For many, orthodontic treatments that shift the teeth are enough to correct our bite. But, when orthodontia isn’t enough, corrective jaw surgery may be required. Formally known as orthognathic surgery, the procedure is used to correct pronounced underbites and overbites and improve facial symmetry. “Orthognathic surgery is necessary when the teeth and jaws do not align properly,” explains Douglas Monasebian, MD, DMD, a New York City-based board certified plastic and maxillofacial surgeon and assistant professor at the Mount Sinai School of Medicine. “Very often, when this surgery is performed, the facial features will also come more into harmony adding to a more aesthetic appearance.”
Here, we break down everything you need to know about the surgery and talk to patients about their experience.
What Does Jaw Surgery Involve?
Jaw surgery is often part of a larger treatment plan that includes fixed-bracket braces, wisdom teeth removal, and more to correct an underbite or overbite. Surgery tends to be part of that teeth alignment process. “Orthodontic treatment (braces) is performed both before and after the surgery,” Dr. Monasebian says. “The length of time in braces can be between one to two years, with the surgery occurring usually at the halfway point.”
Depending on the patient's needs, orthognathic surgery can be performed on the upper jaw (maxilla), the lower jaw (mandible), or both. “The surgeries may be performed together or separately,” he explains. “The decision for this is determined by both the surgeon and the orthodontist. The evaluation includes clinical photographs, x-rays, and dental models.”
The Anatomy of the Face & Jaw:
Needless to say, there are surgical and anatomic differences between upper (maxillary) and lower (mandibular) jaw surgery, but both procedures are, as Dr. Monasebian shares, “quite involved” (think: four to six hours of operating) and performed under general anesthesia in the hospital. Another similarity? “All incisions are placed inside the mouth, so, after the swelling resolves, there is no visible scarring on the face,” he says.
During the surgery, the surgeon will cut into the bone and realign the bone, teeth, and soft tissue into their correct position. The bone is fixed in place using a combination of metal plates and screws, which are usually permanent. The screws should fuse into your jaw bone over time. In some cases, bone may be collected from another part of your body (i.e. the hips or ribs) to aid in that fusion process or to alter the shape of the jaw bone. In this case, patients have a small incision where that bone tissue is collected.
Recovering From Jaw Surgery
Today, jaws are stabilized with small metal plates and screws, which means they do not have to be wired together for six weeks like they used to be. But recovery from jaw surgery still takes time, with patients generally needing to take several weeks off of work or school. While patients usually return home the day after surgery, it is recommended that they have a caretaker for the first couple of weeks. Pain, swelling, and discomfort are common — especially in the first seven to 10 days — and are treated with pain medication and antibiotics.
Patients receive specific post-operative instructions that encompass the first couple of months after surgery. They will vary depending on the provider and procedure, but your surgeon should provide specific information on what you can and can’t eat, oral hygiene, when to resume regular activity levels, and when to return to work or school.
“The surgical results are immediate in that the jaws are placed in their new and correct position at the time of surgery,” Dr. Monasebian says. “The final surgical result will become apparent when all the swelling resolves, which is mostly gone after several weeks.” The bones heal in approximately six weeks, at which point braces are applied. “There will be another year or more of braces to have the teeth align,” he adds.
Recovery from jaw surgery takes time, but knowing what to expect can make the process much more manageable. We asked two patients to share their experience healing from orthognathic surgery.
Noah, 27, Chicago
Noah had jaw surgery to correct an underbite and improve his side profile. He spoke to us about what it’s like to have the procedure and shared some of his tips to make recovery more comfortable.
The AEDITION: What was the first week after surgery like?
Noah: The first day after surgery, I was pretty out of it. My brother drove me home and made sure I was comfortable. My mom brushed my teeth for me and made sure I’d taken the medication and eaten as scheduled. The following two days were intense. It’s pretty unpleasant being in pain and not being able to open your mouth or breathe properly through your nose because of all the swelling, but it really was only like that for around four days at the most. Once I’d made it through that point, things got a little better each day.
The AEDITION: How did the recovery process compare to your expectations?
Noah: I’d done a whole lot of research beforehand, and the one thing that I hadn’t truly realized is that everyone’s recovery is different. It was similar to many of the experiences I had read about before the surgery, but it was not the same as any of them. I used a lot of the tips that I’d learned from other people, and they were absolutely valuable (definitely buy yourself a cat toothbrush, they’re smaller than regular toothbrushes and so much easier to use right after surgery!), but I do wish I hadn’t created such a fixed timeline in my mind from what I’d seen online. It’s difficult to cut yourself some slack and rest when you think that you should be able to do such and such a task by whichever day post-surgery it is.
The AEDITION: Are you pleased with the results of the procedure?
Noah: I am. During the first two weeks after surgery, I wondered if the results could possibly be worth all the pain and swelling, but they totally were. I was fortunate that surgery was pretty much the last step in my treatment plan after long years of braces and wisdom teeth being removed, so it’s been amazing to finally get to see my face in the shape my doctors had planned for me all along. The shift in my confidence has shocked me. Pre-COVID, I had found myself having a better social life than I’d ever had before because I’m so much more confident in how I look.
Jeanie, 30, Los Angeles
Jeanie chose to undergo jaw surgery to change the look of her side profile, which was affected by a severe underbite. She had the surgery two years ago after undergoing orthodontic treatment for a year beforehand.
The AEDITION: Do you have any tips on how to prepare for recovery from jaw surgery?
Jeanie: First and foremost, get yourself a good network of people to help look after you in the first week after the procedure and to just be there when needed for the weeks following that. I would also advise printing out your recovery ‘schedule’ (i.e. when you should be starting to eat soft foods, do more activity, etc.), so you and the people taking care of you know what’s what. Having a pill organizer with days of the week and times was very useful to help me to keep track of when I had taken my painkillers also.
The AEDITION: Did you buy anything to make recovery more comfortable?
Jeanie: I got this laptop desk that sat on my bed so I could watch Netflix without having to move, it was amazing (I may or may not still use it now!). I also got some nice new pillows and some cozy bedding, which I really appreciated — especially in those first few days. My surgeon also advised me that those squeezy sauce bottles are good to help you eat liquids, and they were useful too.
The AEDITION: What advice do you have for people considering jaw surgery?
Jeanie: Get a good schedule set up for your recovery. Having ‘scheduled rest’ helped me so much. I know for sure I would have felt so bad about just laying around letting my body heal itself if it hadn’t been part of my care plan. Beyond that, it helped me to make sure I was getting enough fluids, taking all the drugs I needed to, keep on track with my eating. All those things just felt easier with them being planned out, instead of having to think about them on a daily basis.
Performed by an oral and maxillofacial surgeon (OMS) or plastic and reconstructive surgeon, orthognathic surgery can be a life-changing procedure to align the mouth, optimize facial proportion, and improve quality of life.
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