Correcting Lower Jaw Position & Restoring Facial Balance
A bilateral sagittal split osteotomy (BSSO), commonly referred to as lower jaw surgery or mandibular osteotomy, is a specialist procedure used to reposition the lower jaw (mandible). The operation can improve bite function, facial balance, jaw symmetry, and, in selected cases, airway function.
Dr Tom Pepper is a Consultant Oral and Maxillofacial Surgeon in London specialising in orthognathic surgery, facial skeletal surgery, and advanced 3D surgical planning. Treatment is carefully planned to improve both functional outcomes and overall facial harmony.
Consultations are available in London at Harley Street and Cromwell Hospital.
What Is a BSSO?
A bilateral sagittal split osteotomy (BSSO) is the most commonly performed operation for repositioning the lower jaw.
The procedure allows the mandible to be moved in a controlled manner to create a more balanced relationship between the upper jaw, lower jaw, teeth, and facial structures.
A BSSO may be used to:
- Advance the lower jaw
- Set the lower jaw back
- Correct asymmetry
- Improve bite alignment
- Restore facial balance
By correcting the underlying skeletal relationship, treatment addresses the root cause of the problem rather than compensating for it.
Who May Benefit From Lower Jaw Surgery?
BSSO may be considered for patients with:
- Underbite (Class III malocclusion)
- Significant overbite (Class II malocclusion)
- Receding chin associated with mandibular deficiency
- Jaw asymmetry
- Open bite
- Difficulty chewing
- Speech concerns
- Jaw function problems
- Airway-related concerns in selected patients
Many patients seek treatment because they are concerned about both the function of their bite and the appearance of their jaw profile.
What Problems Can a BSSO Correct?
Underbite
An underbite occurs when the lower jaw sits too far forward relative to the upper jaw.
This can result in:
- Bite problems
- Speech difficulties
- Difficulty chewing
- Facial imbalance
Lower jaw surgery may be used to reposition the mandible into a more harmonious relationship with the upper jaw.
Receding Lower Jaw
Some patients have a lower jaw that sits too far back.
This may contribute to:
- Weak jawline definition
- Bite discrepancies
- Lip incompetence
- Airway narrowing in selected patients
Advancement of the lower jaw can improve both function and facial balance.
Jaw Asymmetry
Differences in jaw growth may result in:
- Chin deviation
- Dental midline discrepancies
- Uneven facial proportions
BSSO can be used alongside other procedures to improve facial symmetry and bite function.
Lower Jaw Surgery and Facial Appearance
The position of the lower jaw has a major influence on facial appearance.
Changes in mandibular position can affect:
- Jawline definition
- Chin position
- Facial profile
- Neck contour
- Facial symmetry
For this reason, treatment planning considers not only the bite, but also the relationship between the lower face, chin, lips, and overall facial proportions.
As a Consultant Oral and Maxillofacial Surgeon with experience in facial aesthetics and facial skeletal surgery, Tom Pepper carefully evaluates how jaw movements may influence the appearance of the face.
The aim is to achieve a result that feels functional, balanced, and natural.
Lower Jaw Surgery and Airway Function
In selected patients, mandibular position may influence airway dimensions.
Advancement of the lower jaw can increase the space available behind the tongue and may form part of treatment strategies for:
- Airway narrowing
- Sleep-disordered breathing
- Obstructive sleep apnoea
Where airway concerns are identified, these factors form an important part of treatment planning.
Advanced Surgical Planning
Every BSSO is planned using:
- Clinical examination
- Photographic analysis
- Orthodontic records
- CT imaging
- 3D virtual surgical planning
Modern planning techniques allow the proposed jaw movements to be visualised before surgery and improve the accuracy of treatment.
This helps ensure predictable outcomes and precise transfer of the surgical plan to the operating theatre.
The Procedure
Surgery is performed under general anaesthetic.
During the procedure:
- The lower jaw is divided internally through carefully planned cuts
- The mandible is repositioned into the desired alignment
- Small titanium plates and screws are used to stabilise the jaw
- All incisions are made inside the mouth
There are no visible external scars.
Orthodontic treatment is usually carried out before surgery and may continue afterwards to achieve the final result.
Recovery After BSSO
Recovery occurs gradually over several weeks and months.
Patients can generally expect:
- Swelling during the early healing phase
- Temporary dietary restrictions
- Gradual return to normal jaw function
- Progressive improvement in comfort and appearance
Most patients return to many normal activities within a few weeks, although complete healing and refinement continue over a longer period.
Regular follow-up appointments help ensure appropriate healing and long-term bite stability.
Results
Lower jaw surgery aims to improve both function and appearance.
Patients commonly notice:
- Improved bite alignment
- Better chewing function
- Increased comfort
- Enhanced jawline definition
- Improved facial balance
- Greater facial symmetry
Because treatment addresses the underlying skeletal relationship, results are stable and long-lasting.
Frequently Asked Questions
What is a BSSO?
A bilateral sagittal split osteotomy (BSSO) is an operation used to reposition the lower jaw in order to improve bite function, jaw alignment, and facial balance.
Will lower jaw surgery change my appearance?
Yes. The position of the lower jaw influences the jawline, chin, profile, and lower facial proportions. Changes are carefully planned to achieve natural and balanced results.
Will I need braces?
Most patients undergoing orthognathic surgery require orthodontic treatment before and after surgery.
Are there visible scars?
No. Incisions are typically placed entirely inside the mouth.
How long is recovery?
Initial recovery takes several weeks, although swelling and final refinement continue to improve over a longer period.
Can lower jaw surgery be combined with chin surgery (genioplasty)?
It is possible to perform a BSSO and genioplasty as a combined procedure, but whether this is advisable depends on a full facial assessment and discussion with your surgeon.
Can lower jaw surgery improve sleep apnoea?
In selected patients, advancement of the lower jaw may improve airway dimensions and contribute to sleep apnoea treatment strategies.
Why Choose Dr Tom Pepper?
Orthognathic surgery sits at the intersection of facial aesthetics, dental function, airway health, and facial skeletal surgery. Dr Tom Pepper is a dual-qualified Consultant Oral and Maxillofacial Surgeon trained in both medicine and dentistry, with expertise in:
- Orthognathic surgery
- Facial skeletal surgery
- Airway surgery
- Facial aesthetics
- Advanced 3D planning
Treatment is planned around the individual patient, with careful consideration of both function and facial balance.
Consultation
Consultations for lower jaw surgery (BSSO) 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, ensuring a personalised treatment plan tailored to your needs.
Book An Appointment
For assessment of lower jaw surgery in London, arrange a consultation to discuss your case in detail.