The spectacular beginning of craniofacial surgery in the modern era involved a case of craniosynostosis. Progress from that time to the present in the development of our understanding of this disease process and its management reflects the wider progress in the development and institutionalization of the discipline of craniofacial surgery. Complex surgical interventions have led the way to multidisciplinary units that have developed a greater understanding of the pathology and natural history of the craniosynostoses. New technologies have been developed to further advance the surgical techniques and these can now be evaluated by the institutions that have spawned them. This paper deals with the development of the discipline, the current status of the management of craniosynostosis, both syndromal and non-syndromal, and discusses the technological advances including imaging, distraction osteogenesis and the current status of genetic investigations.