The treatment of adult cleft lip and palate patient with severe skeletal anteroposterior discrepancy requires orthognathic surgery. In those cases, we need to consider the previous sequential surgical history, including lip and palate surgery, velopharyngeal flap, and alveolar bone graft, which would be directly related with surgical treatment planning and relapse. We report the case of 35-year-old man who had a unilateral cleft lip and palate with skeletal Class III malocclusion, hypodivergent pattern, facial asymmetry to left side and underwent velopharyngeal surgery in childhood. Also there was constricted upper arch, especially premolar area, and severe alveolar bone defect on #21-22 area up to nasal floor without any missing tooth. As recovering alveolar bone continuity could improve stability of maxillary segment before orthognathic surgery, we planned preparation of defect site and alveolar bone graft. And healing of soft tissue would be directly related to the success of bone grafting, thus we decided to extract peg lateralis (#22). It was extracted for graft site preparation and then iliac bone graft was performed to treat his severe alveolar bone defect before pre-surgical orthodontic treatment. Then through orthodontic treatment with extraction of upper second premolars for Class II molar finishing and double jaw surgery for maxillary advancement with canting correction and mandibular set-back, his skeletal and dental problems were corrected and facial aesthetic was improved. Because we minimized advancement of maxilla segment for preventing tension of velopharyngeal flap, Class II molar and Class I canine relationships and favorable profile were well maintained after 2 years. In addition, we could consider the revision of velopharyngeal flap for increasing the amount of maxillary advancement. For orthognathic treatment of adult CLP patient, previous surgery related factors should be considered. Especially, history of velopharyngeal surgery and alveolar bone graft would influence the amount of maxillary advancement.