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Patients with acromegaly have a 10-yr reduction in life expectancy compared with healthy subjects when left untreated. Surgical resection can provide durable biochemical remission of disease in nearly 100% of microadenomas as well as 61% of macroadenomas. In recalcitrant cases, a combination of medical therapy and/or radiosurgery can further improve rates of remission. Despite a multi-disciplinary approach, the skeletal deformities associated with acromegaly do not necessarily reverse by correction of abnormal growth hormone dynamics. In cases with severe craniofacial deformation as a result of chronic growth hormone exposure, surgical intervention to reverse coarse facial features and airway obstruction associated with this disease can improve the quality of life of a number of patients. We will describe here the current management strategies for acromegaly, including craniofacial and plastic surgery as well as future directions in the management of this complex disease.