Patients with cleft lip and palate could develop dentofacial deformity characterized by malocclusion, midface retrusion, midline discrepancy and asymmetry. Cleft orthognathic surgery has evolved from the simple maxillary LeFort I advancement with correction of dental malocclusion to the current model of patient-centered approach focusing on skeletofacial reconstruction using computer-assisted diagnosis and planning. Three-dimensional imaging and surgical simulation have provided valuable information for facial aesthetics and surgical feasibility. Surgery-first approach and two-jaw orthognathic surgery have gradually become prevalent replacing the conventional method. A better dentofacial outcome is achieved with reduction of the burden of care.