Orthognathic Surgery
Also known as double jaw surgery, BSSO, Le Fort I, jaw surgery
The most transformative facial surgery there is. It fixes the skeleton rather than decorating it — and it is a genuinely major operation.
US $25,000–80,000 out of pocket including orthodontics; frequently insurance-covered with a functional indication. Substantially cheaper in Europe and Korea.
How it works
The maxilla (Le Fort I osteotomy) and/or mandible (bilateral sagittal split osteotomy) are cut and repositioned to correct the jaw relationship, then fixed with titanium plates. Advancing or rotating the jaws changes the entire midface and lower face, and counter-clockwise rotation in particular improves chin projection, lip support and the submental angle. It is done for functional reasons — bite, breathing, sleep apnoea — with dramatic aesthetic consequences.
How it's used
Requires a maxillofacial surgeon working with an orthodontist. Typically 12–18 months of pre-surgical orthodontics to align the teeth, then surgery, then 6–12 months of finishing orthodontics. Virtual surgical planning from CT is now standard and worth insisting on. Often insurance-covered where a functional indication exists.
Trade-offs
In favour
- Changes facial structure more than any other procedure
- Corrects bite function, chewing and often sleep-disordered breathing
- Frequently insurance-covered on functional grounds
- Permanent and highly stable
Against
- Two to three years end to end including orthodontics
- Major surgery with a hard recovery
- Substantial temporary disability — diet, speech, swelling
- Requires excellent surgeon–orthodontist coordination
Risks and side effects
- Inferior alveolar nerve injury causing lower lip numbness — common temporarily, permanent in a minority
- Relapse of jaw position
- Non-union or hardware failure
- Condylar resorption, particularly relevant in some patient groups
- TMJ dysfunction
- Significant swelling and a genuinely difficult first fortnight
Recovery
Week 1: severe swelling, liquid diet, possible elastics restricting jaw opening, hospital stay of 1–3 days. Weeks 2–4: swelling peaks around day 3 then declines steadily; soft diet; back to desk work around week 3. Weeks 6–12: chewing gradually restored, bone union progressing. Months 3–12: residual swelling resolves and numbness recovers.
How good is the evidence?
Extensively documented in maxillofacial literature with strong functional and aesthetic outcome data.
Sources
- Orthognathic surgery outcomes and stabilityPubMed
- Maxillomandibular advancement for obstructive sleep apnoeaPubMed
Sources point to guideline bodies and literature searches rather than single papers, so they stay accurate as the evidence moves.