Orthognathic Surgery in London: What to Know Before Treatment

Orthognathic surgery — jaw surgery — is used to correct skeletal discrepancies in the position of the upper jaw, lower jaw or both. For patients with a significant underbite, overbite, crossbite, open bite or facial asymmetry that has a skeletal cause, braces or aligners alone are not enough. The underlying jaw position needs to be corrected surgically before orthodontic treatment can achieve a stable, functional result. This guide explains what orthognathic surgery is, who it is for, what the treatment involves alongside orthodontics, what the procedure entails and what patients should realistically expect from the process and recovery.

What Is Orthognathic Surgery?

The word orthognathic comes from the Greek for “straight jaw.” Orthognathic surgery encompasses a range of surgical procedures that move the jawbones to a corrected position — improving the bite, facial symmetry and overall jaw function. It is not cosmetic surgery in the conventional sense, though the improvements in facial balance that often result from correcting a jaw discrepancy can be significant. Orthognathic surgery is always planned in close collaboration between an oral or maxillofacial surgeon and an orthodontist. The orthodontist prepares the teeth through pre-surgical braces or aligners, the surgeon repositions the jaws, and the orthodontist then fine-tunes the bite in the months after surgery. Neither the surgery nor the orthodontics alone produces the full result — both are essential parts of the treatment.

Who Needs Orthognathic Surgery?

Orthognathic surgery is considered when jaw discrepancies are too severe to be corrected by orthodontics alone. Braces and aligners move teeth — they cannot move the bones of the jaw. When the underlying skeletal structure is significantly out of alignment, surgery is needed to reposition the jaw before the teeth can be properly aligned within it.

• Severe underbite — lower jaw protrudes significantly beyond the upper jaw (Class III skeletal relationship)
• Severe overbite or overjet — upper jaw protrudes significantly, or the upper front teeth bite too far over the lower (Class II skeletal relationship)
• Open bite — upper and lower front teeth do not meet when the back teeth are closed
• Crossbite with skeletal cause — upper teeth sit inside lower teeth due to jaw width discrepancy
• Facial asymmetry — significant difference in jaw position between left and right sides
• Jaw-related sleep apnoea — selected cases where jaw advancement can improve the airway
• Difficulty chewing or biting — due to a bite that cannot be corrected orthodontically

Types of Orthognathic Surgery

Le Fort I Osteotomy — Upper Jaw

The Le Fort I osteotomy repositions the upper jaw (maxilla). An incision is made inside the upper lip, the bone is carefully cut and the upper jaw is moved to the planned position — forwards, backwards, upwards, downwards or rotated depending on the correction needed. It is secured in the new position with small titanium plates and screws.

Bilateral Sagittal Split Osteotomy (BSSO) — Lower Jaw

The BSSO repositions the lower jaw (mandible). The bone is cut on both sides and the front section of the lower jaw is moved to the planned position — forwards to correct a severe overbite, or backwards to correct a severe underbite. The segments are secured with titanium fixation hardware. This is the most common orthognathic procedure for lower jaw discrepancies.

Bimaxillary Osteotomy — Both Jaws

When the discrepancy involves both the upper and lower jaw, or when better results can be achieved by moving both, a bimaxillary (two-jaw) procedure is performed. This is the most complex type of orthognathic surgery but allows the greatest degree of correction and facial balance improvement.

Genioplasty — Chin

A genioplasty repositions the chin bone independently of the lower jaw. It can be performed alone or alongside other jaw surgery to refine the overall facial profile. A receding chin that is disproportionate to the rest of the face can be significantly improved with a genioplasty.

Orthodontics and Jaw Surgery: How They Work Together

One of the most important things to understand about orthognathic surgery is that it is almost always a combined treatment involving orthodontics. The full process typically follows this sequence:

• Pre-surgical orthodontics (12–18 months): Braces or aligners are used to align the teeth within each jaw. This stage often makes the bite temporarily worse — the teeth are being positioned for where they will sit after the jaws are surgically moved, not for where they currently sit
• Surgery: The jaw or jaws are repositioned under general anaesthesia. Fixation hardware holds everything in the new position during healing
• Post-surgical orthodontics (6–12 months): The bite is refined and finalised once the jaws have healed in their new position
• Retention: Retainers maintain the orthodontic result long term

Total treatment time — from the start of pre-surgical orthodontics to the end of post-surgical treatment — typically ranges from 18 to 24 months. Patients should be prepared for this timeline from the outset.

The Planning Process

Careful planning is essential for orthognathic surgery. Modern planning uses 3D CBCT imaging, digital models and virtual surgical planning software to simulate the jaw movements and predict the outcome before surgery takes place. This allows the surgical team to rehearse the procedure digitally, produce custom cutting guides if needed and give patients a realistic preview of what the result will look like. The planning stage involves close collaboration between the oral surgeon, the orthodontist and — where relevant — other specialists. For patients with sleep apnoea, a sleep medicine team may also be involved. Getting the planning right is what makes the surgical outcome predictable.

What Does Orthognathic Surgery Cost in London?

Orthognathic treatment at DentAkademi London starts from £5,000 for the combined orthodontic and surgical planning component. The full cost of treatment — including all orthodontic treatment, surgical fees, anaesthetic and follow-up care — varies depending on the complexity of the case, the type of surgery required and the overall treatment plan. A detailed written treatment plan with full costs is provided at the consultation before any commitment is made.

Recovery After Orthognathic Surgery

Orthognathic surgery is performed under general anaesthesia and involves a hospital stay — typically one to two nights. Swelling is expected to be significant in the first two weeks and peaks at around 48 to 72 hours after surgery. Bruising is common and can extend to the neck and chest. A liquid and soft diet is required for several weeks as the jaw heals. Most patients feel substantially better within six to eight weeks and return to work and most normal activities within two to four weeks depending on the nature of their job. Full healing — including the resolution of swelling and the settling of the jaws — takes up to 12 months. Numbness or altered sensation in the lips, chin or cheeks is common in the early weeks and usually resolves gradually as the nerves recover.

Risks and Considerations

Orthognathic surgery is a significant procedure with a range of potential risks that should be discussed fully before treatment begins. These include infection, bleeding, temporary or permanent altered sensation, relapse of the jaw position, the need for further surgery and general anaesthetic risks. The risk of permanent nerve injury is low but real, particularly for lower jaw surgery. In experienced hands, serious complications are uncommon — but honest risk discussion is a prerequisite for proper informed consent.

Frequently Asked Questions