Jaw surgery, formally called orthognathic surgery, involves cutting and repositioning the bones of your upper jaw, lower jaw, or both to correct alignment problems. The entire procedure takes one to four hours under general anesthesia, and all incisions are made inside the mouth, so there are no visible scars on your face. Here’s what happens at each stage.
Before the First Cut
You’ll be under general anesthesia for the entire surgery. A breathing tube is placed through your nose rather than your mouth, since the surgeon needs full access to your teeth and jaws throughout the procedure. A nasal decongestant is applied beforehand to reduce swelling in the nasal passages and make the tube more comfortable. You’re positioned with your head slightly elevated, which helps reduce bleeding during surgery.
Controlling blood loss is one of the anesthesia team’s main jobs. The anesthesiologist may lower your blood pressure intentionally during the operation, a technique called induced hypotension, to keep the surgical field clear and minimize the amount of blood you lose.
Upper Jaw Surgery (LeFort Osteotomy)
If your upper jaw needs repositioning, the surgeon begins with an incision along the inside of your upper lip, running from one side to the other at about the level of your first molars. This exposes the bone of the upper jaw while keeping all cuts hidden inside the mouth.
The surgeon carefully lifts the soft tissue away from the bone, working upward to identify and protect the nerve that provides sensation to your cheeks and upper lip. Using a small oscillating saw under continuous water irrigation to prevent heat damage, the surgeon cuts through the bone on both sides of the upper jaw. Additional cuts are made along the side of the nose and through the thin wall that separates the nasal cavity from the mouth. The nasal septum is then separated from the upper jaw using a specialized chisel.
Once all the bone cuts are complete, the surgeon applies gentle hand pressure to free the upper jaw from the surrounding bone. This step, called “down-fracturing,” allows the entire upper jaw to be moved as a single piece. The surgeon shifts it forward, backward, up, or down according to the surgical plan, then temporarily wires your teeth together to confirm the new bite aligns correctly.
Small titanium plates and screws lock the jaw into its new position. Typically four plates are used, secured near the base of the nose and along the cheekbone area on both sides. These plates are thin and sit flush against the bone.
Lower Jaw Surgery (Bilateral Sagittal Split Osteotomy)
The most common lower jaw procedure is called a bilateral sagittal split osteotomy. The surgeon makes incisions inside your mouth along the back of the lower jaw on both sides, then separates the soft tissue from the bone along the outer edge of the jaw and up the back surface of the jaw’s vertical branch (the ramus).
The bone cuts are designed to split the lower jaw into an inner segment (which holds the teeth) and an outer segment on each side. This split is made carefully because an important nerve, the inferior alveolar nerve, runs through a canal inside the lower jawbone. This nerve controls sensation in your lower lip and chin. Refined surgical techniques developed over several decades focus on limiting how much tissue is stripped away from the bone, which reduces swelling, bleeding, and risk to that nerve.
Once the jaw is split on both sides, the tooth-bearing segment can be slid forward or backward into the planned position. As with upper jaw surgery, the teeth are temporarily wired together to verify the bite, and titanium plates and screws secure the bone in place.
Double Jaw Surgery
When both jaws need correction, both procedures are performed in the same session. The upper jaw is typically repositioned first, followed by the lower jaw. This combined approach, called bimaxillary surgery, is the longest version of the procedure and generally falls toward the three-to-four-hour end of the time range.
How the Bones Are Held Together
Titanium plates and screws remain the gold standard for holding repositioned bone in place. They’re small, strong, and well tolerated by the body. Most people keep them permanently without any issues.
A newer option is bioresorbable plates and screws, made from materials that gradually dissolve and are absorbed by the body over months. The potential advantage is that you wouldn’t need a second surgery if the hardware ever needed to be removed. Both materials have shown acceptable results, though titanium still has the longer track record.
In some cases, a bone graft is needed to fill a gap created by repositioning the jaw. This bone can come from your own body, often harvested from the chin area, the back of the lower jaw, or the hip. Alternatively, donor bone from a tissue bank or synthetic bone substitutes can be used.
What You Wake Up To
After surgery, you’re moved to a recovery room where nurses monitor you as the anesthesia wears off. Your jaws will not be wired shut in the traditional sense, but you’ll likely have small elastic bands connecting brackets on your upper and lower teeth. These bands guide your bite into the correct position while the bone heals. An acrylic splint, a thin plastic wafer that fits between your upper and lower teeth, may also be in place to keep the segments precisely aligned during the early healing phase.
Your face will be noticeably swollen, and your nose may be congested from the nasal breathing tube. Numbness in your lips and chin is normal and expected, especially after lower jaw surgery, because the nerves that were carefully protected during the procedure still need time to recover from being handled.
How Long You Stay in the Hospital
For a single-jaw surgery, a hospital stay of up to three days is typical. Double-jaw surgery usually requires up to four nights. Less invasive procedures may allow you to go home the same day once your surgical team confirms you’re stable, alert, and able to manage fluids.
During your hospital stay, the focus is on managing swelling, controlling pain, and making sure you can breathe comfortably and take in enough liquids. You’ll be on a liquid diet initially, progressing to soft foods over the following weeks as your jaw heals and you gradually regain the ability to open your mouth fully.