Background Facial profile soft tissue changes after orthognathic surgery are crucial for surgery success. This retrospective study evaluated soft tissue changes after maxillo-mandibular Advancement and counter clockwise rotation surgery in obstructive sleep apnea syndrome patients. Methods Thirty-seven obstructive sleep apnea syndrome patients (30 male, 7 female, mean age 35.8 years) whose underwent maxillo-mandibular-advancement and counter clockwise rotation surgery were studied after two intervals of time, presurgical, postsurgical and follow up (1–6 months and 1–5 years) using Dolphing Imaging Software. The soft tissue changes that were evaluated included Glabela, nasal projection, Subnasale, superior incisor, superior lip, inferior incisor, inferior lip, soft tissue B’ point and soft tissue Pogonion. Points were measured from true vertical line on the horizontal plane according to Arnett soft tissue profile analysis. Wilcoxon test was applied for testing differences between T0 (pre surgical), T1 (1–6 months postsurgical) and T2 (1–5 years postsurgical). Results Cephalometric points changed to more aesthetic parameters. The largest advancements took place in the mandible, due to patients’ anatomic characteristics and treatment planning, whose were measured at cephalometric points B′ (9,05 mm) and Pog’ (11,92 mm) at T0–T2. In all patients aesthetics goals were accomplished. Conclusion This study showed that maxillo-mandibular advancement and counter clockwise rotation surgery is an effective treatment for OSAS, with good aesthetic results.