Application of distraction osteogenesis to the human craniofacial skeleton in properly selected cases represents a major advance in the treatment of craniofacial deformities. We report our initial clinical experience with a system of miniature distraction devices that permitted maxillary, orbital, and mandibular distraction in a 4-month-old boy with unilateral craniofacial microsomia and anophthalmia. At 6 months of age, after maxillary repositioning and orbital expansion, a costochondral rib graft was used to construct the missing left mandibular ramus and condyle.