Procedures
Orthognathic Surgery: The Complete Guide
Key takeaways
- Orthognathic surgery repositions the upper jaw, lower jaw, or both to correct bite and breathing problems that braces alone cannot fix.
- Most orthognathic cases run two to three years from the first braces to the final retainer, with surgery in the middle of that sequence.
- Jaw surgery is usually postponed until facial growth is complete, which for most patients means the later teen years.
- Numbness of the lower lip and chin is a common temporary effect of lower jaw surgery and occasionally lasts long term.
- A cone beam CT scan takes under a minute to capture and about 10 to 15 minutes as a full appointment.
Orthognathic surgery is corrective jaw surgery. It moves the upper jaw, the lower jaw, or both into a better position so the teeth meet correctly and the airway and facial structure work the way they should. In the simplest terms: braces move teeth, and orthognathic surgery moves the bones the teeth sit in.
It is usually recommended when a bite problem comes from skeletal differences rather than tooth position alone — an underbite, a severe overbite, an open bite where the front teeth never touch, or a jaw that sits noticeably off to one side. It is planned work, not emergency work, and it is almost always done together with an orthodontist.
What orthognathic surgery is
The jaws are two separate bones: the maxilla (upper) and the mandible (lower). When they grow at different rates or in different directions, the teeth can be straight and the bite still wrong. Orthodontics can tip and slide teeth, but it cannot change where the bone sits. Orthognathic surgery makes precise cuts in the jawbone, repositions the segment, and secures it with small titanium plates and screws while it heals.
Common versions include a Le Fort I osteotomy to move the upper jaw, a bilateral sagittal split osteotomy to move the lower jaw, a genioplasty to reshape the chin, or a combination of these in one procedure. Planning is done digitally. We take a cone beam CT scan and digital impressions, build a three-dimensional model of your jaws, and simulate the movement before anything is scheduled.
Who it is for
People generally arrive at orthognathic surgery through one of a few doors:
- An orthodontist says braces alone cannot close an open bite or correct an underbite.
- Chewing is difficult or inefficient, and food is hard to bite through with the front teeth.
- Speech is affected by how the jaws meet.
- Jaw joint strain, uneven wear on the teeth, or chronic jaw fatigue traces back to the bite.
- A sleep physician has diagnosed obstructive sleep apnea linked to a small or recessed lower jaw.
- A facial asymmetry or jaw position that has been a long-standing concern, where function and appearance overlap.
- A past injury healed with the jaw out of position — a situation that overlaps with facial trauma care.
Who it is not for
Honest exclusions matter more than the list above. Orthognathic surgery is usually not appropriate if:
- Jaw growth is not finished. In most patients that means the later teen years; operating too early can mean the correction shifts as growth continues.
- The bite problem is small enough that orthodontics, selective tooth reshaping, or restorative dentistry can handle it.
- Gum disease, untreated decay, or an active infection needs to be resolved first.
- Smoking, uncontrolled diabetes, or certain bone medications make healing unpredictable until those are addressed.
- The goal is purely cosmetic and unrelated to how the jaws function — other procedures are a better fit.
- The patient is not prepared for 12 to 24 months of orthodontic treatment around the surgery. Commitment to the full sequence is part of what makes the result hold.
How it works, stage by stage
Stage 1: Consultation and records
The first visit is an exam and a conversation. We look at how your teeth meet, how your jaw moves, your breathing, and your medical history. We take records: digital scans of the teeth, photographs, and a cone beam CT. People often ask how long a CBCT takes — the scan itself is usually under a minute, and the whole appointment including setup is typically 10 to 15 minutes. You sit or stand still while the arm rotates once around your head.
Stage 2: Joint planning with your orthodontist
We review the 3D model together with your orthodontist and agree on where the jaws need to end up. This is also when we confirm whether one jaw or both will move, and whether a chin procedure is part of the plan.
Stage 3: Pre-surgical orthodontics
Braces or aligners go on first, usually for 9 to 18 months. The goal is to line the teeth up within each jaw — which often makes the bite look worse temporarily, because the teeth are no longer compensating for the skeletal difference. This stage surprises people, so it helps to expect it.
Stage 4: Final planning and surgical scheduling
New scans are taken once the teeth are aligned. The surgical movement is finalized digitally and custom guides or splints are produced. You will have a pre-operative visit covering anesthesia, medications, what to eat afterward, and how to arrange time away from work or school.
Stage 5: Surgery
Orthognathic surgery is done under general anesthesia. Incisions are made inside the mouth, so there are typically no visible facial scars. Depending on the complexity, surgery runs a few hours. Many patients stay overnight; some procedures are done on an outpatient basis. That decision is made in advance, not on the day.
Stage 6: Early recovery
Expect significant swelling for the first week to ten days, peaking around day two or three. Most people take two to three weeks off work or school. A liquid and soft diet is standard for several weeks, and elastics may be used to guide the bite. Jaws are rarely wired shut in modern practice; plates and screws hold the position instead.
Stage 7: Finishing orthodontics and follow-up
Bone healing is well advanced by six to eight weeks, with full remodeling over several months. Orthodontics resumes to settle the bite, usually for another 6 to 12 months, then retainers. Plates and screws normally stay in permanently and are not felt.
What it costs
Orthognathic surgery is a multi-part cost: the surgical fee, anesthesia, imaging, facility or hospital charges, and separate orthodontic treatment before and after. Because it corrects function rather than appearance, it is frequently reviewed under medical insurance rather than dental, and pre-authorization is a normal part of the process. The variables are the number of jaws moved, whether a hospital stay is involved, and what your plan covers.
We verify benefits and give you a written estimate before anything is scheduled, so there are no guesses. Payment and financing questions are covered in more detail on our dedicated page.
Risks and tradeoffs
Every surgery has real limitations, and knowing them in advance is part of consenting well.
- Numbness of the lower lip and chin is common after lower jaw surgery. It usually fades over weeks to months, but in a small number of patients some altered sensation is permanent.
- Swelling is substantial and visible. Social downtime is longer than physical downtime for most people.
- Your face will change. The change is usually welcome and the plan predicts it closely, but it is a genuine adjustment.
- Diet is restricted for weeks. Weight loss during recovery is common.
- Infection, bleeding, or hardware issues are uncommon but possible, and occasionally require a second minor procedure.
- Relapse can occur, especially in larger movements or if retainers are not worn.
- The total timeline is often two to three years from first braces to final retainer. This is not a quick fix.
- Upper jaw surgery can slightly change the voice or sinus drainage in some patients.
Alternatives worth considering
Surgery is not the only route, and the right choice depends on how much of the problem is skeletal.
Orthodontics alone. For mild to moderate discrepancies, braces or aligners with elastics can camouflage a skeletal difference by moving teeth. It avoids surgery, but it does not change jaw position and has limits.
Restorative dentistry. Crowns, onlays, or bonding can rebuild worn teeth and improve how they meet when the underlying skeleton is close to correct.
Dental implants and implant-supported teeth. When the real problem is missing teeth rather than jaw position, implants restore chewing without jaw surgery. Patients often ask whether implants are worth it if they already wear dentures — for many people the answer is yes, because implant-supported dentures stop the slipping and sore spots and slow the bone loss that comes with wearing a removable denture for years. You can compare the options directly.
Medical management of sleep apnea. If apnea is the main driver, CPAP or an oral appliance may be tried first. Jaw advancement surgery is typically considered when those are not tolerated or not sufficient.
Watchful waiting. In younger patients still growing, monitoring with periodic records is often the correct next step rather than a decision.
Related care you may hear about
Two terms come up often in oral surgery consultations. Oral pathology is the evaluation of abnormal tissue in the mouth, jaws, or face — a sore that will not heal, a lump, a white or red patch, or a cyst seen on an X-ray. It involves examination, sometimes a biopsy, and a diagnosis. Any suspicious finding is checked before elective jaw surgery proceeds.
Other oral surgery services is the catch-all category covering procedures that do not fit the main headings: sinus lifts to prepare for upper implants, pre-prosthetic surgery to shape bone and gum tissue before dentures, exposure of impacted teeth for orthodontics, and management of dental emergencies. Many patients need one of these as a supporting step rather than as the main treatment.
How to get started
Bring these to a first consultation:
- A referral or notes from your orthodontist or general dentist, if you have them.
- Any recent X-rays or scans, or permission to request them.
- A current list of medications, supplements, and allergies.
- Your medical insurance information as well as dental.
- A written list of what bothers you most — chewing, breathing, speech, appearance, jaw fatigue. Order matters when we prioritize.
Good questions to ask: Is my problem skeletal or dental? What happens if I do nothing? How many jaws would move? What is the realistic total timeline? What does recovery look like week by week? What sedation or anesthesia is planned and why?
The first appointment establishes a diagnosis, a set of records, a recommendation, and a cost estimate. You should leave knowing whether surgery is on the table, what the alternative path would be, and what the next concrete step is. Nothing is scheduled at that visit unless you want it to be.
Request a consultation with Los Gatos Oral & Facial Surgery
Frequently asked questions
What is orthognathic surgery in simple terms?
It is surgery that moves the jawbones into a better position. Small, precise cuts are made in the upper jaw, lower jaw, or both, and the bone is secured in its new position with titanium plates and screws. Braces move teeth; this moves the bone the teeth sit in.
How long does a cone beam CT scan take?
The scan itself usually takes less than a minute while the imaging arm rotates once around your head. The full appointment, including positioning and setup, is typically 10 to 15 minutes. It produces the 3D model used to plan jaw surgery and implant placement.
Are dental implants worth it if I already wear dentures?
For many denture wearers, yes. Implants anchor the denture so it stops slipping and rubbing, restore much more chewing force, and help slow the jawbone loss that continues under a removable denture. A consultation with a scan determines whether you have enough bone or need a preparatory step like a sinus lift.
What is oral pathology?
Oral pathology is the evaluation and diagnosis of abnormal tissue in the mouth, jaws, and face. That includes sores that do not heal, lumps, white or red patches, and cysts found on an X-ray. Diagnosis may involve an exam, imaging, and sometimes a biopsy.
Will I have visible scars after jaw surgery?
Usually not. Most orthognathic procedures are performed through incisions inside the mouth, so there are no facial scars. A chin procedure or certain complex cases may occasionally use a small external incision, which is discussed with you beforehand.
How much time off work or school should I plan for?
Most patients plan for two to three weeks away, with swelling peaking around the second or third day. A liquid and soft diet continues for several weeks beyond that. We give you a week-by-week recovery outline at your pre-operative visit so you can arrange your schedule in advance.