Orthognathic Surgery - 謝明吉、姜厚任 顎顏面 美學 重建 專科診所-風華整形聯合診所
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Orthognathic Surgery


Orthognathic Surgery

Dentofacial deformity indicates the abnormal relationship between the facial proportion and the upper and lower teeth alignments. This type of deformity is enough to be noticeable by an untrained person. The most often seen deformity in our country is the under bite (moon face) facial shape, over bite, concave face, long face (over exposure of gum) and asymmetrical face. These dentofacial deformities often combined with malocclusion, pronouncement, chewing, and digestive difficulties while hinders social confidence with discriminative treatment in community may also occur. It is often seen that individuals with over bite and receded facial shape rarely receive promotion, whereas individuals with long face or over gum exposure are believe to be less bright. For a girl with protruded chin like a crescent whose often believes to be lack of feminity or inauspicious in superstitious belief. These individuals have tried to avoid awkwardness all their lives. They always try to avoid eating food items that require chewing or laugh whole heartedly in public. About one third of all patients who sought help for this condition had a lot of associated stress that negatively affected their confidence and life quality. This condition is known as oral-maxillo-facial deformity or oral-maxillo-facial developmental abnormality.

Myth - Orthodontics vs. Orthognathic Surgery

Oral-maxillo-facial developmental abnormality often has both occlusal and aesthetic deficiencies, but for majority of patients their main objectives are stemming from the concerns of achieving a delicately and elegantly balanced appearance. What this says is that although patients with oral-maxillo-facial developmental abnormality often combine malocclusion problems, but patient with malocclusion problem may not have oral-maxillo-facial developmental abnormality. In consultation sessions many patients with this abnormality condition who already have orthodontic treatments often express their frustrations. Although their occlusion problems have resolved but their facial deficiencies remain (i.e. over bite with concave face, or under bite with moon face)! It is demonstrative that for a patient whose condition requires the improvements derived from the right orthognathic surgery but receives only orthodontic treatment. The resultant outcomes remain unsatisfactory many years after the orthodontic treatment because the problematic facial alignments have not been resolved for better improvements. For patients with oral-maxillo-facial developmental abnormality a successful treatment requires the techniques derived from a rightful orthognathic surgery. In an orthognathic surgery, the patient's upper and lower jaws or other facial alignments can be work on with accessibility. And in the combinations of nose augmentation, osteotomy, genioplasty, and eye contouring a final attractive face emerges.

What is the Corrective Jaw Surgery – Orthognathic Surgery?

Orthognathic surgery is performed to treat minor or severe abnormality in "jaw bone (mandible) - the facial bone that encloses teeth alignments." This surgical treatment can improve the functions of chewing, occlusion, pronunciation, and breathing. Besides these functions, the patient's appearance will be markedly improved as well.

Who needs Orthognathic Surgery?

In simple words, individuals with oral-maxillo-facial developmental abnormality that have relatively enough degree of severity which cannot be corrected by orthodontic treatment alone to achieve a delicately and elegantly balanced appearance, these individuals should then receive orthognathic surgery.

Patient with oral-maxillo-facial developmental abnormality that causes malocclusion combines with unbalanced facial appearance should received the treatment of orthognathic surgery. This abnormality is caused by uneven growth rates among upper and lower jaws which can be controlled by congenital factors such as genetics or affected by environmental factors later in life, such as trauma to the jaw bone during adolescence. The definition is often confusing but orthodontic treatment is for malocclusion (irregularity in teeth alignments) and orthognathic surgery is for the uncoordinated upper and lower jaws. Besides treating the malocclusion problems it can also improve the overall harmony in the aesthetic appearance of the patient.

If you have the following condition, you may need a Orthognathic Surgery evaluation:

  1. Bony over bite
  3. Receding chin (chinless)
  5. Elongated chin (under bite)
  7. Pronunciation abnormality, inarticulate speech
  9. Malocclusion causes biting and swallowing difficulties
  11. Open bite (gaps remain when the lips are at rest or between the upper and lower teeth alignments)
  13. Unbalanced front or side Facial appearance
  15. Upper and lower lip cannot close in "relax" resting position (exclude forceful closing of the lips)
  17. Facial trauma during adolescence
  19. Chronic mouth breathing (often has dried mouth)
  21. Chronic temporomandibular joint (lower bone joint) or jaw bone pain
  23. Sleep apnea or snoring

Evaluate to See If You Need an Orthognathic Surgery

Dr. Hsieh will evaluate your needs for designing a best treatment plan. If you need an orthognathic surgery, then considering what type of orthognathic surgery would give the best outcome (upper or lower jaw alone, or both jaws with chin procedures). Should the orthognathic surgery be performed alone or in combinations or other alternative procedures can be considered to deliver similar outcome (such as cosmetic treatment on the face that gives similar result as orthognathic surgery like artificial face implant insertion, cheek pads, upper jaw pad, low jaw pad or chin pad)? These are vital questions to answer for designing a suitable treatment plan. Sometimes patients are required to undergo pre-surgery (approximately 2 – 12 months) and post-surgery (approximately 3 – 6 months) orthodontic treatments. Dr. Hsieh fully understands it is a difficult decision (undergoes long term orthodontic treatment) so he will offer the most practical evaluation on the need of an orthognathic surgery if there are other alternatives. Dr. Hsieh will also explain the possibility of undergoing these alternative procedures.。

The Most Common Types of Oral-maxillo-facial developmental abnormalities:



How to select the right orthognathic surgeon?

The key success factors for orthognathic surgery are communication and design. Dr. Hsieh will spend a lot of time and effort to communicate with you because Dr. Hsieh believes these are the most important determinants in a successful surgery. He will spend a lot of time analyzing your profiles for simulation and design purposes in such professionally stringent manner that a final treatment plan is formulated to suit your needs. The date for surgery is then arranged. In addition, we are in close collaborations with many orthodontists. We welcome your visit to experience with us the results of our thorough accomplishments.

How Orthognathic Surgery is performed?

For orthognathic surgery combines with orthodontic treatment, the orthodontist will align you teeth with braces to move them to a new position which gives ideal occlusion between the upper jaw teeth alignment and the lower jaw teeth alignment after the surgery. So at the beginning (pre-surgery period) you mightl feel the occlusion is worse than before. However, after Dr. Hsieh performed the surgery then the occlusion will become aligned.

Before surgery, Dr. Hsieh will obtain information for facial analysis that includes cranial x ray, teeth model and facial profile photographs (for patients with asymmetrical faces, sometimes it is necessary to perform 3-D computer imaging scan and maxillo-facial reconstructive model). The most advanced computer imaging software is used to integrate your profile information to facilitate the selection of possible surgical procedures. When it is necessary, Dr. Hsieh will simulate the surgical outcome for better visualization of how the improvements take place if the surgery is performed. Within the consultation session Dr. Hsieh aims to facilitate better understandings for consumers to gain deep insights about the treatment process, regime selected, and the beneficial outcomes of maxillofacial surgery.

Majority of maxillofacial surgery (orthognathic surgery and face sliming osteotomy) is performed under general anesthesia. The procedure can be performed in a maxillofacial surgical center or a medical center depending on the complexity of the surgery involved. Orthognathic surgery in simple words is a surgery that moves the maxillofacial bone to a new position then secured. Shorten procedures involve cutting the bone while lengthen or heighten procedures involve adding of bones.

Different surgical durations are required depending on the type of surgery involved. For general treatment of over bite, under bite or deficient chin, the required duration is approximately 3 ~ 5 hours. There will be additional 2 hours if such procedure is combined with nose or chin augmentation. All surgeries are performed via intraoral incisions. When the bones involved are re-aligned and secured with titanium nails and plates the incisions are then sutured.  

After surgery, Dr. Hsieh will advise on dietary changes for recovery period. When to start solid foods will vary depending on the body type of each patient. Generally, if the surgery involves the degree of jaw bone alignment and if both upper and lower jaws are aligned then longer time will be required to allow healing before solid food can be consumed. Usually it will take 1 ~ 2 months. During recovery period, the patient should rest more to avoid fatigue and high intensity exercise. One special note is that smoking will slow the healing of surgical wounds.

Most patients concern about the pain after surgery. For maxillofacial surgeries (includes osteotomy) good circulations often take place within the surgical areas so the recovery is relatively fast and pain can be easily controlled by pain reliever. Even though each patient feels differently, but in general most patients can return to work within 1 ~ 2 weeks after surgery. The initial healing stage takes about a month, however the edema will dissipate completely and the desired final surgical outcome will emerge about 4 ~ 6 months.

Psychological Adaptation

Mental health has fundamental importance for orthognathic surgery, unfortunately it is often overlooked. Dr. Hsieh cannot emphasize enough for its important role in orthognathic surgery.

Sometimes after orthognathic surgery the facial appearance will be drastically changed. It may take some time for the adaptation of a new look to emerge. Not everyone is very adaptive. The new appearance should make you rejoice, feeling confident and hopeful for the reason that you have fall in love with your new look. To achieve this, thorough considerations before taking the surgery must be carried out. Vital questions must be asked such as "What are the areas that I want to improve?" "How do my friends and family think of me?" "Do I hold the same opinion as them?" "What are my expectations on the surgical outcome?" "Are these expectations in line with the doctor's expectations?" When you, your families and friends, and your doctor hold the same mutual understandings, then the new you will be blessed and emerged.

 Dr. Hsieh encourages his patients to search the net for information, or raise questions to us. It is vitally important to understand the surgery you are about to receive and the psychological preparation required. Patients are encouraged to be actively involved in the decision making process where he or she should not blindly follow the doctor's instructions without seeking better understanding. Each patient is important to Dr. Hsieh so he takes time in making orthognathic surgery a better understood surgery. Your effort for such understanding is important too, and hopefully psychological adaptation will be one of your important issues to consider.

Enjoy the Outcome

Orthognathic surgery will move your jaws to the most coordinated and healthy new position. The improvements not just include better occlusion, chewing and pronunciation, the confidence and appearance of the patient will be markedly changed. There are numerous positive changes that orthognathic surgery has made for your life so enjoy the new you!

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Copyright © 2007-2017 

All Written Contents and Pictures Created by Dr. Adrian M. Hsieh and Dr. Scott H. Jiang





Results of surgery vary among patients. Please consult your doctor.