Orthognathic surgery, commonly known as jaw surgery, corrects severe bite problems and skeletal discrepancies that cannot be resolved with orthodontics alone. The procedure involves moving the upper jaw, lower jaw, or both to align them correctly, restoring proper function to the bite, speech, and breathing. While the primary goal is functional correction, repositioning the underlying bone structure profoundly changes the facial profile and appearance. The aesthetic transformation results from balancing the facial skeleton, which positions the overlying soft tissues into a more harmonious appearance.
Identifying the Underlying Structural Issues
Jaw surgery is necessary when the upper jaw (maxilla) and lower jaw (mandible) have grown disproportionately, creating a skeletal misalignment. This disparity results in malocclusion, where the upper and lower teeth do not meet correctly. The surgery addresses these skeletal abnormalities, establishing the correct foundation for the teeth and facial features.
Common issues include mandibular deficiency, where a recessed lower jaw causes an “overbite” appearance and a weak chin profile. Another problem is mandibular prognathism, characterized by an overly prominent lower jaw, often leading to an “underbite.” Vertical issues, such as maxillary excess, can result in a “gummy smile” where too much gum tissue shows. A skeletal open bite occurs when the back teeth touch, but the front teeth do not, a structural problem braces cannot resolve alone.
Specific Aesthetic Transformations
The visual changes after jaw surgery are highly predictable because the soft tissues of the face conform to the newly positioned bone structure. Advancing the lower jaw, often done for mandibular deficiency, produces a more defined chin projection and sharpens the angle of the jawline and neck. This forward movement stretches the soft tissues under the chin, reducing the appearance of a “double chin” and improving the overall neck-to-chin contour.
Movement of the upper jaw (maxilla) creates distinct changes in the mid-face and lip area. Moving the maxilla upward (impaction) shortens the vertical length of the mid-face and significantly reduces a gummy smile by decreasing gum tissue visibility. Advancing the maxilla brings the upper lip forward, which can make the lips appear fuller and reduce the depth of the nasolabial folds.
A secondary effect of maxillary movement is the alteration of the nose’s appearance at the base. Maxillary advancement can cause the base of the nose to widen and the tip to rotate slightly upward, which surgeons manage with specialized sutures to control the nasal width. The soft tissue of the upper lip moves forward by approximately 90% of the forward movement of the underlying bone. When both jaws are repositioned in a single procedure, known as bimaxillary surgery, the overall facial profile achieves maximum balance and harmony by correcting discrepancies in both the mid-face and lower-face simultaneously.
The Timeline of Visual Change
The final aesthetic outcome of jaw surgery is not immediately visible due to significant post-operative swelling, or edema. Swelling typically peaks within the first 48 to 72 hours after the procedure and then begins a gradual resolution. This initial severe swelling temporarily obscures the final facial contours, making the face appear puffy or disproportionately wide.
A significant portion of the swelling, approximately 60% to 80%, resolves within the first six weeks following surgery. During this period, the major visual changes—the improved profile and jawline—become much more apparent. Patients often notice a dramatic improvement in their appearance around the two-month mark as the acute phase of swelling subsides.
The complete resolution of subtle, deeper soft tissue swelling takes considerably longer. The final 5% to 10% of edema may take between six and twelve months to completely dissipate. The soft tissues continue to adapt to the new skeletal framework for up to a full year, meaning the face will continue to refine and settle into its final contours.