Surgical interventions for the upper airway have long been a part of treatment algorithms for sleep-disordered breathing. Genioglossus advancement is one such procedure designed to specifically treat obstructed breathing related to hypopharyngeal collapse. The procedure involves surgical manipulation of the genioglossus muscle's attachment to the mandible. The result is reducing obstruction at the hypopharynx and tongue base by displacing this musculature anteriorly. The last 30 years have introduced variations of the procedures and further explored the relevant anatomy. Although there is a paucity of high-level evidence, studies have shown promising outcomes when the procedure is tailored to those with appropriate anatomy and pathophysiology.