Treacher Collins syndrome is a complex congenital malformation. The most important manifestations of this syndrome are hypoplastic or absent malar bone, centrofacial over-projection, eyelid coloboma, and micrognathia. This article presents an approach to re-establish the right centrofacial proportions through "flattening osteotomies" of the maxilla, malar bone reconstruction, and other maxillo-mandibular osteotomies.