At a glance
Orthognathic surgery is an operation that repositions one or both jaws to correct their alignment with each other and with the skull base.
During the procedure, an oral and maxillofacial surgeon cuts the jawbone or bones at precisely planned locations, moves them to a new position, and holds them there with titanium plates and screws. The bones then heal in that corrected position over the following months. Because the jaws anchor the teeth, this shift changes how the upper and lower teeth meet, which is why orthodontic treatment with braces is almost always part of the overall plan.
Medical Condition
Orthognathic surgery is recommended when the jaw misalignment is too severe to be corrected by orthodontics alone, and when it is causing functional problems or significant facial imbalance.
- Skeletal Class III malocclusion (underbite): the lower jaw protrudes too far forward relative to the upper jaw.
- Skeletal Class II malocclusion (overbite): the lower jaw sits too far back, making the chin appear recessed.
- Open bite: the front teeth do not meet when the back teeth are closed.
- Crossbite: some upper teeth sit inside the lower teeth instead of outside them.
- Facial asymmetry: one side of the face or jaw is noticeably larger or positioned differently from the other.
- Obstructive sleep apnoea (repeated pauses in breathing during sleep) caused by a jaw that restricts the airway.
- Difficulty chewing, biting, or swallowing linked to jaw position.
- Speech difficulties related to jaw structure.
- Temporomandibular joint (TMJ) pain or dysfunction that has not responded to other treatments.
Surgery is generally not suitable in certain situations. Growth of the jaw must be complete before the operation is performed, which usually means waiting until the late teens at the earliest. Surgery is also avoided when the misalignment can realistically be managed with orthodontics alone, or when the patient's general health makes general anaesthesia (being put to sleep) unsafe.
- Ongoing jaw growth (typically before the mid to late teens).
- Mild misalignment that can be corrected with braces only.
- Serious uncontrolled medical conditions that raise the risk of surgery under general anaesthesia.
- Active gum disease or untreated dental infections that must be resolved first.
Risks & Complications
Like any major operation under general anaesthesia, orthognathic surgery carries recognised risks that your surgical team will discuss with you before you sign a consent form.
- Swelling and bruising of the face and neck, which is expected and usually peaks in the first few days.
- Temporary numbness or altered sensation in the lips, cheeks, chin, or teeth, caused by stretching of nearby nerves.
- Permanent or prolonged numbness in a small area, most often the lower lip or chin, if a nerve is injured.
- Bleeding during or after surgery, sometimes requiring a blood transfusion.
- Infection of the bone, plates, or surrounding soft tissue, treated with antibiotics or, rarely, removal of the hardware.
- Relapse: the jaw partially returning toward its original position during healing, which may require additional orthodontic adjustment or, rarely, revision surgery.
- Poor wound healing or scarring at incision sites inside the mouth.
- Temporomandibular joint (jaw joint) pain or dysfunction after repositioning.
- Risks of general anaesthesia, including breathing problems or adverse drug reactions.
- Rarely, damage to tooth roots or the need to extract a tooth near the surgical cuts.
Preparation & Procedure
Preparation for orthognathic surgery spans months, not days. The orthodontic phase with braces, which aligns the teeth into the position they will occupy after the jaws are moved, typically takes one to two years before the surgical date is set.
In the weeks leading up to surgery, your team usually asks you to stop smoking, as smoking slows bone healing, and to avoid alcohol for at least a week beforehand. Blood-thinning medications and certain supplements are typically paused as directed by your surgeon. You stop eating and drinking, including water, from midnight or a set number of hours before your scheduled time under general anaesthesia.
Standard pre-operative tests usually include a blood count, clotting studies, and an assessment of your heart and general health. Imaging is central to planning: dental moulds or digital scans, panoramic jaw X-rays, a lateral skull X-ray called a cephalogram (an image of the head from the side), and sometimes a CT scan are used to create a precise surgical plan, often with computer simulation.
On the day of surgery, the usual steps are as follows.
- You arrive at the hospital, usually fasted, and are admitted to a pre-operative area.
- The anaesthesia team reviews your health, places an intravenous line (a drip in a vein), and gives you medication to help you relax.
- General anaesthesia is administered; you are asleep and feel nothing during the operation.
- The surgeon makes incisions inside the mouth, so there are no visible cuts on the face in most cases.
- The jawbone or bones are precisely cut, moved to the planned position, and fixed with titanium plates and screws.
- The bite is checked against the pre-made surgical guide, a custom splint fitted between the teeth.
- The incisions inside the mouth are closed with dissolvable stitches.
- You are moved to a recovery area where you wake up under nursing supervision.
- Most patients stay in hospital for one to three nights, though this varies with the extent of surgery.
Aftercare
Recovery from orthognathic surgery is measured in weeks for the initial phase and months for full bone healing. The first one to two weeks are typically the most uncomfortable, with significant swelling and a very limited diet.
- Hospital stay: most patients are discharged after one to three nights, once swelling is manageable and pain is controlled with oral medication.
- Diet: a liquid or soft diet is followed for several weeks, gradually progressing to soft solid foods as the surgeon approves. Hard or crunchy foods are avoided for months.
- Jaw mobility: the surgeon may wire or band the jaws together for a short period in some cases, or use elastic bands on the braces to guide healing. Follow your team's instructions on this.
- Oral hygiene: gentle rinsing with an antiseptic mouthwash starts quickly after surgery; careful brushing resumes as directed to keep incision sites clean.
- Swelling: cold packs in the first 24 to 48 hours help reduce swelling. Most visible swelling subsides within two to three weeks, but subtle swelling can remain for up to a year.
- Activity: strenuous exercise and contact sports are avoided for at least six weeks. Most patients return to desk work or study within two to three weeks.
- Driving is typically off limits while strong pain medication is being taken.
- Orthodontic follow-up: braces remain on after surgery and are adjusted at regular appointments to fine-tune the bite as the bones consolidate. This phase often lasts six to twelve months.
- Surgeon follow-up: appointments are scheduled at regular intervals, often at one week, one month, three months, six months, and one year, to monitor bone healing with X-rays and assess the bite.
- Bone plates and screws: these are usually left in place permanently. Removal is only considered if they cause discomfort or infection.
- Sun protection for the face and avoiding extreme temperature changes helps during healing.
- Numbness in the lips or chin may persist for many months; most patients notice gradual improvement over time.
Cost & What Determines It
Orthognathic surgery is one of the more complex elective procedures in oral and maxillofacial surgery, and its cost reflects that complexity. The price varies widely depending on how many jaws are operated on, which country and class of hospital is chosen, and what the total care pathway includes.
- Extent of surgery: single-jaw surgery (upper jaw only, or lower jaw only) costs less than double-jaw surgery (bimaxillary osteotomy), which repositions both jaws simultaneously.
- Surgical complexity: additional procedures performed at the same time, such as genioplasty (chin reshaping) or correction of severe facial asymmetry, add to the overall cost.
- Hospital class and country: prices differ significantly between countries and between public, private, and internationally accredited hospitals within the same country.
- Length of hospital stay: a longer inpatient stay, whether planned or due to complications, increases costs through room, nursing, and monitoring fees.
- Implants and hardware: titanium plates and screws used to fix the bone are priced separately in many hospitals and represent a meaningful portion of the total bill.
- Anaesthesia fees: general anaesthesia for a multi-hour procedure is billed based on time and the anaesthetist's fee structure.
- Pre-operative imaging and planning: CT scans, cephalograms, dental scans, and computer surgical simulation can add substantial cost.
- Orthodontic treatment: braces before and after surgery are usually managed and billed separately by an orthodontist, and the total duration often spans two to three years.
- Post-operative medication: pain relief, antibiotics, antiseptic mouthwashes, and other medications needed during recovery.
- Follow-up appointments and repeat X-rays during the months of bone consolidation.
Hospital packages for orthognathic surgery typically cover the surgeon's fee, the operating theatre, anaesthesia, the hardware implanted during surgery, the inpatient stay, and standard nursing care. Items that are often billed separately include the pre-operative workup, advanced imaging, orthodontic fees, prescribed medications to take home, and any outpatient follow-up visits after discharge.
For Indonesian patients, BPJS Kesehatan and most Indonesian private insurance policies do not cover treatment received abroad. Patients travelling for this surgery therefore usually pay out of pocket or through a private international health insurance plan that explicitly covers overseas procedures. Before making any travel arrangements, ask the hospital for a detailed written cost estimate that itemises every component, including hardware, imaging, anaesthesia, and the expected length of stay. This protects you from unexpected charges and makes it easier to compare options across different destinations.
Frequently Asked Questions
How long does orthognathic jaw surgery take?
Orthognathic surgery usually takes between two and six hours, depending on how many parts of the jaw need to be repositioned. Moving both the upper jaw (maxilla) and the lower jaw (mandible) in the same operation takes longer than correcting only one. Your surgeon will give you a more specific estimate after reviewing your scans and treatment plan.
What kind of anaesthesia is used, and will it be painful afterwards?
Jaw surgery is performed under general anaesthesia, meaning you will be fully asleep and feel nothing during the procedure. Swelling and discomfort in the days after surgery are normal, and doctors typically manage pain with prescribed pain relief. Most patients find the discomfort eases noticeably within the first one to two weeks.
How long is the recovery, and when can I go back to work?
Most people need about six to twelve weeks before they feel ready to return to a desk job, though full healing of the bone takes several months longer. For the first few weeks, your diet will be limited to soft or liquid foods because the jaw needs time to settle in its new position. Physical work or sport should wait until your surgeon clears you, which is usually after the bone has healed more fully.
How much does orthognathic jaw surgery cost?
The cost varies based on several factors specific to this procedure, including whether one jaw or both jaws are being repositioned, the complexity of the bone cuts required, the length of your hospital stay, and the surgical hardware such as plates and screws used to hold the jaw in place. Hospital class and the experience of the oral and maxillofacial surgeon also affect the final figure. Requesting a written estimate from the hospital, based on your own scans and treatment plan, is the most reliable way to get an accurate number.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
