Background: Many forms of facial deformity have a strong underlying vertical deficiency. Traditionally, attempts at addressing the vertical deficiency of mandibular ramus have been rife with significant relapse. Distraction osteogenesis has emerged as a predictable and safe method to address vertical deficiencies in the facial skeleton. Objectives: To find out if correction of the vertical dimension through distraction osteogenesis allows for an appropriate aesthetic and functional correction of facial deformity, with an acceptable rate of complications. Methods: Records of 12 patients with facial deformity with a significant vertical component who underwent distraction osteogenesis of the mandibular ramus using internal distractors, placed through an extraoral approach, were assessed retrospectively. Data was collected for distraction distance, effectiveness of vector and complications encountered and analysed accordingly. Findings: All distracted bone segments achieved successful bone union. An average of 19 mm distraction distance was achieved. All except one were able to be managed subsequently with orthodontics or a common orthognathic procedure. Only significant complication encountered was one case of marginal mandibular nerve weakness. Conclusion: Distraction osteogenesis in a primarily vertical vector allows one to achieve adequate stability and to allow occlusion to reach a stage where it can be predictably managed with orthodontics, in conjunction with a regular orthognathic procedure.