Facial asymmetry involving extensive maxillofacial skeletal discrepancy presents a complex surgical challenge. This case report presents a comprehensive surgical solution for a 35-year-old woman with pronounced facial asymmetry due to unilateral mandibular hypoplasia. The patient was treated using a surgery-only orthognathic approach combined with adjunctive facial contouring and revision genioplasty. The surgical plan included Le Fort I osteotomy and a combination of sagittal split and vertical ramus mandibular osteotomies, supplemented by reduction malarplasty, reduction mandibular anguloplasty, buccal fat pad removal, and revision genioplasty following liquid silicone extraction with genial muscle realignment. The patient’s preexisting stable occlusion allowed for the omission of orthodontics, aligning with her primary aesthetic concerns. Postoperative assessments over 12 months demonstrated stable occlusion, enhanced facial symmetry, and high patient satisfaction. This case supports that, in carefully selected patients, a surgery-only orthognathic approach combined with targeted facial contouring can provide efficient, predictable, and aesthetically favorable correction of complex facial asymmetry.