Jaw surgery, known clinically as orthognathic surgery, is a safe and well-established procedure. A 15-year review of nearly 3,000 orthognathic procedures found an overall complication rate of 9.7%, with the majority of those complications being infections that resolved with treatment. Serious, life-altering complications are uncommon, but like any surgery performed under general anesthesia, it carries real risks worth understanding before you commit.
What the Complication Rates Look Like
That 9.7% complication rate from a study of 1,294 consecutive patients deserves some context. Of all complications recorded, 7.4% were postoperative infections, meaning infection accounted for the vast majority of problems. Among those infections, roughly 58% were acute (appearing soon after surgery and responding to treatment) and about 42% were chronic (lingering or recurring). The remaining complications beyond infection made up a small fraction of the total.
Double-jaw surgery, where both the upper and lower jaw are repositioned in a single operation, carries more risk than single-jaw procedures. It involves longer time under anesthesia and greater blood loss. In the study above, over 80% of patients underwent double-jaw surgery, so the complication rate reflects a patient population skewed toward the more complex end of the spectrum. If you’re having only one jaw repositioned, your risk profile is likely lower.
Nerve Numbness: The Most Common Concern
The risk that worries most patients is nerve damage, specifically to the nerve that provides sensation to your lower lip, chin, and gums. During lower jaw surgery, this nerve runs directly through the bone being cut and repositioned, so some degree of temporary numbness is expected. Most people experience altered sensation immediately after surgery, and it can feel strange or unsettling.
The good news is that most nerve injuries are temporary. Recovery typically happens within three to six months as the nerve heals. However, a small percentage of patients develop permanent changes in sensation, with reported rates ranging from roughly 1% to 13% depending on the study and the complexity of the case. “Permanent” doesn’t always mean total numbness. It can mean a subtle difference in how your lip feels compared to before, a slight tingling, or a patch of reduced sensitivity that you stop noticing over time.
Modern 3D planning technology has helped reduce this risk. Virtual surgical planning now allows surgeons to visualize the exact path of nerves before making any cuts, letting them design osteotomy lines that give these structures the widest possible berth.
How Technology Has Improved Safety
Jaw surgery today looks very different from jaw surgery 20 years ago. Computer-aided planning and 3D-printed surgical guides have transformed the procedure’s precision and predictability. Surgeons now plan the entire operation digitally, mapping osteotomy lines around tooth roots and nerve pathways before entering the operating room. Custom cutting guides and positioning splints are then 3D-printed for each patient, so the surgical plan transfers to the real procedure with accuracy reported at around 1 millimeter.
This level of precision does more than improve cosmetic outcomes. It reduces guesswork during the operation, which means shorter time under anesthesia and less tissue disruption. In studies using comprehensive virtual planning, researchers reported no major complications across their case series, and the custom devices worked successfully in every patient. While no technology eliminates risk entirely, these advances represent a meaningful leap in surgical safety.
What Anesthesia Involves
Jaw surgery requires general anesthesia, and the procedure typically lasts several hours for double-jaw cases. Because the surgeon needs unobstructed access to your mouth, the breathing tube is usually placed through your nose rather than your mouth. This is routine for maxillofacial surgery, though it requires careful coordination between the anesthesiologist and surgeon, particularly during the most intensive phases of the operation when bone is being separated and repositioned.
Post-surgical nausea and vomiting are a known concern, especially because your jaw will be swollen and potentially banded shut or restricted in movement. Anesthesia teams use multiple strategies to prevent this, including specific drug combinations and pain management approaches designed to minimize the need for medications that increase nausea risk.
The Full Recovery Timeline
Recovery from jaw surgery is measured in weeks and months, not days. The first week is the hardest. Your face will be significantly swollen, you’ll have difficulty opening your mouth, and you’ll be managing pain with prescribed medication. Light activity like short walks is generally possible within the first one to two weeks.
You’ll be on a liquid-only diet for about a month after the procedure. This is one of the aspects patients find most challenging, and it’s worth planning for in advance with a blender and a stockpile of soups, smoothies, and protein shakes. Most people return to work or school after three to four weeks, though you may still have visible swelling and dietary restrictions at that point.
Full healing of the bone takes longer. Surgeons typically recommend avoiding contact sports and heavy physical exertion for several months. The final results of the surgery, both functional and aesthetic, can take up to a year to fully settle as residual swelling resolves and soft tissues adapt to the new jaw position.
Risks Listed by Major Medical Centers
The Mayo Clinic lists the following as potential risks of jaw surgery:
- Blood loss during the procedure
- Infection at the surgical site
- Nerve injury causing numbness or altered sensation
- Jaw fracture at or near the surgical site
- Relapse, where the jaw gradually shifts back toward its original position
- Bite problems or jaw joint pain after surgery
- Need for additional surgery to correct remaining issues
- Root canal treatment on select teeth affected by bone cuts
These are all possible outcomes, not probable ones. Most patients go through the procedure and recovery without encountering any of them. But the list helps illustrate why choosing an experienced oral and maxillofacial surgeon matters. Surgeons who perform these procedures frequently, use current planning technology, and work within a coordinated team tend to have lower complication rates.
Who Faces Higher Risk
Jaw surgery is best performed after the jaw has stopped growing. For females, that’s typically age 16 to 18 or older. For males, it’s usually 18 to 21 or older. Operating before growth is complete increases the chance that the jaw will continue to change shape after surgery, potentially undoing the correction.
Tobacco use is a significant risk factor. Smoking impairs blood flow to healing tissues and dramatically increases the likelihood of infection and poor bone healing. Surgical teams instruct patients not to use tobacco during recovery, and many surgeons strongly recommend quitting well before the procedure date. Patients with bleeding disorders or certain conditions affecting bone healing may also face elevated risk and need additional evaluation before being cleared for surgery.