Aim: Obstructive sleep apnea (OSA) is a significant health issue with considerable public and personal costs. This study evaluated the efficacy of a modified version of barbed reposition pharyngoplasty (BRP) and coblation tongue channelling (CCT) in adult OSA patients. Additionally, we assessed airway obstruction sites using the Velum, Oropharynx, Tongue base, and Epiglottis (VOTE) classification during awake nasoendoscopy to identify the most correctable types of airway collapse. We propose that Friedman staging is not a reliable predictor of surgical success, suggesting the need for a new prognostic index. Methodology: A prospective, two-centre cohort trial was conducted to evaluate outcomes of combined modified BRP and CCT in 105 adult OSA patients. Polysomnography, Epworth Sleepiness Scale (ESS), and VOTE anatomy assessments were performed preoperatively and three months post-surgery by a single investigator. The results showed significant improvements in sleep quality, daytime alertness, and upper airway anatomy. Results: The study enrolled 105 participants (77% male; mean age 40.7 ± 12.7 years). Statistically significant improvements were observed in AHI and ESS. Mean AHI improved from 32.4 ± 23 to 12.1 ± 14.5 (p = 0.000), and mean ESS improved from 12.7 ± 5 to 5.3 ± 3.8 (p = 0.000). Surgical success was achieved in 78.9% of patients, with 77.6% no longer requiring CPAP postoperatively and 43% being cured (AHI < 5 and AHI reduction > 50% from baseline). Most patients (37.1%) had Friedman stage 3 anatomy; from this cohort, 79.3% achieved success and 48% were cured. Conclusion: Modified BRP with CCT is a safe and effective surgical option for OSA patients. Friedman stage III anatomy is not a barrier to success. Future studies should investigate new staging systems to better predict postoperative outcomes of modern sleep surgery techniques.