Jaw Surgery

Introduction

If your dentist, orthodontist, or surgeon has told you that jaw surgery may be part of your treatment plan, you are likely weighing a lot of questions at once. Jaw surgery is a significant operation. It is also, for the right patient, a procedure that changes how the teeth meet, how the face is balanced, how comfortably you chew and speak, and sometimes how well you breathe at night.

This guide is written for patients who already know that jaw surgery is on the table — either being planned, being considered, or scheduled. It explains what the operation is, the different approaches surgeons use, how to prepare, what happens on the day of surgery, what the weeks and months of recovery look like, and what outcomes patients can reasonably expect. The aim is to help you understand the medical landscape so that the conversation with your own surgical and orthodontic team is easier to follow.

Jaw surgery is rarely a stand-alone event. It is usually part of a longer journey that includes braces or aligners before the operation, the surgery itself, and a second phase of orthodontic fine-tuning afterwards. Understanding the full arc is the best way to feel prepared.

What Is Jaw Surgery?

Jaw surgery, known clinically as orthognathic surgery (from the Greek words for “straight” and “jaw”), is a surgical procedure that repositions one or both jaw bones to correct problems with how the upper and lower jaws fit together. It is performed by an oral and maxillofacial surgeon, typically in coordination with an orthodontist.

During surgery, the surgeon makes precise cuts in the jaw bone (called osteotomies), moves the bone into a new, planned position, and fixes it there using small titanium plates and screws. These plates usually stay in place permanently and are not felt under the skin.

Jaw surgery is different from cosmetic facial surgery. The primary goal is functional: to correct the way teeth bite together and how the jaws work. Improvements in facial balance and profile happen alongside the functional correction, because the position of the jaws strongly influences the shape of the lower face.

Why Is Jaw Surgery Performed?

Jaw surgery is considered when the upper and lower jaws are positioned in a way that braces or aligners alone cannot fix. Orthodontics can move teeth within the jaw bones, but it cannot move the bones themselves. When the underlying skeleton is the source of the problem, surgical repositioning is the way the bite can be reliably corrected.

Common reasons a surgeon and orthodontist may recommend jaw surgery include:

• Severe underbite — where the lower jaw projects forward of the upper jaw, often because the lower jaw is too large, the upper jaw is too small, or both.
• Severe overbite or overjet — where the upper teeth and jaw project well in front of the lower jaw.
• Open bite — where the front teeth do not meet when the back teeth are closed, leaving a visible gap.
• Crossbite — where some upper teeth sit inside the lower teeth when biting down, often linked to a narrow upper jaw.
• Facial asymmetry — where one side of the jaw has grown differently from the other.
• Chronic difficulty chewing or biting food.
• Speech problems related to jaw position.
• Obstructive sleep apnoea — where the airway is narrowed at night, sometimes because of small or set-back jaws.
• Significant temporomandibular joint (TMJ) pain that has been linked, after careful assessment, to jaw position.
• Excessive tooth wear caused by a bite that does not distribute forces evenly.
• Congenital or developmental conditions such as cleft lip and palate, where the jaws may not develop in proportion.

Surgeons generally consider jaw surgery only when the problem is significant enough to affect function or health, and when non-surgical options have been carefully evaluated.

Who Is a Candidate?

Candidacy for jaw surgery is decided through a joint assessment by an orthodontist and an oral and maxillofacial surgeon, often with input from a dentist and sometimes a sleep physician. Several factors are weighed.

Skeletal maturity

Jaw surgery is usually performed once facial growth is complete. For most girls, this is around the mid- to late teens; for most boys, slightly later, often into the late teens or early twenties. Operating before growth is finished risks the jaws moving again as growth continues. Some growth-related conditions are exceptions and are managed differently — this is a clinical judgement made by the surgical team.

The nature of the bite problem

The discrepancy between the jaws must be in a range that orthodontics alone cannot correct. Mild to moderate bite problems can often be managed with braces, aligners, or a combination including small dental procedures. Larger skeletal differences are where surgery is typically considered.

General health

Because the operation is performed under general anaesthesia and involves several hours of surgery, a candidate should be in reasonable general health. Conditions such as poorly controlled diabetes, bleeding disorders, heart disease, or active gum disease will need to be addressed or stabilised before surgery is scheduled.

Commitment to the full treatment plan

Jaw surgery is part of a longer process. Most patients wear braces or aligners for 12 to 18 months before the operation and for several more months afterwards. A candidate needs to be ready for that time commitment and for the recovery period itself.

Realistic expectations

A clear understanding of what surgery can and cannot achieve is important. The operation reliably corrects bite and skeletal position. It also changes facial appearance, often noticeably. A pre-surgical consultation usually includes a discussion of likely changes so that expectations are aligned with what the surgery is designed to do.

Alternatives to Consider

Before agreeing to jaw surgery, most patients have a conversation with their orthodontist and surgeon about whether other options might work. Whether an alternative is appropriate depends on the severity and type of the bite problem, and that decision belongs to your clinical team. The main options that may be discussed include:

Orthodontics alone

For mild and some moderate bite problems, braces or clear aligners can move the teeth enough to produce a functional and acceptable bite, even when there is some underlying skeletal mismatch. This is sometimes called “dental camouflage” because the teeth are positioned to compensate for the jaw position. It works best in less severe cases and where the patient prioritises avoiding surgery.

Growth modification in children and adolescents

In younger patients whose jaws are still growing, orthodontists sometimes use appliances designed to influence the direction of jaw growth. This may reduce the size of the discrepancy by adulthood and, in some cases, change whether surgery becomes necessary later. Growth modification is only an option while growth is still happening.

Tooth extractions combined with orthodontics

Removing certain teeth can create space that allows orthodontics to correct a bite that might otherwise need surgical help. This is a long-standing approach for some specific patterns of malocclusion.

Restorative dentistry

Crowns, veneers, or bite-raising restorations are sometimes used to improve how teeth meet, particularly when the discrepancy is small and largely cosmetic.

Treatment for sleep apnoea by other means

Where the main reason for considering surgery is obstructive sleep apnoea, alternatives such as CPAP (continuous positive airway pressure) therapy, mandibular advancement devices worn at night, and weight management may be discussed. Jaw surgery is typically considered when these have not been adequate, or in carefully selected patients where the jaw anatomy is the dominant factor.

Major professional associations of oral surgeons and orthodontists encourage a full discussion of alternatives before surgery is planned, so that the choice is informed.

Surgical Approaches

The term “jaw surgery” covers several distinct operations, alone or in combination. The specific approach depends on which jaw is in the wrong position and how it needs to move — forward, back, up, down, rotated, or widened. The most common procedures are described below.

Maxillary osteotomy (upper jaw surgery)

This operation, also called a Le Fort I osteotomy, repositions the upper jaw. The surgeon cuts the maxilla above the roots of the teeth and frees it from the rest of the facial skeleton so it can be moved into its new planned position. The upper jaw can be moved forward, backward, upward, downward, or tilted, depending on what the bite and facial balance require. It is commonly used for open bite, crossbite from a recessed upper jaw, gummy smile related to a long upper jaw, or as part of correcting an underbite together with lower jaw surgery.

Mandibular osteotomy (lower jaw surgery)

The most common lower jaw operation is the bilateral sagittal split osteotomy (BSSO). The surgeon makes a controlled split in the back portion of the lower jaw on each side, which allows the tooth-bearing front section to be moved forward or backward as planned. BSSO is used to correct underbite (by moving the lower jaw back) or overbite and small lower jaw (by moving the lower jaw forward). When the lower jaw is advanced, the airway behind the tongue is widened, which is one of the reasons this approach is used in obstructive sleep apnoea surgery.

Bimaxillary surgery (both jaws)

Many patients need surgery on both the upper and lower jaws at the same time. This is called bimaxillary or “double jaw” surgery. It is often the approach used for larger skeletal discrepancies, significant asymmetry, or sleep apnoea where both jaws need to be advanced. Operating on both jaws gives the surgeon more flexibility to plan the final position of the teeth and the face together. The operation is longer than a single-jaw procedure but the recovery pattern is broadly similar.

Genioplasty (chin surgery)

The chin is part of the lower jaw but can be repositioned on its own. A genioplasty involves cutting the lower edge of the chin bone and moving it forward, backward, up, down, or to one side. It is often performed at the same time as upper or lower jaw surgery to fine-tune the lower face, but it can also be done as a stand-alone procedure when the bite is acceptable and only the chin needs adjustment.

Surgically assisted rapid palatal expansion (SARPE)

In adults whose upper jaw is too narrow, the bones of the palate have fused and cannot be widened by orthodontics alone. SARPE is a smaller surgery that releases the bones of the upper jaw so that an expander appliance can gradually widen the jaw over weeks. It may be a stand-alone procedure or a first stage before a later, larger jaw operation.

Distraction osteogenesis

In some complex cases, particularly large jaw movements, severe asymmetry, or congenital conditions, the surgeon uses a technique called distraction osteogenesis. After a bone cut is made, a small device is fitted that the patient adjusts daily over several weeks. The bone gradually lengthens as new bone forms in the gap. This is a specialised approach used in selected cases.

Preparing for Jaw Surgery

Preparation for jaw surgery is unusually thorough because the operation depends on precise planning of how the teeth and jaws will fit together afterwards. The preparation phase often lasts a year or more.

Pre-surgical orthodontics

Most patients wear braces or aligners for 12 to 18 months before surgery. The purpose is to level and align the teeth within each jaw so that, once the jaws are repositioned during surgery, the teeth meet correctly in their new alignment. This phase often involves moving the teeth in a way that temporarily makes the bite look worse, because the surgical correction is what will bring everything together. Understanding this in advance helps patients trust the process when their bite seems to be getting more uneven before the operation.

Imaging and digital planning

Before surgery, the team collects detailed records: dental impressions or digital scans, photographs, panoramic and cephalometric X-rays, and often a cone-beam CT scan that gives a three-dimensional picture of the facial skeleton. Modern planning uses these to create a virtual model of the surgery. Your surgeon can simulate where each jaw segment will move and predict how the bite and face will look afterwards. Custom-made surgical splints or guides are sometimes printed from the digital plan and used during the operation to position the bones precisely.

Medical evaluation

You will have a pre-operative health check, including blood tests, an ECG in some cases, and a review of any medications you take. Tell your team about all prescription drugs, over-the-counter medicines, herbal supplements, and any history of bleeding problems, allergies, or reactions to anaesthesia.

Lifestyle preparation

Several practical steps help healing:

• Stop smoking well before surgery. Smoking slows bone healing and increases the risk of complications. Most surgeons ask patients to stop several weeks before the operation and not to restart during recovery.
• Limit alcohol in the weeks before surgery.
• Maintain excellent oral hygiene, including regular dental cleanings, so that the mouth is as healthy as possible going into surgery.
• Plan time off work or studies. Most patients need two to four weeks before returning to non-physical work, and longer for physically demanding jobs.
• Stock your kitchen. A soft and liquid diet will be your main food for several weeks. Smoothies, soups, blended foods, yogurts, and nutritional drinks are useful to have ready.
• Arrange a carer. You will need someone with you for at least the first few days after discharge.

Emotional preparation

Jaw surgery changes facial appearance, sometimes noticeably. Many patients find it helpful to discuss this in advance with their surgeon, look at predictive imaging, and speak with others who have had the operation. Some surgical centres offer a meeting with a counsellor or psychologist where this is useful.

What Happens During Jaw Surgery

Jaw surgery is performed in a hospital, under general anaesthesia. You will be asleep throughout and will not feel any pain during the operation.

An important feature of orthognathic surgery is that, in nearly all cases, the cuts are made inside the mouth. This means there are no visible scars on the face. The surgeon works through incisions in the gums or inside the cheeks to reach the underlying bone.

A typical operation includes the following steps:

• The anaesthesia team places you under general anaesthesia and inserts a breathing tube, usually through the nose.
• The surgeon makes the planned incisions inside the mouth to expose the jaw bone.
• Using fine surgical instruments, the surgeon makes precise cuts in the bone according to the plan.
• The freed segment of bone is moved into its new position. Surgical splints made from the digital plan help guide the placement.
• Small titanium plates and screws are fixed across the bone cuts to hold the new position. These usually stay in place permanently. They are not usually visible or felt and do not normally need to be removed.
• The gum and mucosal incisions are closed with dissolving stitches.

The length of surgery depends on the procedure. A single-jaw operation often takes two to three hours; a two-jaw operation, with or without genioplasty, can take four to six hours or more.

After the operation, you are taken to a recovery area and then to a hospital ward. Many surgeons no longer wire the jaws together. Instead, small elastic bands attached to the orthodontic braces guide the jaws into the correct position while still allowing limited opening. This is more comfortable and safer than the older practice of full wiring.

Recovery and Healing

The hospital stay

Most patients spend one to three nights in hospital. During this time:

• Pain is managed with medications given through a drip and then by mouth.
• Swelling builds over the first 48 to 72 hours and is usually at its peak around day three.
• Ice packs or cold compresses are used around the face to help reduce swelling.
• You will be offered a liquid diet and helped to take small sips.
• You will be shown how to keep your mouth clean using gentle rinses and a soft toothbrush.
• The nursing team will monitor breathing, particularly important after upper jaw or two-jaw surgery because of swelling around the nose and palate.

The first two weeks at home

This is generally the hardest part of recovery. Expect:

• Significant swelling of the face, lips, and sometimes the eyes. Bruising may appear in the cheeks and neck. Swelling begins to reduce noticeably from the end of the first week.
• Numbness or altered sensation in the lips, chin, gums, or cheeks. This is normal after the operation because nerves running through the jaw bone are stretched.
• Difficulty speaking clearly because of swelling and unfamiliar jaw position.
• A liquid diet — smoothies, soups, blended meals, milk, and nutritional drinks. Adequate nutrition is important for healing, so keeping calories and protein up matters even when appetite is low.
• Mouth cleaning with a soft brush and prescribed rinses.
• Limited activity. Rest with the head slightly elevated helps swelling go down. Light walking is encouraged.
• Follow-up visits with the surgeon to check healing and adjust the guiding elastics.

Weeks three to six

Most patients begin to feel more like themselves during this period. Major swelling continues to decrease, although a degree of puffiness lingers for months. Diet typically progresses from liquids to soft foods such as scrambled eggs, well-cooked pasta, soft fish, and mashed vegetables. Patients with desk-based jobs often return to work around three to four weeks, depending on energy levels and how visible the swelling still is.

Six weeks to three months

By six weeks, the bone is well on its way to healing in its new position, although full bony union takes longer. Diet can be advanced further, with the surgeon’s guidance, towards normal textures. Physical activity is gradually resumed. Contact sports are usually avoided for three to six months. Numbness in the lips and chin often starts to improve during this period, although it can take much longer to resolve fully.

Three to twelve months

Subtle swelling continues to settle over many months, which is why the final facial appearance is judged at around a year, not at a few weeks. Orthodontic treatment usually resumes around four to eight weeks after surgery to fine-tune the bite. This second phase of braces or aligners often lasts six to twelve months.

Beyond one year

Most patients are considered fully healed by 12 months. A retainer is usually worn long-term to keep the teeth in their final position, just as after any orthodontic treatment.

Risks and Complications

Jaw surgery is generally safe when performed by experienced oral and maxillofacial surgeons in a well-equipped setting. As with any major operation, it carries risks that should be understood before consenting.

Possible complications include:

• Numbness or altered sensation. This is the most common after-effect. Nerves that run through the jaw, particularly the inferior alveolar nerve in the lower jaw, can be stretched during surgery. Most sensation returns over weeks to months, but a small minority of patients have areas of permanent numbness, most commonly in the lower lip and chin after lower jaw surgery.
• Infection. Mouth bacteria mean infection is possible. It is usually managed with antibiotics and good oral hygiene; serious infections are uncommon.
• Bleeding. Some bleeding is expected. Significant bleeding requiring transfusion is uncommon but possible, particularly with larger movements or two-jaw surgery.
• Problems with bone healing. In rare cases, the bone segments do not unite as expected. This may require additional treatment.
• Hardware issues. The titanium plates and screws are usually well tolerated, but occasionally one may need to be removed if it causes irritation or infection.
• TMJ symptoms. The temporomandibular joint may become sore or stiff after surgery. In most cases this settles. Some patients experience longer-term TMJ issues; pre-existing joint problems are discussed during planning.
• Changes in bite. Small unplanned shifts can occur during healing and are corrected with post-surgical orthodontics.
• Relapse. Over time, jaws can move slightly back towards their original position. Modern planning and rigid fixation reduce this risk; retainers help maintain results.
• Sinus problems after upper jaw surgery, usually temporary.
• Nasal changes. Upper jaw surgery can slightly widen the base of the nose. Surgeons use techniques to minimise this where it matters to the patient.
• Anaesthesia-related risks, which the anaesthetist will review with you separately.
• Emotional adjustment. Facial change, even when planned and desired, can take time to get used to. Some patients experience low mood during the swelling-heavy early recovery.

Your surgeon will discuss which risks are most relevant to your specific operation.

Life After Jaw Surgery

The combination of repositioned jaws, correctly meeting teeth, and finished orthodontics produces results that are designed to be long-lasting. Most patients report meaningful changes in several areas of daily life.

Functional changes

Patients often describe being able to chew a wider range of foods more comfortably, bite into things like sandwiches and apples for the first time in years, and speak more clearly. Where jaw surgery was used to treat obstructive sleep apnoea, many patients see substantial improvement in sleep quality and daytime alertness; the degree depends on the individual airway anatomy.

Facial appearance

Because the jaws form the foundation of the lower face, repositioning them changes how the face looks. The change may be subtle or quite noticeable, depending on how much movement was needed. Many patients say the change feels like “looking more like themselves” rather than looking different; for others, the change is significant and takes time to integrate emotionally. The final appearance is best judged after a year, when residual swelling has fully settled.

Long-term dental health

A bite that distributes chewing forces evenly tends to wear teeth less unevenly, makes cleaning easier, and supports the long-term health of the gums and jaw joints. Continued routine dental care is important to maintain these benefits.

Sensation

By a year, most sensation in the lips, chin, and cheeks has usually returned, although some patients have residual mild numbness that may be permanent. Most people adapt without lasting impact on daily life.

Ongoing orthodontic retention

As with any orthodontic treatment, a retainer is usually worn long-term, often nightly, to maintain the position of the teeth.

Jaw Surgery and Younger Patients

Parents of children and teenagers who have been told that jaw surgery may eventually be needed often have a particular set of questions. The most important point is that jaw surgery is usually delayed until facial growth is complete. Operating earlier risks the corrected position shifting as growth continues.

While waiting for skeletal maturity, the orthodontist may use growth-modifying appliances, early braces, or expanders to manage the situation and, in some cases, reduce how much surgical movement will eventually be needed. Some growth-related conditions, including significant asymmetries, severe sleep apnoea in children, and certain craniofacial conditions, may need earlier surgical input; these are specialist decisions made case by case.

For most teenagers, the typical pathway is:

• Monitoring of jaw growth through adolescence.
• Pre-surgical orthodontics started once growth is nearly complete.
• Surgery in late adolescence or early adulthood.
• Final orthodontics and long-term retention afterwards.

Open conversation between the orthodontist, oral surgeon, and family helps everyone plan around school, exams, and other life commitments.

Frequently Asked Questions

Will I have visible scars on my face after jaw surgery?

In almost all cases, no. Modern jaw surgery is done through cuts inside the mouth, so there are no scars on the face. A small external scar is sometimes left when a chin operation is done from below, but this is unusual.

Will my jaws be wired shut?

Most surgeons no longer wire the jaws fully shut. Instead, small elastic bands attached to orthodontic brackets guide the bite while allowing limited opening. This is more comfortable, safer, and makes early recovery easier.

How long until I can eat normally again?

You will be on liquids for the first one to two weeks, then soft foods for several more weeks. Most patients are eating a near-normal diet by around six to eight weeks, with guidance from their surgeon.

Will I look very different afterwards?

Your face will change because the bones that shape the lower face are being moved. The size of the change depends on how much the jaws need to move. Most patients say they still look like themselves, but more balanced. Predictive imaging before surgery helps you understand what to expect.

Is the numbness permanent?

Some numbness in the lips, chin, or cheeks is normal after surgery and usually improves over weeks to months. A minority of patients have small areas of permanent altered sensation, most often after lower jaw surgery. Most people adapt and do not find it limiting.

Do the plates and screws need to be removed later?

Usually not. The titanium plates and screws are designed to stay in place permanently and are normally not felt. They are removed only if they cause problems, which is uncommon.

When can I go back to work or school?

Many patients return to desk-based work or studies between two and four weeks after surgery, depending on energy and comfort with appearance. Physically demanding jobs and contact sports take longer.

Will I need braces after surgery as well as before?

Yes. Post-surgical orthodontics, usually lasting six to twelve months, is part of the standard treatment plan to fine-tune the final bite.

Can jaw surgery treat sleep apnoea?

For carefully selected patients, advancing the jaws (especially both jaws together) widens the airway and can substantially improve obstructive sleep apnoea. Whether this is the right treatment depends on the type and cause of the apnoea and is decided with a sleep physician and surgeon.

Are the results permanent?

The repositioned jaws are designed to be a permanent correction. Long-term retention with a retainer keeps the teeth aligned. Some small changes over years are possible, but major relapse is uncommon when the treatment plan is followed.

Conclusion

Jaw surgery is a major step, but for patients whose bite and jaw position cannot be corrected by orthodontics alone, it can make a lasting difference to how the teeth meet, how the face is balanced, how comfortably daily life happens, and, in selected cases, how well a person breathes at night. The operation itself takes a few hours; the journey around it — orthodontics before, surgery, recovery, and orthodontics after — takes one to two years for most patients.

Understanding the stages of that journey, the choices among surgical approaches, and the realistic shape of recovery is what allows you to walk into your consultations with confident, specific questions. The decisions ahead — whether to proceed, when, with which approach — belong to you and your surgical and orthodontic team together. The clearer the picture you carry into that conversation, the more useful it becomes.