Jaw realignment surgery (orthognathic surgery)
Planned surgery to reposition the upper jaw, lower jaw or both, almost always combined with a long course of braces, to correct the bite and the balance of the face.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It corrects the bite and jaw position when braces alone are not enough, and is almost always combined with a long course of braces before and after surgery.
- It is a major operation under general anaesthetic, and the whole pathway commonly takes around two to three years.
- Numbness of the lip, chin or face is very common afterwards — usually temporary, but occasionally permanent.
- It is available on the NHS for recognised functional problems; cosmetic-only requests are usually private, and results cannot be guaranteed.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Corrects a bite that braces alone cannot fix
The bite problem can be corrected by orthodontics (braces) alone without moving the jaw bones.
Swelling and bruising build to their worst. You are on liquids, with pain relief and anti-sickness medicines. Most people go home after 1–3 nights.
Joint follow-up by both the surgeon and the orthodontist over the months after surgery.
Swelling and bruising build to their worst. You are on liquids, with pain relief and anti-sickness medicines. Most...
Most swelling settles. You continue a soft or liquid diet, keep the mouth very clean, and avoid strenuous...
Many people return to work or study and move towards normal food. Subtle swelling and numbness often remain...
Numbness gradually improves in most people. Braces stay on for around six months to finish the bite, with no...
What is jaw realignment surgery (orthognathic surgery)?
Orthognathic surgery repositions the jaw bones so the teeth meet correctly and the jaws and face are better balanced. The upper jaw, the lower jaw, the chin, or a combination can be moved. The word means 'straight jaws'.
It is almost never a stand-alone operation. It is part of a long pathway run jointly by an orthodontist and a maxillofacial surgeon: braces are used for many months to line the teeth up before surgery, the surgery is done under general anaesthetic, and braces continue for around six months afterwards to settle the bite. The whole journey commonly takes around two to three years.
It is done mainly to correct a bite that braces alone cannot fix, to help with chewing, speech or breathing, and to improve facial balance. It cannot give a guaranteed cosmetic outcome, and it is not a quick fix — the commitment to the orthodontic part is as important as the operation itself.
Almost everyone has some numbness of the lip, chin or face afterwards because nerves run very close to where the bone is cut. This is usually temporary but can occasionally be permanent.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Braces alone vs braces with jaw surgery
| Option | What it can do |
|---|---|
| Braces alone | Move teeth within the existing jaws; cannot move the jaw bones |
| Braces + jaw surgery | Repositions the jaw bones as well, for bigger bite and balance problems |
| Time involved | Surgery pathway is longer overall and includes a major operation |
| Reversibility | Tooth movements take time; the bone surgery is not reversible |
Your orthodontist and surgeon will explain whether your problem can be corrected by braces alone or genuinely needs surgery.
Preparing for your surgery
- Expect a joint assessment with an orthodontist and a maxillofacial surgeon, with X-rays, photos, scans and models of your teeth.
- Understand that braces usually go on many months before surgery to line up the teeth (this can temporarily make the bite look worse).
- Stop smoking well before surgery, as it slows bone healing.
- Tell the team about all medicines and your full medical history, and arrange any pre-operative checks.
- Plan for 3–6 weeks off work or study and for a soft or liquid diet for several weeks.
- Arrange help at home, a lift after discharge, and time for follow-up appointments with both surgeon and orthodontist.
- Make sure you have realistic, written information on the likely result, the risks and the long timescale before you consent.
What happens
The operation is done under general anaesthetic, so you are asleep throughout, and usually takes between about one and four hours depending on whether one or both jaws are moved.
The surgeon works through cuts inside the mouth, so there are usually no cuts on the face. The jaw bone is carefully divided, moved into its planned position and fixed with small titanium plates and screws. A guide (a splint) and elastic bands on the braces may be used to position the bite.
Most people stay in hospital for one to three nights. Swelling and bruising build up and are usually worst on the second or third day. You start on liquids, move to soft foods, and gradually return to a normal diet over about four to six weeks.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- The bite problem can be corrected by orthodontics (braces) alone without moving the jaw bones.
- The person is not willing or able to commit to the long orthodontic treatment before and after surgery.
- Active gum disease, poor oral hygiene or untreated dental disease that must be sorted first.
- A medical condition or smoking habit that makes major surgery or bone healing unsafe.
- Expectations are mainly cosmetic and unrealistic, or driven by factors better helped by other support.
Delay surgery if…
- Facial growth is not yet complete (surgery is usually deferred until growth has finished).
- Gum disease, decay or poor oral hygiene need treating before surgery.
- You are pregnant or planning pregnancy in the near term.
- Smoking has not yet been stopped, as it impairs bone healing.
- The orthodontic teeth alignment that must come first is not yet complete.
Alternatives to discuss
- Orthodontics (braces or aligners) alone where the problem allows.
- Camouflage orthodontics that disguises a mild jaw discrepancy without surgery.
- Restorative or cosmetic dentistry for minor concerns.
- Accepting the current bite if symptoms are mild and function is acceptable.
- Speech and language therapy or other support where relevant, alongside or instead of surgery.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Corrects a bite that braces alone cannot fix
- Can make chewing and biting more comfortable and effective
- Can improve speech or breathing in selected people
- Improves the balance and proportions of the jaws and face
- Provides a stable, long-lasting result once healing is complete in most people
Risks & complications
- Marked swelling and bruising of the face, worst around day 2–3
- Numbness or altered feeling of the lip, chin, cheek or gums (very common early on)
- Difficulty eating, with a soft or liquid diet needed for several weeks
- Tiredness and a fair amount of disruption for several weeks
- The bite not being quite right, sometimes needing a small further operation to adjust plates and screws
- Infection around the plates, which may need them removed (usually months later)
- Numbness or tingling that lasts several weeks before recovering
- Some relapse, where the jaws drift slightly back towards their old position
- Numbness of the lip or chin that lasts more than a year and may be permanent
- An unfavourable or 'bad' split of the bone during lower-jaw surgery
- Heavy bleeding, or rarely a blood clot in the leg or lung (DVT/PE)
- Chest infection or other general anaesthetic complications
The single most important thing to understand is that altered sensation of the lip and chin is very common straight after surgery; about one in ten people have tingling or numbness lasting several weeks, and fewer than one in a hundred have changes lasting more than a year that may be permanent. Larger jaw movements carry more risk of relapse and nerve problems. Ask your surgeon about your specific movement, your personal risk of lasting numbness, and how the bite will be checked and adjusted if it is not quite right.
Published figures to discuss
Reported nerve-injury rates after jaw surgery vary enormously between studies because researchers measure sensation in different ways and at different times, and because the figure depends on which jaw is moved and how far. Subjective patient-reported numbness is higher than numbness found on objective testing, and most early numbness recovers. Relapse risk depends on the direction and size of the movement. Figures below are broad indicators for discussion, not precise personal predictions.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Altered lip/chin sensation lasting several weeks (lower-jaw surgery) | About 1 in 10 people (around 10%) | Per NHS patient information; the majority recover over weeks to months. | University Hospitals Plymouth NHS Trust — Orthognathic surgeryplymouthhospitals.nhs.ukPublished figure |
| Altered sensation lasting more than a year / possibly permanent | Fewer than 1 in 100 (under about 1%) | Per NHS patient information; risk relates particularly to lower-jaw (mandibular) surgery. | University Hospitals Plymouth NHS Trust — Orthognathic surgeryplymouthhospitals.nhs.ukPublished figure |
| Inferior alveolar nerve disturbance after BSSO (research) | Early disturbance is common in research series; recent reviews report most recover by 6–12 months, with permanent changes usually low single figures | Wide variation reflects different measurement methods and follow-up; discuss your own surgeon's figures. | Systematic review of inferior alveolar nerve injury in bilateral sagittal split osteotomy (PubMed)pubmed.ncbi.nlm.nih.govSource-linked context |
| Need for a small further operation to adjust the bite/plates | Uncommon, but recognised; plates are usually removed only for symptoms or infection | Per NHS patient information; the bite is checked and corrected if not quite right. | University Hospitals Plymouth NHS Trust — Orthognathic surgeryplymouthhospitals.nhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from jaw surgery is a matter of weeks for everyday life but months for full settling. Swelling, a restricted diet and altered sensation are expected at first, and the orthodontic part continues well after the operation.
- Significant facial swelling and bruising in the first two weeks
- Numbness or tingling of the lip, chin or cheek that improves over weeks to months
- A soft or liquid diet for several weeks before normal food returns
- Tiredness and feeling 'not yourself' for a few weeks
- Subtle swelling that can take several months to fully disappear
Aftercare
- Take pain relief and any anti-sickness or antibiotic medicines as prescribed.
- Keep to the recommended liquid then soft diet and stay well hydrated.
- Keep your mouth scrupulously clean with gentle brushing and any prescribed mouthwash.
- Sleep with your head raised and use cold packs early on to help swelling.
- Avoid smoking, strenuous activity and contact sport as advised.
- Wear elastic bands on the braces exactly as instructed if you are given them.
- Attend all appointments with both your surgeon and your orthodontist.
- Soft and liquid foods and nutritious drinks stocked at home
- Prescribed painkillers, anti-sickness and any antibiotics collected
- A soft toothbrush and any prescribed mouthwash
- Extra pillows to keep your head raised, and cold packs
- Time off work or study booked (about 3–6 weeks)
- Someone to collect you and help at home for the first days
- The surgical team's contact number for problems
Scars and how they heal
Jaw surgery is usually done through cuts inside the mouth, so there are normally no visible scars on the face. Chin or some specific approaches can occasionally involve a small external cut, which your surgeon will tell you about beforehand. Small titanium plates and screws stay in the bone and are not usually felt.
⚠ Get urgent help if…
- Difficulty breathing or swallowing — seek urgent help
- Heavy bleeding from the mouth that will not stop
- Spreading swelling, redness or pus with fever (possible infection)
- A calf that is hot, swollen or painful, or sudden chest pain or breathlessness (possible clot) — seek urgent help
- A sudden change in how your teeth meet, or a feeling the jaw has shifted
- Numbness that is getting worse rather than slowly better
- Being unable to keep fluids down or showing signs of dehydration
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the teeth meet correctly, chewing and speech are comfortable, and the jaws and face are better balanced, with the bite finished off by the braces. This is judged over many months as swelling settles and the orthodontics is completed.
Surgery cannot promise a precise cosmetic outcome or guarantee that feeling will fully return. The final position is the product of teamwork between the surgery and the orthodontics, and a small amount of relapse can occur, particularly with larger movements.
For most people the corrected bite and jaw position are stable and long-lasting once healing and orthodontics are complete, helped by wearing retainers as advised. Some relapse can happen, more so with large advancements or specific movements. The titanium plates usually stay in permanently and only occasionally need removing if they cause problems.
Combining with other procedures
Jaw surgery is, by design, combined with orthodontic treatment before and after the operation. It may also be combined with chin surgery (genioplasty) in the same operation. Occasionally it is planned alongside treatment for the jaw joint or for breathing problems; your team will explain how these fit together.
Follow-up & long-term care
You will be reviewed before leaving hospital and then jointly by your surgeon and orthodontist over the following months, often for up to two years. Reviews check healing, the bite, recovery of sensation and the progress of the orthodontics. Report any breathing difficulty, heavy bleeding, signs of a clot or a sudden change in your bite straight away.
- Wear retainers after the braces come off, as long as advised, to hold the result.
- Keep up excellent oral hygiene and regular dental and orthodontic reviews.
- Tell your team if numbness worsens, or if your bite changes after treatment.
- Plates are usually left in place; report any plate that becomes tender or infected.
Revision and secondary surgery reality
- Occasionally a second, smaller operation is needed to fine-tune the bite or reposition plates and screws.
- Some relapse can occur, especially with large movements, and may need orthodontic or, rarely, surgical management.
- Plates are usually left in but can be removed later if they become infected or troublesome.
- The final result is judged over many months once swelling settles and orthodontics is complete.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Joint follow-up by both the surgeon and the orthodontist over the months after surgery.
- Clear written instructions on diet, mouth care, medicines and warning signs, with a named contact.
- A plan to check the bite and to act if it is not quite right.
- Honest tracking of sensation recovery, with onward advice if numbness persists.
- Retainer and long-term orthodontic plan to hold the result and limit relapse.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether one jaw, both jaws, or the chin are operated on
- The length and complexity of the operation and the surgeon's and anaesthetist's fees
- Theatre time and the length of hospital stay
- The long orthodontic treatment before and after surgery (often a separate, substantial cost)
- Imaging, 3D planning, surgical guides, plates and screws
- Follow-up appointments with both surgeon and orthodontist over up to two years
- Any further surgery to adjust the bite or remove plates if needed
- The surgeon's and anaesthetist's fees and theatre/hospital costs
- The full orthodontic cost before and after surgery, and who provides it
- Imaging, 3D planning and the cost of plates, screws and surgical guides
- The expected number of nights in hospital
- All follow-up reviews with the surgeon and orthodontist
- What happens, and what it costs, if the bite needs adjusting or plates need removing
- The cancellation policy and what is included if a complication occurs
On the NHS? Orthognathic surgery is available on the NHS when there is a recognised functional need that meets local criteria; requests for purely cosmetic reasons are usually private.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Underplaying how common early lip and chin numbness is, and that it can occasionally be permanent.
- Not making clear how long the whole orthodontic-plus-surgery pathway takes.
- Presenting it as a cosmetic procedure with a guaranteed look.
- Not explaining the risk of relapse with larger movements.
- No clear plan, or cost on the private pathway, for adjusting the bite or removing plates if needed.
Marketing red flags
- Marketing jaw surgery mainly as a 'jawline' cosmetic enhancement.
- Promising a precise, guaranteed facial result.
- Downplaying the long braces pathway or skipping the orthodontic assessment.
- Not mentioning that numbness is common, or that it can be permanent.
- Offering surgery before facial growth is complete in younger patients.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Is my problem genuinely one that needs surgery, or could braces alone fix it?
- Will you move one jaw or both, and roughly how big is the movement?
- What is my personal risk of lasting numbness of the lip or chin?
- How long will I be in braces before and after surgery?
- How will you check my bite afterwards, and what happens if it is not quite right?
- What is the chance of relapse for my type of movement, and how is it minimised?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Can I have jaw surgery on the NHS?
How long does the whole treatment take?
Will my face be numb afterwards?
Will I have my jaws wired shut?
When can I eat normally and go back to work?
Will the result be exactly what I imagine?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: University Hospitals Plymouth NHS Trust — Orthognathic surgery Cambridge University Hospitals NHS — Jaw or chin corrective (orthognathic) surgery Queen Victoria Hospital NHS FT — Guide for patients considering orthodontics and jaw surgery Maxfacts (UK OMFS patient information) — Jaw disproportion Systematic review of inferior alveolar nerve injury in bilateral sagittal split osteotomy (PubMed) Neurosensory disturbance after orthognathic surgery — PMC Orthognathic surgery and relapse — systematic review
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Lower jaw (mandibular) surgery · Upper jaw (maxillary) surgery · Treatment of jaw joint disorder (TMJ / TMD) · Cheekbone fracture repair · Cleft lip and palate surgery