Dogs presenting with brachycephalic obstructive airway syndrome suffer from multilevel obstruction of the airway as well as secondary structural collapse. Stenotic nares, aberrant turbinates, nasopharyngeal collapse, soft palate hyperplasia, macroglossia, tonsillar hypertrophy, laryngeal collapse, and left bronchial collapse are described as the most common associated anomalies. Rhinoplasty and palatoplasty as well as newer surgical techniques and prudent preoperative and postoperative care strategies have resulted in significant improvement even in middle-aged dogs.