Trans-Palatal Advancement (TPA) remains a useful tool in the subspecialty sleep surgeon’s arsenal. With careful, considered patient selection and surgical planning, excellent results can be achieved in improving obstructive sleep apnoea (OSA) and thus reducing its associated cardiovascular risk. Our case report highlights the decision-making process, the surgical method with detailed intraoperative videos. ST was a patient with moderate OSA (AHI 22) with a high arched palate and was reviewed in a multi-disciplinary sleep centre. The patient was previously compliant with CPAP for almost a decade but remained morbidly obese and a poor surgical candidate. With the aim to come off CPAP use, he lost 45 kg (148kg to 108kg) and was then reconsidered for surgical management of OSA. Awake and sleep dynamic assessment of his anatomy indicated partial concentric retropalatal collapse with a minor lateral muscular wall with tonsillar generated collapse at the oropharyngeal level. TPA is usually reserved for long vertical soft palates that does not create enough retropalatal space with a modified uvulopalatoplasty (mUPPP) alone. It also potentially increases stiffness of the oropharyngeal lateral muscular wall by tensing the muscles that are attached to the posterior edge of the hard palate. This patient had a TPA as part of multi-level sleep surgery including a tonsillectomy, mUPPP, lingual tonsillectomy and radiofrequency tongue channelling. This procedure was filmed in close detail with patient consent, outlining the many different steps and technique utilised by our subspeciality sleep surgical clinicians with the aims to correct the clear retropalatal collapse. Post operatively, AHI was reduced from 22 to 9 and was able to have a significant subjective improvement in his sleep. Our case study explains the careful use of TPA as an effective surgery for patients with narrow high arched palate and retropalatal collapse that can be improved.