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Acromegaly is a chronic and progressive disease related to a disorder of growth hormone production. It may present with a variety of clinical signs and a dento-facial deformity and this results in a loss of self-esteem and a reduction of Quality of Life. Presentation of case: A 38-years–old male patient, affected by acromegaly with class III malocclusion, noticeable nose deformity and macroglossia was treated. Bi-maxillary orthognathic surgery and partial glossectomy have been performed in one-step surgey. Open rhinoplasty was done in a second step. Both dento-skeletal class III and restoration of the facial appearance have been solved. Dento-skeletal class III was completly solved together with the restoration of the facial appearance and the patient satisfaction has been achieved. Conclusions: This case report describes the successful and stable treatment of an adult patient affected by acromegaly.