About Orthognathic Surgery

What is involved with surgery

Improving Balance of the Face

Orthognathic surgery involves repositioning one or both jaws into a correct functional alignment. Typically, the overall balance of the face will be simultaneously improved, for example: 

1. Correction of facial asymmetry to one of right and left balance.
2. Improvement of a flat or concave facial profile to one that is more convex.
3. Correction of an overly long, thin face to a more rounded or heart-shaped appearance. 
4. Increased prominence of the cheekbones.
5. Having one’s chin in a more cosmetically pleasing shape and position.
6. Having a more well-defined lower jawline.
7. Loss of a double chin or sloping neckline creates a more attractive transition between the lower jaw and neck.

As part of this process, the cosmetic appearance of the teeth and mouth are typically improved- examples of this are the following: 

1. Correction of a slanted or off-center smile.
2. Correction of a cosmetically unattractive overbite, “underbite,” or open-bite (“shark- bite”).
3. Increased teeth visibility in both a relaxed state and while smiling.
4. Increased width of the smile so that the width of the upper jaw teeth corresponds to the width of the mouth. 
5. Loss of an overly “toothy “appearance in a relaxed state and loss of a “gummy smile” when smiling.
6. Improve the appearance of short, thin upper lips to ones with increased fullness. 
7. Loss of straining and wrinkling of the chin during the closure of the lips.

It has been my experience that state-of-the-art orthognathic surgery can achieve optimal facial cosmetics and optimal function, resulting in predictable long-term stability. While the surgery’s primary intended benefits are optimizing the bite, improving the airway and breathing, and decreasing pain while simultaneously improving TMJ problems, the cosmetic results are frequently quite dramatic. Everyone is different, and I individualize treatment plans to respect my patient’s wishes. I always invite people to express their cosmetic concerns and wishes openly. In most cases, their goals can be incorporated into the surgical treatment plan to simultaneously achieve optimal functional and cosmetic goals.

I use Virtual Surgical Planning software based on my patient’s CT scan and state-of-the-art motion capture 3D photography to plan each surgery. I have performed these procedures well over a thousand times. To better understand the power of this technology, please refer to the following websites.

• https://www.youtube.com/watch?v=SLXFx8asYiA
• https://3dmd.com/products/#https://3dmd.com/products/#!/face
• https://www.3dsystems.com/healthcare/craniomaxillofacial-solutions

These technologies allow me to create a treatment plan for you visually. Your input and aesthetic preferences are respected so you and I can visualize them — together — very early in the planning process, in the virtual realm — from the time of the initial consultation. 

You and I will repeat this planning process several weeks before surgery to verify that we have stayed on track for our goal. Additionally, at this time, we can make any final adjustments to your specific surgical plan.

This extremely sophisticated, accurate, and powerful technology has revolutionized the practice of orthognathic surgery. However, like any planning tool, its potential can only be maximized fully if the surgeon possesses an excellent imagination and artistic sense and can visualize the desired result. This requires the surgeon to backward-plan the entire treatment, typically 1 to two years in advance, so the final goal is achieved precisely as planned one to two years prior. 

Finally, the surgery must be performed flawlessly so that patients can quickly recover and return to work or school.

Is This Surgery Necessary?

Patients will frequently ask if this type of surgical procedure is necessary. Possible consequences and risks of not treating abnormal facial growth patterns are the following:

1. Abnormal tooth wear. Wear can be significant enough in some cases to require the placement of crowns.
2. Abnormal mechanical forces that result in the loosening of the teeth and premature tooth loss.
3. Breathing and airway problems, including upper airway resistance, obstructive sleep apnea, and abnormal and fragmented sleep patterns. Consequences of these problems include neurologically impaired executive functioning, mood disorders, possible cognitive decline including dementia, and heart problems. Please refer to further details below.
4. TMJ problems include muscular pain, arthritis, chronic pain, and progressive joint deterioration.
5. Continued or worsened difficulty with chewing and speech.
6. Psychological consequences include low self-esteem due to societal conditioning and the value placed on physical attractiveness, impairments related to social anxiety, and, tragically, the increased risk of ostracism and social isolation, bullying, ridicule, and other forms of abusive behavior. Most of us know these events are commonplace among adolescents and teens. The long-term consequences of these psychological traumas, especially in the developing brain, often lead to lifelong impairment and become “frozen in the psyche” over time. Sadly, they are usually left untreated.

Some patients never experience any difficulty with an abnormal facial growth pattern. If you are satisfied with your present condition and can accept the possible occurrence of the abovementioned problems, then a non-surgical approach may be the correct choice. However, be aware that if a nonsurgical route is chosen, significant functional and cosmetic compromises in your orthodontic treatment and facial appearance may need to be accepted. Moreover, your orthodontist may opt not to begin orthodontic treatment in situations involving some malocclusions.

THE REMAINDER OF THIS WEB PAGE CONTAINS IMPORTANT INFORMATION THAT, AS YOUR POTENTIAL SURGEON, I BELIEVE IS IMPORTANT FOR YOU TO KNOW ABOUT ORTHOGNATHIC SURGERY

General

• Braces are typically placed on your teeth six months to 1 ½ years before surgery, remain on the teeth during surgery, and are required on average 6-12 months after surgery. 
• The surgery is done in the operating room under general anesthesia. Patients can often have this surgery performed in an “outpatient” surgical center and go home the same day after surgery. At other times, patients are admitted to a hospital overnight and leave the day after surgery.
• The bones of the face are cut and repositioned; the incisions are made inside the mouth. Two tiny incisions (less than 1/8 of an inch) are sometimes made on the face near the back of the lower jaw. Significant visible scars following surgery would be very rare indeed. I have personally never had this occur among my patients.
• Postoperative swelling can be significant but decreases rapidly within the first two weeks and is almost completely gone within six weeks.
• Most of the discomfort after surgery is due to swelling. It is normal following surgery to have temporary numbness in the face, similar to receiving a dental anesthetic for a filling. 
• Most patients will require a prescription pain medicine around the clock for only two days and once per day for the next 2 to 3 days. After this, Advil is all that is required!
• Most patients return to school or work within 3-6 weeks.
• In some cases, the jaws are immobilized (fixed shut with stainless steel wire) for one week following surgery. A diet of smoothies will be required for one week if this is the case.
• One week after surgery, you will need to have elastics between your top and bottom teeth 24 hours per day. These can be taken out during eating and brushing. Over the next two months, you will use progressively fewer elastics and wear them for fewer hours daily. Finally, they will be discontinued entirely.
• Starting one week following surgery, a non-chew (very soft) diet is required for up to four months after surgery. At four months, you may start to chew again very carefully, starting on softer foods initially and then progressing to a regular diet within a month or so.
• Your orthodontist will begin fine-tuning your bite approximately three weeks after surgery. As stated above, this typically requires 6–12 months.
• Occasionally, patients require a short preliminary surgery to widen an excessively narrow upper jaw near the beginning of orthodontic treatment. I will advise you if this is necessary.

Appointments after surgery typically require the following schedule:

1. 4 to 5 appointments during the first six weeks.
2. 3-month follow-up appointment
3. 6-month follow-up appointment
4. 1 and 2-year follow-up appointments

Activity and Exercise- Non-strenuous activities such as walking can be resumed immediately. 

• In 6 weeks, you can do any non-impact exercise that does not involve bouncing, shaking, or rapid decelerations. The following are acceptable: Swimming, rowing, elliptical training, yoga, Pilates, and cycling. 
• Running, jogging, and treadmill are not allowed until four months. 
• In 6 weeks, weight training is allowed if you do not clench your teeth.
• 4 months after surgery, there are no restrictions on exercise.
• Contact sports with a risk of direct facial trauma should be avoided for one year.
• Close follow-up after surgery is necessary to ensure the best possible result!

Possible Risks and Complications

• Numbness. There is a slight chance of long-term or permanent loss of feeling in the lower lip, chin, or bottom front teeth. 
• Need for Hardware Removal. Titanium (metal) plates and screws are used to place and hold the bones in the new position during healing. Initial bone healing occurs in 6 weeks. After this, the titanium plates and screws are no longer necessary. However, the metallic hardware is usually left in place permanently with no long-term problems. This metallic hardware will not set off the “metal detectors” at airports. In some cases, there may be a reason to remove some or all the metal plates and screws. This usually occurs due to inflammation or a low-grade infection around the hardware. If removal is necessary, it is usually performed in the operating room under general anesthesia as a 10 to 20 procedure.
• The above two scenarios describe the most common complications, uncommon as they may be. However, even rarer complications, such as damage to the teeth or gums or a return trip to the operating room for an adjustment or revision surgery, could conceivably occur.
• Although complications are always possible, they are rare. Multiple studies have demonstrated that the surgeon’s experience is the main determining factor for not only the probability but the severity of surgical complications. In my opinion, all surgeons should know their complication rates and be competent to quote these statistics to their patients. This is the only way patients can make informed decisions based on relevant data- relevant to the individual surgeon with whom consultation is taking place. My complication rate is 1.15%. This is approximately one-quarter of the complication rate published in peer-reviewed scientific studies conducted in the US, and 1/10 of internationally published studies. 

Orthognathic surgery is highly likely to: 

• improve your ability to chew and swallow food, 
• allow you to breathe easier, 
• make speaking easier, and
• enjoy a cosmetically pleasing result. 

Moreover, these benefits will be lifelong and stable over time. Almost without exception, patients report to me after surgery that their decision is one they would readily make again. Perhaps most importantly, they overwhelmingly report being more comfortable in social situations- due to their improved self-image, sense of ease and self-confidence, and greater self-esteem.