue volume reduction via radiofrequency or coblation, genioglossus advancement/genioplasty, and tongue suspension (transoral or transcervical). The mechanism of action in these procedures is either by volumetric reduction or by stabilization of the tongue but is not in conflict with each other. Volume reduction tongue surgery (targeting on lingual tonsil) is more widely used than stabilization of the tongue (suspension). The use of robotic (transoral robotic surgery) or non-robotic (coblation endoscopic lingual lightening) is the mainstream for volume reduction tongue surgery. Otherwise, radiofrequency or coblation (channeling) has its unique role in reducing intralingual fat volume and tightening lingual muscle for enlargement of retroglossal airspace and lessening tongue collapse. It is noteworthy that stabilization technique via tongue base suspension may increase the risk of epiglottic collapse in OSA patients with long epiglottis.