Retention
The part that keeps the result. Which retainers, how long you wear them, and what to do if one breaks.
Specialist orthodontics in Midland
Jaw surgery is one day in a longer plan
Jaw surgery sounds like the whole treatment. It is actually one day inside a course of orthodontics that runs either side of it, performed by an oral and maxillofacial surgeon in hospital. This page sets out the sequence, the recovery week by week, and whether braces alone could get you there instead.
- No referral needed
- Specialists since 1984
- Clear quote before you start
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The threshold
When braces alone cannot get there
Braces move teeth. They do not move jaws. Where the upper and lower jaws are a long way out of proportion with each other, teeth can be tilted to disguise it up to a point, and past that point the only way to correct it is to reposition the bone itself.
There are usually two honest answers, not one
For most people in this position there is a version of treatment with braces alone that improves things without surgery, and a version with surgery that corrects the underlying discrepancy. The first is quicker, cheaper and carries no surgical risk. The second gets closer to a normal bite and a balanced profile. Neither is automatically right, and we will lay both out with what each can and cannot achieve for you.
Nobody at this practice is paid more if you choose surgery. If camouflage will do the job for you, we will say so.
The lower jaw sits well behind the upper
A markedly recessed lower jaw, often with front teeth that stick well forward and a chin that reads as small. Common, and one of the most frequent reasons surgery is discussed.
The lower jaw sits in front
The lower front teeth close ahead of the upper ones and the lower jaw is genuinely longer, rather than the teeth simply being tipped. Tends to become clearer through the late teens as growth finishes.
The front teeth do not meet at all
An open bite where the back teeth touch and the front teeth stay apart, so biting into food is difficult. Where this is skeletal rather than habit-related, braces alone often relapse.
The face is noticeably asymmetric
One side of the jaw has grown differently from the other, so the chin sits off centre and the bite is off on one side. Repositioning is the only way to level it.
Obstructive sleep apnoea from a small airway
Where a physician has diagnosed sleep apnoea and jaw position is contributing to it, moving the jaws forward can open the airway. This is a medical indication and is managed alongside your sleep physician.
The whole sequence
The two years, drawn to scale
Everyone imagines this treatment as the operation. The bar below is the real proportion: two years of orthodontics with a single day of surgery inside it. Almost all of the time you will spend on this, you will spend in braces feeling entirely normal.
The operationOne day
- Braces before surgery 12 to 18 months
- The operation One day, one or two nights in hospital
- Recovery at home About 6 weeks
- Braces after surgery 6 to 12 months
- 12 to 18 months
Braces before surgery
The longest phase, and the one nobody expects. Braces line the teeth up within each jaw so that when the surgeon moves the jaws, the bite fits together.
- Your teeth are straightened to fit the planned jaw position
- The bite often looks worse before surgery, which is expected
- Records, scans and surgical planning happen towards the end
- You meet your surgeon during this phase, not at the end of it
- One day, one or two nights in hospital
The operation
Performed by an oral and maxillofacial surgeon under general anaesthetic. All the cuts are inside the mouth, so there are no visible scars on the face.
- Carried out by your surgeon, not by us, in a hospital
- Upper jaw, lower jaw or both, depending on the plan
- Held with small titanium plates and screws that stay in place
- Jaws are not wired shut. Guiding elastics are used instead
- About 6 weeks
Recovery at home
The part people underestimate. You will feel unwell for the first week and increasingly normal after that, on a diet that starts liquid and slowly widens.
- Swelling peaks around day three and then falls away
- Most desk workers are back at two to three weeks
- Soft diet throughout, with no hard or chewy food
- Reviews with both your surgeon and us during this window
- 6 to 12 months
Braces after surgery
Finishing orthodontics. The jaws are now in the right place, so this phase settles the bite precisely into it and then the braces come off.
- Fine detailing of a bite that now has bone in the right position
- Elastics worn as directed, which matters more here than anywhere
- Braces removed once the bite is stable, not once time is up
- Retainers fitted, and for this result they are permanent
These are typical ranges rather than a promise. A straightforward single jaw case can run shorter, and a complex or asymmetric case longer. You will be given a plan with your own expected timings before you commit to anything.
The honest part
The first six weeks, week by week
The most specific thing any Perth practice publishes about recovery is a range of weeks off work. Here is what those weeks actually contain, so you can plan leave, meals and help around the house before you are in the middle of it.
- Day 1 to 2
In hospital
Usually one or two nights. You will wake with significant swelling and a numb lower lip, which is expected. Most people describe pressure and congestion rather than sharp pain, and it is managed with regular medication.
- Week 1
The worst of it
Swelling peaks around day three and then starts to fall. You will be on liquids, tired, and sleeping propped up. Plan to have someone around. This is the week people wish they had cleared the calendar for.
- Weeks 2 to 3
Turning the corner
Swelling drops noticeably and you start to look like yourself. Diet moves from liquid to smooth soft food. Most people doing desk work go back somewhere in this window, often part time to begin with.
- Weeks 4 to 6
Back to normal life
Light exercise resumes on your surgeon's advice. The diet widens to anything soft. The bone is still knitting, so nothing hard, crunchy or chewy, and no contact sport.
- Months 3 to 6
Sensation returns
Numbness in the lower lip and chin fades gradually over months as the nerve recovers. In a small number of people some altered sensation is permanent. Your surgeon will explain this risk properly as part of consent, and it is the main reason this decision deserves time.
What actually helps in the first fortnight
You are under a general anaesthetic for the operation itself, so there is nothing to feel while it is happening. Afterwards, most people describe pressure, swelling and a stiff jaw rather than sharp pain, and your surgeon prescribes pain relief to cover the days when it is worst. An ice pack held against the face brings the swelling down, and sleeping with your head raised stops it settling overnight. Fill the freezer with soft food before you go in, and have someone at home with you for that first week.
The groundwork
What the operation involves, and when it is done
Orthognathic surgery is a long established procedure with a settled sequence around it. These are the parts people want confirmed before they are willing to think about it properly, and they are easier to hear before the decision than during it.
The work is done inside the mouth
It is carried out in hospital under a general anaesthetic. Small, precise cuts are made in the jawbone so the surgeon can move it into a better position, and that can almost always be done from inside the mouth, which means no visible scarring on the face.
The bone is held with plates and screws
Once the jaw is in its new position it is fixed there with small titanium plates and screws that stay in place. They hold the bone steady while it knits, which is the reason the jaws are not wired shut and guiding elastics are used instead.
Timing follows growth rather than age
There is no set age. The operation is best done once the bone is mature and the teenage growth spurt is behind you, which for most people is somewhere around eighteen. Depending on the case it can be done earlier or considerably later.
Starting the assessment early still makes sense
The orthodontics runs for a year or more before the operation, so an assessment at fifteen or sixteen is not premature. It gives us time to watch how growth finishes, which sometimes changes the answer on its own.
See the orthodontist first, not the surgeon
Not everyone with a jaw or bite concern needs an operation. The assessment here works out whether yours is one of the cases where it is genuinely warranted, and the referral to an oral and maxillofacial surgeon comes from us once there is a plan worth referring.
Want to know whether surgery even applies to you?
One assessment tells you whether braces alone could get you there, what surgery would add, and the likely timings for your own case. Nothing is booked on the day.
FAQs
What people ask before they decide
What people ask before deciding whether to go ahead. If yours is not here, call the practice and ask it.
No. We are specialist orthodontists. The operation is performed by an oral and maxillofacial surgeon in a hospital, and we do the orthodontic treatment either side of it. We work with your surgeon throughout, and you will meet them well before any decision is made.
In current practice, generally not. The jaws are fixed internally with small titanium plates and screws, which means they are stable straight away and guiding elastics are used instead of wiring. Your surgeon will confirm what applies in your case.
Sometimes, and it is always discussed. Where the discrepancy is moderate, tilting the teeth can disguise it and give a real improvement without an operation. Where it is large, that approach has limits and can look and function worse rather than better. You will be shown both options with an honest account of what each can achieve.
Plan on two to three weeks for desk work, and longer if your job is physical or public facing. The first week is the hard one. It is worth arranging help at home for that week rather than assuming you will manage.
It can. The jaw bones are the scaffold the face sits on, so moving them alters the profile, and how noticeable that is depends on how large the original discrepancy was. The intended change is planned in advance from your own scans and shown to you before you agree to anything, so it is not something you find out about afterwards.
You are under a general anaesthetic, so there is nothing to feel during it. Afterwards, most people describe pressure, swelling and stiffness rather than sharp pain, and it is managed with medication your surgeon prescribes. The first few days are the worst of it and it settles steadily from there.
Surgery is normally done once facial growth has finished, which is usually around seventeen or eighteen for women and a little later for men. There is no upper limit as such, though general health matters more with age. Starting the assessment before growth is complete is fine and often sensible.
It is major surgery under general anaesthetic and it carries real risks, including altered sensation in the lip and chin that is occasionally permanent, infection, and the small possibility of further surgery. Your surgeon takes you through these properly as part of consent. Anyone who makes it sound risk free is not giving you what you need to decide.
Not to see us. You can book an orthodontic assessment directly and we will tell you whether surgery is worth considering. A referral to the surgeon comes later, from us, once there is a plan worth referring.
Not sure whether this applies to you?
An assessment will tell you whether braces alone can get you there, and what each path would actually involve. No decision is asked for on the day.
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