Distraction osteogenesis has become an important part of pediatric oral and maxillofacial surgery. It is especially useful in the midface to overcome the perturbations of growth caused by congenital malformations, benign and malignant tumors, and traumatic injuries. Midfacial distraction osteogenesis can take various forms, depending on the exact anatomic site where it is applied in the midfacial skeleton. This article reviews the various locations in the midface in which distraction techniques might be used and highlights the important differences in application at these sites.