The surgery-first(SF) approach is a clinical treatment that proceeds with the orthognathic surgery in the beginning without presurgical orthodontic preparation or with minimal orthodontic preparation(MOP)for less than 6 months. Preoperative orthodontic procedures of conventional orthodontic-orthognathic treatment requires longer pre-surgery time, and patients with skeletal Angle Class Ⅲ malocclusion suffer from negative esthetic and functional effects. SF has been proposed to resolve thes erelevant inconveniences. However, compared to conventional treatment, SF approach has a relatively unstable postoperative occlusion which increases the risk of relapse. This article summarizes the history, advantages and disadvantages, indications, and post-operative stability of SF in skeletal Class Ⅲ malocclusion.