A Structured, Balanced Approach
Orthognathic treatment is delivered through a carefully planned sequence, combining orthodontics and surgery to achieve a stable, functional bite and a balanced facial outcome.
Modern planning is facially and aesthetically driven, with the bite arranged to support the desired facial proportions—not the other way around.
Treatment is therefore a coordinated process, not a single procedure.
1. Initial Assessment
Your first joint surgeon-orthodontist consultation involves:
- Clinical examination
- Assessment of facial proportions as well as the bite
- Imaging (X-rays / CBCT as appropriate)
- Impressions or intraoral scans
This stage determines:
- Whether surgery is required
- Which jaw(s) are involved
- The desired facial outcome and how this guides treatment
2. Orthodontic Preparation
Before surgery, teeth are aligned orthodontically. This phase:
- Positions teeth correctly within each jaw
- Prepares the bite to support the planned facial movements of the jaws
- May temporarily make the bite appear less aligned
Duration is typically 18 months, depending on complexity.
3. Surgical Planning
Surgical planning aims to balance:
- Facial analysis and proportions
- Desired aesthetic changes (profile, projection, symmetry)
- Functional requirements (bite, airway, stability)
This involves:
- Detailed measurements and analysis
- 3D virtual surgical planning and computer simulation of different surgeries to determine optimal jaw movements and rotations (e.g. counter-clockwise / clockwise)
- Close coordination between surgeon and orthodontist
The objective is to position the jaws to achieve a balanced face, with the occlusion refined to fit this outcome.
4. Surgery
Surgery is performed under general anaesthetic. Depending on the case, this may involve:
- Upper jaw (maxillary osteotomy)
- Lower jaw (mandibular osteotomy)
- Both jaws (bimaxillary surgery)
- Both jaws + genioplasty (triple jaw surgery)
Movements are precisely executed according to the pre-operative plan, designed to optimise both function and facial balance.
5. Early Recovery
Following surgery:
- Swelling and temporary discomfort are expected
- A modified diet is required
- Light activity can usually resume within a few weeks
Close follow-up ensures stable healing and maintenance of planned jaw position.
6. Orthodontic Finishing
After surgery, orthodontic treatment continues for 6–9 months.
This phase:
- Refines the bite
- Finalises tooth positioning
- Ensures long-term stability
7. Final Outcome
Once treatment is complete, patients typically achieve:
- Balanced facial proportions and profile
- A stable, well-aligned bite
- Improved function
Results are designed to be both natural and durable, with the facial outcome guiding the overall treatment plan.
Expected Facial Changes
Orthognathic surgery produces changes not only in the bite, but in the overall shape, balance, and profile of the face.
Dr Tom Pepper’s treatment philosophy aims to maximise positive facial changes while minimising negative changes.
Common areas of change include:
- Facial profile
Movement of the jaws alters projection of the midface and lower face, improving convex or concave profiles. - Nasal tip rotation
Movement of the upper jaw can affect nasal tip position, most often resulting in a slight upward rotation of the nasal tip. - Nasal base width
Movement of the upper jaw can slightly broaden the nasal base - Upper lip support and tooth show
Position of the upper jaw influences lip fullness and how much tooth is visible at rest and smiling. - Lower face height and proportions
Vertical changes can lengthen or shorten the lower face, improving overall facial harmony. - Chin position and projection
Forward or backward movement of the lower jaw affects chin prominence and overall lower facial balance. - Jawline definition
Adjustment of the lower jaw can refine contour and adjust chin-throat angle. - Facial symmetry
Correction of jaw position can address underlying skeletal asymmetry, improving balance across the face.
These changes are not incidental – they are planned outcomes of treatment. The objective is a result that appears natural and proportionate, rather than over-corrected.
A Coordinated, Balanced Approach
Movements are designed to optimise facial proportions as well as function. The anticipated effects on profile and appearance are discussed in advance
Orthognathic treatment requires:
- Close collaboration between surgeon and orthodontist
- Careful sequencing at each stage
- A planning philosophy that prioritises facial harmony and aesthetics alongside function
Consultation
A detailed consultation allows for a structured assessment and clear explanation of the treatment pathway, with discussion of both functional correction and anticipated facial changes.
Book a Consultation
For orthognathic surgery assessment in London, arrange a consultation to discuss your case in detail.