Orthognathic surgery, often referred to as corrective jaw surgery, corrects significant irregularities in the jaw bones. These skeletal adjustments improve a patient’s ability to chew, speak, and breathe, while also creating better functional and aesthetic balance in the facial structure. A common concern for anyone considering this complex correction is the potential for visible scarring on the face following the operation. Modern surgical techniques are designed to minimize visible evidence, making the question about external scars straightforward.
The Location of Incisions: Inside the Mouth
The immediate answer to the question of visible scarring lies in the standard surgical approach, which overwhelmingly favors making incisions inside the mouth. For procedures correcting the upper jaw, known as a maxillary osteotomy, the surgeon accesses the bone through the gum tissue above the upper teeth, beneath the lip. Similarly, for lower jaw correction, or mandibular osteotomy, the cuts are strategically placed in the gum tissue behind the back molars. This method, known as the intraoral approach, allows the surgeon to perform the bone cuts and repositioning entirely beneath the facial skin, eliminating the need for large external cuts. Because the incisions are made in the mucosal lining of the mouth, which heals efficiently, they do not result in external facial scars.
When External Scars Are Necessary
While the majority of the work is done internally, there are a few specific instances where small external marks are necessary for patient safety and optimal results. During lower jaw surgery, for example, tiny “stab” incisions, often only a few millimeters long, may be required on the outer cheek. These small openings provide a pathway for the surgeon to insert specialized instruments used to place the titanium plates and screws that hold the jaw segments in their new position. These minute incisions are placed discreetly and typically require only a single, fine stitch for closure.
In cases where a genioplasty, or chin reshaping, is combined with jaw surgery, the primary incision is also intraoral, but hardware placement can sometimes necessitate a small external incision under the chin. Procedures to remove hardware years after the initial surgery, which happens in a minority of cases, may also require a small external cut. Any necessary external scars are usually placed in natural skin folds to aid camouflage.
Post-Operative Care and Scar Maturation
The long-term visibility of any scar, whether internal or the rare external one, depends significantly on the patient’s adherence to post-operative care instructions. Within the mouth, the initial gum tissue incisions heal quickly, often closing within the first few weeks with the help of dissolvable sutures. However, the internal scar tissue that forms can feel firm or bumpy to the touch for several months following the procedure as the tissue remodels.
For any small external incisions, strict sun protection is one of the most important steps to reduce long-term visibility, as ultraviolet exposure can cause a healing scar to darken permanently. Surgeons often recommend gentle massage of the external scar site once the surface wound has fully closed, which can help break down disorganized collagen fibers and soften the tissue. The application of silicone sheets or gels can also aid in scar maturation.
Full scar maturation, where the tissue flattens and fades to a color closer to the surrounding skin, is a lengthy biological process. While initial swelling subsides significantly within a few weeks, the deep remodeling of the bone and soft tissues continues for many months. For both internal and external sites, the final appearance of the scar is not typically realized until 12 to 18 months after the operation. Following all instructions regarding oral hygiene, diet, and avoiding factors like smoking, which impairs blood flow and wound healing, is paramount to achieving the best possible cosmetic outcome.