Introduction: Face form is largely dictated by one__ampersandsignrsquo;s ethnic origin and genetic inheritance. Individuals presenting with significant facial disproportion may be disadvantaged both aesthetically and functionally. Surgery First Orthognathic Approach (SFOA) is a novel approach which was floated initially a decade ago. . The major driving factor for SFOA is the immediate esthetic results for the patient as well as reduction of the duration of treatment. Objective: To reliably predict the final structural, functional and esthetic outcome of patients with facial disproportion undergoing __ampersandsignldquo;Surgery First Orthognathic Approach (SFOA)__ampersandsignrdquo; before the commencement of procedure and compare it with the final achieved result. Methods: Study conducted at our centre was a prospective study over 24 months. Participants with facial disproportion who met the criteria for SFOA were included in our study. Complete data acquisition was carried out for all the participants, following which both conventional and digital assisted cephalometric analysis was done. Based on these analyses, the treatment plan was formulated and the surgical procedure was finalized. At 6 month, post-op lateral cephalogram was obtained and both conventional and digital assisted cephalometric analysis was done and compared with a predicted outcome. Results: Twelve participants reported with facial discrepancy during our study period, of which seven participants met the criteria for SFOA. Among seven participants, all had manual and Digital assisted cephalometric tracing. Four Participants had Computer Assisted Surgical Simulation (CASS). Our result showed no statistically significant differences between the predicted and final outcome in both conventional and digital assisted cephalometric analysis. Conclusion: In our study, we found that the maxillary repositioning was reliably predicted by both Conventional and digital assisted Cephalometric prediction analysis whereas conventional prediction was still much better than the digital prediction for mandibular repositioning.