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Bimaxillary Osteotomy (Double Jaw Surgery)

Comprehensive Correction of Jaw Position, Facial Balance and Function

Bimaxillary osteotomy, often referred to as double jaw surgery or DJS, is an orthognathic procedure that repositions both the upper jaw (maxilla) and lower jaw (mandible) to improve bite function, facial balance, and, in selected cases, airway function.

By addressing both jaws simultaneously, treatment can achieve changes that would not be possible by moving either jaw alone. This allows correction of complex bite discrepancies, facial asymmetry, skeletal imbalance, and airway-related concerns while maintaining harmony between the teeth, jaws, and facial structures.

Dr Tom Pepper is a Consultant Oral and Maxillofacial Surgeon in London specialising in orthognathic surgery, facial skeletal surgery, and advanced 3D surgical planning. Consultations are available in London at Harley Street and Cromwell Hospital.

What Is Double Jaw Surgery?

Bimaxillary surgery (double jaw surgery, DJS) frequently combines:

The procedure allows both jaws to be repositioned independently in three dimensions to achieve an optimal relationship between:

Because both jaws can be moved together, bimaxillary surgery often provides the most comprehensive and stable correction for complex jaw discrepancies.

Who May Benefit From Bimaxillary Surgery?

Double jaw surgery may be suitable for patients with:

Many patients seek treatment because they are concerned about a combination of functional and aesthetic issues rather than a single problem in isolation.

What Can Double Jaw Surgery Correct?

Overbite

In some patients, the lower jaw sits significantly behind the upper jaw. This can result in:

Double jaw surgery can reposition both jaws to improve skeletal relationships and facial proportions.

Underbite

Where the lower jaw projects beyond the upper jaw, patients may experience:

Double jaw surgery can restore a more balanced relationship between the jaws.

Open Bite

An open bite occurs when the upper and lower teeth fail to meet properly. This can affect:

Double jaw surgery often provides the most effective correction for significant skeletal open bites.

Facial Asymmetry

Asymmetrical jaw growth can lead to:

Repositioning both jaws allows comprehensive correction of the skeletal imbalance.

Three Different Philosophies of Orthognathic Treatment

One of the most interesting aspects of modern orthognathic surgery is that treatment planning can be approached from several different perspectives.

Historically, treatment focused primarily on the bite.

Today, facial aesthetics and airway function are increasingly recognised as equally important considerations.

The challenge is determining the appropriate balance for each individual patient.

Occlusion-Oriented Planning

Traditional orthognathic surgery focuses primarily on achieving the ideal relationship between the upper and lower teeth.

The goals include:

This approach remains fundamental because treatment must function well for decades after surgery.

However, a technically excellent bite does not always produce the most balanced facial result.

Aesthetics-Oriented Planning

Some surgeons are driven entirely by external facial appearance. This approach considers:

Modern facial analysis allows prediction of how jaw movements influence facial appearance.

While aesthetics are important, treatment should not be driven solely by appearance if this compromises function or stability.

Airway-Oriented Planning

Increasing attention is now given to the relationship between jaw position and airway size. This approach considers:

Procedures involving advancement of one or both jaws may significantly improve the dimensions of the upper airway in appropriately selected patients.

For some patients, airway improvement represents an important treatment objective alongside correction of the bite and facial proportions.

An Individualised Approach

There is rarely a single “correct” treatment plan. Two patients with very similar bites may benefit from entirely different surgical movements depending on:

As a Consultant Oral and Maxillofacial Surgeon with expertise in orthognathic surgery, facial aesthetics, and airway surgery, Dr Tom Pepper adopts a balanced treatment-planning philosophy. Every patient is individually assessed from three perspectives simultaneously:

The aim is not to maximise one objective at the expense of the others, but to develop a treatment plan that is balanced, proportionate, and appropriate for the individual patient. This approach allows jaw movements to be planned with consideration of both current concerns and long-term outcomes.

What Is the Difference Between Double Jaw Surgery and MMA?

Both procedures involve surgery on the upper and lower jaws, but their primary goals are often different. Bimaxillary osteotomy (double jaw surgery) is usually performed to correct:

Treatment planning typically focuses on achieving an optimal balance between:

Maxillomandibular advancement (MMA) is primarily an airway procedure performed for obstructive sleep apnoea. The principal objective is to enlarge the upper airway by advancing both jaws, thereby reducing airway collapse during sleep.

Occlusion (the bite) is frequently unchanged following MMA surgery and, while MMA often produces significant facial changes, these are generally secondary to the airway goals of treatment.

In practice, the distinction is not always absolute. Many patients benefit from a treatment plan that considers all three aspects simultaneously:

As a Consultant Oral and Maxillofacial Surgeon with expertise in orthognathic surgery, facial aesthetics, and sleep surgery, Dr Tom Pepper evaluates each patient individually to determine the most appropriate balance between these objectives.

Advanced Surgical Planning

Every double jaw surgery is planned using:

Digital planning allows jaw movements to be visualised before surgery and enables detailed assessment of their effects on:

This improves both precision and predictability.

Clockwise and Counterclockwise Rotation in Double Jaw Surgery

Modern bimaxillary surgery involves more than simply moving the jaws forwards, backwards, upwards, or downwards.

The jaws can also be rotated around a pivot point, allowing significant changes in facial proportions, jaw position, and airway dimensions.

These movements are commonly described as clockwise rotation or counterclockwise rotation (CCW rotation).

Careful rotational planning is often one of the most important aspects of contemporary orthognathic surgery.

Counterclockwise Rotation (CCW Rotation)

Counterclockwise rotation involves rotating the maxillomandibular complex in a way that advances the chin and lower face.

This movement may:

Counterclockwise rotation is frequently incorporated into treatment plans for:

In appropriate patients, counterclockwise rotation can produce significant improvements in both facial aesthetics and airway volume.

Clockwise Rotation

Clockwise rotation involves rotating the jaws in the opposite direction. This movement may be useful when correcting:

Clockwise rotation can help improve overall facial harmony while maintaining stable bite relationships.

The most appropriate rotational movement depends entirely on a comprehensive assessment of individual facial proportions, occlusion, and treatment goals.

Why Rotation Matters

Historically, orthognathic surgery was often planned primarily around linear movements of the jaws. Modern treatment planning increasingly recognises that rotational movements can have profound effects on:

For this reason, rotational planning forms an important part of 3D virtual surgical planning.

Treatment is not simply about correcting a bite, but creating the most balanced relationship between facial appearance, jaw function, and airway health.

The Procedure

Surgery is performed under general anaesthetic.

The procedure typically involves:

There are normally no visible external scars.

Orthodontic treatment is an essential part of the overall treatment pathway.

Recovery After Double Jaw Surgery

Recovery occurs gradually over several weeks and months.

Patients can generally expect:

Most patients return to many normal activities within a few weeks, although final refinement continues as healing progresses.

Regular follow-up appointments help ensure stable healing and long-term bite correction.

Results

Double jaw surgery can provide substantial improvements in both function and appearance.

Patients commonly notice:

Because treatment addresses the underlying skeletal relationship, results are stable and long-lasting.

Frequently Asked Questions

What is double jaw surgery?

Double jaw surgery is another name for bimaxillary osteotomy, a procedure that repositions both the upper and lower jaws.

Why move both jaws instead of one?

In some cases, moving both jaws provides a more balanced correction, better facial proportions, improved bite function, and greater airway benefits.

Will double jaw surgery change my face?

Yes. The position of the jaws influences the entire lower and mid-face. Changes are planned carefully to create a balanced and natural result.

Is double jaw surgery purely cosmetic?

No. The primary goals are a blend of functional objectives, including bite correction and jaw alignment, and cosmetic objectives, including improvements in facial balance and structure.

Will I need braces?

All patients require orthodontic treatment before and after surgery.

Can double jaw surgery help sleep apnoea?

In selected patients, advancement of both jaws may significantly improve airway dimensions and form part of treatment for obstructive sleep apnoea.

Why Choose Dr Tom Pepper?

Successful orthognathic treatment requires more than simply moving jaws. It requires an understanding of:

Dr Tom Pepper is a dual-qualified Consultant Oral and Maxillofacial Surgeon trained in both medicine and dentistry, with expertise in orthognathic surgery, facial aesthetics, airway surgery, and advanced 3D surgical planning.

Treatment recommendations are tailored to the individual, balancing functional correction, facial harmony, and airway health to achieve the most appropriate long-term outcome.

Consultation

Consultations for bimaxillary osteotomy (double jaw surgery) are available in London at Harley Street and Cromwell Hospital.

A detailed assessment allows evaluation of your bite, facial structure, airway considerations, and treatment goals, enabling development of a personalised treatment plan.

Book a Consultation

Written and medically reviewed by:

Dr Tom Pepper
Consultant Oral & Maxillofacial Surgeon
MBBS BDS MSc FRCS

Private consultations available in Harley Street and Cromwell Hospital, London.