Orthognathic Jaw Surgeon, San Francisco

What is Orthognathic (Jaw) Surgery?

Orthognathic surgery (“ortho” meaning to straighten, “gnathic” pertaining to the jaws) describes all types of surgery that involve changing the position of the upper or lower jaws to either correct an incorrect bite (malocclusion) or to alter the shape of the face—or both.

Orthognathic surgery is most commonly performed in young adults to correct a poor “bite” (malocclusion), or sometimes in young adults whose facial proportions are not ideal.

Orthognathic surgery treats the following conditions:

  • Class II malocclusion
  • Class III malocclusion
  • Retrognathia of the upper or lower jaw
  • Short face / long face
  • Gummy smile
  • Small chin
  • Assymetries of the face and/or bite
  • Dental midline asymmetries
  • Bruxism
  • Chewing problems
  • Disharmony of facial proportions

In appropriate patients, large improvements can often be obtained by altering the position of the upper and lower jaws. In addition, this is often needed in young adults who have an over- or undergrowth of one half of the jaw or in those who have severe TMJ problems.

Orthognathic or “corrective” jaw surgery improves:

  • The appearance of the face by improving the proportions that govern the way our face looks to the outside world
  • The relationship between the teeth so that teeth fit better after surgery problems
  • The airway: it may be a sole treatment for patients with sleep apnea  (approaching 80% significant improvement in sleep problems associated with obstructive sleep apnea)
  • Temporomandibular joint (TMJ) problems in those patients in whom a malocclusion (poor bite) contributes to those TMJ

Orthognathic surgery, plastic surgery, and orthodontics work together for a successful result.

Orthognathic surgery is often one of the most incredible forms of plastic surgery because the facial skeleton is the foundation of the face, and often the most significant and yet naturally pleasing results in plastic and maxillofacial surgery come from altering the foundation (and not just the soft tissues) of the face.

Orthognathic surgery is almost always performed in conjunction with an orthodontist.  If you don’t have an orthodontist, we work with some of the very best people on the west coast and can help arrange an appointment for you.

A good relationship and clear communication between the orthodontist surgeon and the orthodontist  is very important because the two have to coordinate the fit of you teeth in conjunction with a plan for your surgery. It’s a team effort.

What are the alternatives to orthognathic surgery?

Some people try alternative procedures to orthognathic surgery to camouflage a poor bite without ever being referred to one of the few specialists who do this type of surgery.

For example, patients with a small jaw would be vastly benefited by moving the lower jaw forward. Yet they may have a surgeon with no experience in this type of surgery use a chin implant instead.

However, this often fails to fix the real problem.  In our practice we often need to remove chin implants (chin revision surgery) and move the jaw forward for patients who have had the “wrong” operation in the first place.

The chin implant leads to a very pronounced chin. The lip almost lies on top of the protruding chin which is sometimes worse than the original problem!

Orthognathic surgery should be considered by anyone before they consider any type of “camouflage” operation so that they know all the facts involved.

New techniques in orthognathic surgery mean faster recovery.

There are new techniques in orthognathic surgery that decrease the swelling and down time associated with larger operations.

Using techniques that involve less trauma to the tissue and by using Platelet Rich Plasma PRP at the onset and conclusion of surgery we have had very good success with patients feeling better faster after these operations.

One big misconception is that patients will have to have their jaw’s wired shut at the conclusion of surgery. This is not the case in our practice and almost always patients will have light elastic rubber bands to guide the bite at the end of surgery.

How orthognathic surgery and aesthetic (plastic) surgery work together.

When you are committing to orthognathic surgery, it’s often the right time to consider other aspects that may be beneficial to the structure and look of your face.

Augmenting the facial skeleton using bone grafts, or reducing various parts of the facial skeleton if they are too prominent, are quite often useful adjuncts to these procedures to improve the final result.  It’s better to think about these aesthetic considerations when one is already planning for a surgery, rather than doing them as a separate procedure.

What can I expect to happen during jaw surgery?

Your surgery will be performed at a hospital or outpatient surgery center in San Francisco. Dr. Deschamps-Braly will then begin by making an incision on the inside of the mouth to access the jawbones. Sections of the jawbones will be precisely cut to enable them to fit together and align smoothly. The incisions will then be closed with sutures. This procedure can take between 3 to 7 hours. After surgery you will most probably need to stay overnight in hospital.

How long will recovery from my jaw surgery take?

Initially you may feel discomfort and mild pain, and depending on your individual procedure you may also experience tingling and swelling. We usually prescribe non-opioid painkillers for the first few days after surgery, but after this time over-the-counter pain relief such as Extra Strength Tylenol will work just as well. Most of the pain and swelling will recede within the first few days after surgery. You will be restricted to a liquid diet for at least 1 week. After this time you will be able to start eating soft foods and eventually resume your normal diet.

Will I need other post-operative treatment?

Depending on your condition and recommended surgery, post-operative therapies may include the surgeon’s collaboration with your orthodontist for further teeth straightening. Dr. Deschamps-Braly will work with your orthodontist and speech therapist to create a collaborative rehabilitation plan.

Why choose us?

Many of the doctors who do orthognathic surgery have very little training or concern for the outcome and aesthetic appearance of the face.  A crude decision to simply move the jaw forward is made and the procedure is then executed.

Coming from an extensive background in plastic surgery, we start with the premise first of an aesthetically good-looking result and work backwards toward having a functional result that merges with an aesthetic one.

For example, movement of the lower jaw forward often results in lengthening of the throat. This also results in improved aesthetics and because of the improved soft tissue support gives the effect of a “skeletal” face-lift.

What we do.

From our practice in San Francisco we offer the following orthognathic (jaw) surgery procedures: