What Is Orthognathic Surgery?

Orthognathic surgery — also called corrective jaw surgery — is a planned operation that moves the upper jaw, lower jaw, or chin into the correct skeletal position. It improves chewing, speech, breathing, facial balance, and long-term dental health. For the right patient, performed by an experienced maxillofacial surgeon, it is one of the most predictable and transformative procedures in modern facial surgery.

Orthognathic surgery is recommended when the jaws do not meet correctly because of a skeletal discrepancy — not just a dental one. If braces alone cannot place the teeth in a stable, functional bite, repositioning the jaw bones is usually the most reliable solution. The procedure is planned in 3D, executed under general anaesthesia, and stabilised with titanium plates and screws. The result is a balanced bite, a clearer airway, and a face that looks more in proportion.

What Is It?

Orthognathic surgery is the surgical repositioning of the upper jaw (maxilla) and/or lower jaw (mandible) to correct a deformity of the jaw bones. The word "orthognathic" comes from Greek — ortho meaning straight, and gnathic meaning jaw. Literally, it means "straight jaws," and that is exactly what the surgery aims to achieve.

It is different from cosmetic facial surgery in one important way: the primary goal is to fix a functional problem — a bite that does not fit, an airway that is too narrow, a jaw that has grown unevenly. The cosmetic change — a more balanced face, a stronger chin, a wider smile — is a welcome and reliable side effect, but it is not the main reason the operation is performed.

Orthognathic surgery is a team effort. Treatment is planned jointly by an orthodontist and a maxillofacial surgeon, and is carried out over a period of 18–24 months in most cases. The orthodontic phase aligns the teeth in each jaw so that, when the jaws are moved into their new position during surgery, the teeth meet correctly and the bite is stable for life.

Who Needs It

Orthognathic surgery is recommended when the jaws do not meet correctly because of a skeletal discrepancy, rather than a simple dental problem. Common reasons include:

• Skeletal malocclusion — a severe underbite, overbite, or open bite that braces alone cannot correct. The teeth may look straight, but the jaws are mismatched.
• Facial asymmetry — one side of the jaw has grown longer, shorter, or wider than the other, leading to a visibly tilted chin or uneven smile. See our guide on the common causes of facial asymmetry.
• Open bite — the front teeth do not meet when the back teeth are closed, often making it hard to bite through food like a sandwich or an apple.
• Crossbite — the upper teeth sit inside the lower teeth, which can cause chewing problems, tooth wear, and jaw joint strain.
• Obstructive sleep apnea (OSA) — when the jaw position narrows the airway during sleep, repositioning the jaws can open it permanently. Read more in our detailed post on how jaw surgery helps with sleep apnea.
• TMJ disorders — chronic jaw joint pain, clicking, or locking that is caused by an unfavourable jaw relationship.
• Cleft lip and palate-related jaw deformity — the upper jaw often grows short after cleft repair, and a Le Fort I osteotomy is the standard correction.
• Traumatic jaw injury or post-cancer reconstruction — restoring the bite and facial shape after an accident or tumour surgery.

You can also read about how jaw surgery overlaps with appearance in our post on can jaw surgery improve facial appearance, and on whether braces alone can fix an asymmetrical jaw.

Types of Procedures

There are three core procedures in orthognathic surgery. Most patients need one or two of them, often combined.

• Le Fort I osteotomy (upper jaw) — the maxilla is separated from the midface above the teeth, then moved forward, backward, up, or down. It is the standard operation for an under-developed upper jaw, a gummy smile, or an open bite of the upper jaw.
• Bilateral sagittal split osteotomy (BSSO, lower jaw) — the mandible is split on both sides behind the molars and slid forward or backward. It is used for a receded lower jaw (a common cause of underbite) or a protruding lower jaw (a common cause of overbite appearance).
• Genioplasty (chin) — the chin tip is detached and reshaped or moved. It is often added to BSSO or Le Fort I surgery to fine-tune the facial profile without using a chin implant.

Beyond these three, your surgical plan may also include:

• Segmental osteotomies — the jaw is split into segments to align a single tooth or a small group of teeth that does not fit the new arch.
• Distraction osteogenesis — a device gradually lengthens bone over days to weeks, often used in cleft and congenital deformity cases when large movements are needed.
• Maxillomandibular advancement (MMA) — both jaws are moved forward to enlarge the airway in moderate-to-severe obstructive sleep apnea. This is one of the most effective surgical treatments for OSA available.

The Process

Orthognathic surgery is planned months in advance and proceeds in well-defined steps.

Step 1 — Consultation. You meet the maxillofacial surgeon and the orthodontist together. They examine your face, your bite, your jaw joints, and your airway, and discuss what you want changed — function, appearance, or both.

Step 2 — Records. Detailed records are taken: clinical photographs, dental impressions or intra-oral scans, an OPG and lateral cephalogram, a cone-beam CT (CBCT), and a bite registration. These records become the digital model of your jaws.

Step 3 — Virtual surgical planning (VSP). Using the CBCT data and your dental scans, the surgeon plans the exact new jaw position in 3D software. Splints are 3D-printed that guide the jaw into the planned position during the operation. VSP is one of the biggest advances in modern jaw surgery — it makes results far more predictable than older plaster-model planning.

Step 4 — Pre-surgical orthodontics. You wear fixed braces for 9–18 months before surgery. The orthodontist aligns the teeth in each jaw separately, undoing any natural dental compensation. At the end of this phase, the teeth look "worse" than they did at the start — that is expected and means the surgery will fit.

Step 5 — Surgery. The operation is performed under general anaesthesia. All incisions are made inside the mouth, so there are no visible external scars. The jaws are moved into the planned position, held with titanium plates and screws, and the gum is closed with dissolvable sutures. Surgery takes 1–4 hours depending on whether one or both jaws are moved.

Step 6 — Post-surgical orthodontics. About 4–6 weeks after surgery, the orthodontist resumes fine-tuning. This phase usually lasts 3–6 months and finishes the bite detail — small contact adjustments, settling the bite, and aligning the gum line.

Step 7 — Retention. You wear retainers for life to keep the teeth in their final position. The surgical change to the jaws is permanent.

Recovery

Recovery after jaw surgery is gradual and follows a fairly predictable pattern. Most patients are surprised by how manageable it is, particularly in the first two weeks.

• Hospital stay: 1 night for single-jaw surgery, 2–3 nights for double-jaw surgery.
• Week 1: swelling peaks around day 3, then starts to settle. You will be on a liquid diet, using ice packs, and sleeping with the head elevated. Most patients walk around the house comfortably from day 2.
• Weeks 2–3: visible swelling reduces by 60–70%. Most patients return to desk work, college, or light duties. Stitches dissolve on their own. You can begin mouth opening exercises.
• Weeks 4–6: soft diet — rice, dal, well-cooked vegetables, scrambled eggs, idlis soaked in sambar. Jaw opening improves steadily. Light exercise is permitted.
• Weeks 6–8: most patients return to full normal activity, including gym work and non-contact sport.
• Weeks 8–12: return to contact sport and physically demanding jobs. Bone healing is well underway.
• Months 6–12: final healing of bone, nerves, and bite. Small refinements settle. The final facial result is fully visible at the 12-month mark.

For a more detailed week-by-week breakdown, see our complete jaw surgery recovery timeline. To understand the possible side effects and how we prevent them, read risks, complications and prevention.

For a fuller guide covering every stage, see our complete patient guide to jaw surgery and the step-by-step walkthrough in purpose, procedure and recovery explained. If you are also considering cosmetic facial work alongside jaw surgery, our post on the best facial cosmetic surgery procedures is a useful read.

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