Background: The authors aimed to compare the effects of total maxillary setback osteotomy (TMSO) and anterior maxillary segmental osteotomy (AMSO) on nasolabial morphology. Methods: This retrospective clinical trial enrolled 130 patients undergoing maxillary surgery using TMSO or AMSO. Ten nasolabial-related parameters and nasal airway volume were measured preoperatively and postoperatively. The soft-tissue digital model was reconstructed using Geomagic Studio and Dolphin image 11.0. Statistical analysis was performed using IBM SPSS Version 27.0. Results: A total of 75 patients underwent TMSO, and 55 underwent AMSO. Both techniques achieved optimal repositioning of the maxilla. Except for the dorsal nasal length, the dorsal nasal height, the length of the nasal columella, and the upper lip thickness, the remaining parameters were significantly different in the TMSO group. In the AMSO group, only the nasolabial angle, the alar base width, and the greatest alar width showed significant differences. There was a significant difference in the nasal airway volume for the TMSO group. The results of matching maps are consistent with the statistical results. Conclusions: TMSO has a more significant impact on both nose and upper lip soft tissues, whereas AMSO has a more significant impact on the upper lip and less on the nasal soft tissue. There is a significant decrease in nasal airway volume after TMSO, whereas AMSO showed less decrease. This retrospective study is helpful for clinicians and patients to understand the different changes in nasolabial morphology caused by the two interventions, which is essential for effective intervention and physician-patient communication. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.