Jaw Surgery 

Jaw surgery (orthognathic surgery) is one of the most difficult procedures to perform well, and can have very dramatic functional and cosmetic outcome for the patient. Dr. Boonipat is well qualified from both an aesthetic perspective from his plastic surgery training in residency, and from his fellowship in jaw surgery where he assisted and performed more than 100 cases of complex double jaw surgeries. He also has extensive experience in 3D planning, and aesthetic optimization as most of his cases are aesthetic driven (rather than how their teeth come together.  If you do not have an orthodontist, we can have you work with one of our orthodontist.

What is the difference between oral/maxillofacial surgeon and a plastic surgeon?

Oral and Maxillofacial Surgeons have a dental background. They went to dental school prior to obtaining their training in maxillofacial surgery. The training involved dental implants, molar removal, facial fractures, orthognathic surgery, and in some situations free flaps reconstruction for the head and neck. 

Plastic Surgeons goe to medical school prior to residency. In plastic surgery residency, the training does not involve dental implants, or molar removal. It does involve facial fractures, orthognathic surgery, free flap reconstruction in the head and neck and the rest of the body. Plastic surgeons also have extensive training in facial aesthetics. 

Dr. Boonipat furthered his plastic surgery training with a concentrated fellowship in aesthetic jaw surgery in Taiwan. He is well qualified to address both your functional concerns by working with your orthodontist, and your aesthetic concerns because of his plastic surgery and fellowship training.  

In many cases, jaw surgery can be performed with other aesthetic procedures to improve your aesthetic outcome, all under one anesthesia. (See page on combined jaw surgery with rhinoplasty or combined jaw surgery with other facial cosmetic procedures.

Overview

Jaw surgery (orthognathic surgery) improves the alignment of your jaw and teeth, how they fit together (occlusion), and also your facial appearance.

Many times, when you have issues with how your teeth fit together, your orthodontist can use braces to align your teeth. However, only small movements is possible with braces, and in many cases the better long term option for both your teeth and your facial aesthetics will be jaw surgery.  In almost all cases, you will need braces before and after surgery. Dr. Boonipat will work with your orthodontist to come up with a comprehensive treatment planning.

What is surgery first jaw surgery?

Surgery first orthognathic approach (SFOA) concept is a new concept of using braces only after surgery. This has been shown to reduce the total treatment time the patient needs to be in braces from more than two years to less than a year in many cases.

This is due to the regional acceleratory phenomenon (RAP), when the tooth movement happens much faster after the jaw have been moved and bones have been cut near the teeth areas.

In his fellowship training, Dr. Boonipat trained with the pioneers and innovators in orthognathic jaw surgery and is trained in the surgery first practice. 

This new approach (SFOA) is, in many cases, now the standard practice in many jaw surgery centers in Asia. It is still not as widely adopted in the West. With this new approach, Dr. Boonipat can offer patient shorter total treatment time and deliver the same final outcome. In most cases, you will still need to wear braces for about 1 month before the operation and then follow up with the orthodontist for a few months afterward. 

You will see improvement to how your face looks right after surgery and the swelling has come down. 

Why is it performed?  

Jaw (orthognathic) surgery can: 

• Enhance biting and chewing functions
• Improve overall chewing ability
• Address swallowing and speech difficulties
• Prevent excessive tooth wear and breakdown
• Fix issues with bite fit or jaw closure
• Correct facial asymmetry, including underbites, overbites, and crossbites
• Enhance lip closure comfort
• Alleviate pain associated with TMJ disorder and other jaw issues
• Treat facial injuries or birth defects
• Offer relief for obstructive sleep apnea (see the page on sleep apnea).
• Improve your overall facial appearance and harmony
• Improve how you look when you smile.
• Improve jawline definition.

How does jaw surgery improve my aesthetic concerns? 

• Orthognathic surgery is a highly effective facial cosmetic procedure that can address various jaw irregularities. 
• It can correct issues such as an overly small or prominent chin or lower jaw, as well as a weak upper jaw. 
• Conditions like microgenia, mandibular prognathism, and maxillary hypoplasia can be treated with this surgery. 
• It can improve your smile. 
• Dental or occlusal problems like class II or class III malocclusions, crossbites, or open bite deformities may also be addressed. 
• Furthermore, significant facial asymmetry or jaw narrowing can be corrected through orthognathic surgery. 
• Additional cosmetic procedures can complement orthognathic surgery to further enhance facial aesthetics. 
• These procedures may include lip enhancements, fillers, fat grafting, facial bone contouring or reduction, implants or augmentation, jowl manipulation, double chin liposuction or tightening, skin tightening, cheek implants, blepharoplasty, and rhinoplasty, among others.

What are the risks of jaw surgery? 

Jaw surgery, when performed by an experienced plastics and maxillofacial surgeon, often in conjunction with an orthodontist, is generally considered safe.

Risks associated with the surgery may include:

• Blood loss
• Risk of infection
• Nerve damage (causing numbness to your chin area, up to 30% with some altered sensation in this area, with less than 5% of patient with permanent numbness).
• Potential jaw fracture
• Possibility of the jaw returning to its original position
• Issues with bite alignment and jaw joint discomfort
• Potential need for additional surgical procedures
• Possibility of requiring root canal therapy for certain teeth
• Partial loss of jaw function
• Post-surgery, you may encounter:
• Pain and swelling
• Difficulties with eating, which can be managed through nutritional supplements or consultation with a dietitian
• A period of adjustment to your altered facial appearance

How to prepare?

In the traditional approach, an orthodontist will put braces on your teeth for 12-18 months before surgery to align your teeth. In the newer surgery first approach, only 1-2 months of braces are needed before surgery. Approximately one month before the surgery, the orthodontist halts tooth adjustment and installs a passive wire. Right before the surgery, the orthodontist might attach small hooks to the wires or brackets. 

The procedure might vary for cases involving “surgery-first,” Invisalign, sleep apnea, or purely cosmetic concerns. Please inquire during your consultation for more details. 

We will work with your orthodontist to come up with a treatment plan.

You will need to take x-rays, facial pictures, dental scan of your teeth (obtain 1-2 weeks prior to surgery), and CT scan or cone bean CT scan. With this information and after discussion about your aesthetic goals, Dr. Boonipat will perform virtual surgical planning and simulated the operation in 3D (VSP, CAD/CAM). He will show you this simulation of how your face and facial aesthetics will look and discuss the surgical plan with you in details. Any modifications can be made at this point.

What to expect:

Before the procedure.

Dr. Boonipat will perform jaw surgery under general anesthesia. 

The procedure is carried out in a hospital setting, necessitating a hospital stay lasting between two to four days.

During the procedure.

Surgery can be conducted internally within the mouth, ensuring no visible scarring on the chin, jaw, or around the mouth outside. You will have well concealed scars inside your mouth that is not visible with smiling or talking. 

During the procedure, Dr. Boonipat makes incisions in the jawbones and adjusts them to the correct alignment. Following this adjustment, small bone plates, screws, wires, is used to secure the bones in their new positions. These screws, smaller than typical braces brackets, gradually integrate into the bone structure. 

Jaw surgery can target the upper jaw (with Le Fort I osteotomy), lower jaw (with bilateral sagittal split osteotomy, BSSO), chin, or a combination of these areas. 

Usually, for the best cosmetic outcome, you will need both upper and lower jaw surgery (double jaw, bimaxillary surgery). 

In many cases, your nasal breathing will also improve because we modify your nasal floor. We perform a limited septoplasty at the same time as the jaw surgery. 

After the procedure.

Dr. Boonipat will discuss with you the guidelines for postoperative care.  

Your jaw will not be wired shut, and in most cases you will not need elastics.  

Dietary recommendations: You should only drink light liquid for 1 day after surgery (no straw the first week), then you may eat very soft food (blenderized) that does not require any chewing for 1 month. (soups, milk, nutrition drinks and fruits and cooked vegetables you can liquefy using a blender.) After that you may gradually advance your chewing, and return to any food by 6 weeks in most cases. You should practice opening your mouth wide after about 4 weeks from surgery date. 

Oral care instructions: You should rinse your mouth with the mouth wash provided for 1 week, and gently brush your teeth after each meal after 1 week. 

Advisories against tobacco usage: Continue to avoid exposure to smoking for 6 months until all bones are healed. Do not use nicotine products or vaping products that contain nicotine.  

Activity: Caution against engaging in strenuous activities: Do not do anything that will raise your heart rate above 100 for 1 month after surgery. You should walk every day starting the day of your surgery. You may return to full activity, but no contact sports, after 6 weeks. 6 months for full healing to go back to high contact/impact sports. 

Prescribed medications for pain management: You should take scheduled Tylenol and ibuprofen (if you do not have contraindication), and only supplement this with opioid medication as needed. Opioid can cause constipation and other complications if you take too much.   

Guidance on when to resume work or school: Typically, within one to three weeks. 

Swelling: Maximum swelling occurs 2-3 days after surgery. Head elevation and walking help with recovery. 

Initial recovery of the jaw generally spans around six weeks post-surgery, with complete healing potentially extending up to 12 weeks. 

Around the six-week mark of initial jaw recovery, your orthodontist will proceed with final adjustments to your teeth alignment using braces. The entire orthodontic journey, encompassing surgery and braces, may extend over several years. Following brace removal, retainers may be employed to maintain tooth positioning.

Cost:

Insurance can cover part of the cost of jaw surgery if it is done for medical indication such as malocclusion or for sleep apnea (OSA).