BACKGROUND: Surgical advancement of the midface has undergone numerous modifications since its infancy 75 years ago, but remains a challenging and controversial area of surgery. We outline the timeline of advances in midface surgery and discuss the continuing importance of the historic context. METHODS: A literature search was completed. Search strategy included a combination of terms including midface advancement, osteotomy, Le Fort III, and distraction osteogenesis. RESULTS: The advent of midface advancement dates to a publication by Sir Harold Gillies and Stewart Harrison in 1949, with the description of an operation to reposition the recessed maxilla, noting an improvement in occlusion, proptosis, and overall facial configuration. Two decades later, Joseph Murray and Lennard Swanson, described a Le Fort III midface advancement with an additional head cap for stabilization. This was the year of Tessier’s historic presentation at the International Meeting of Plastic Surgery in Rome in 1971, a critical moment for the field of craniofacial surgery. Ortiz-Monasterio popularised the monobloc osteotomy for the correction of Crouzon deformity, whilst Synder used a canine model to demonstrate distraction osteogenesis. Twenty-years later, McCarthy would use this technique to lengthen the mandible in hemifacial microsomia, and Chin and Toth would use internal distraction devices in maxillofacial surgery. CONCLUSION: Although management of midface retrusion has been challenging, significant advancements have been made, and they continue to have relevance for today’s surgeons.