Jaw/Orthognathic

Dr. Steinbacher's Expertise

Jaw surgery (orthognathic) is widely regarded as one of the most difficult procedures to perform well – especially when trying to create the best cosmetic outcome. Dr. Steinbacher has written and published extensively on jaw surgery, including representation of 3D results, precise 3D planning, aesthetic and cosmetic optimization of these methods, enhancing and speeding a quick recovery, and many other topics. His background involves dental training and orthodontic understanding, plastic and maxillofacial surgical experience, and an extensive orthognathic case volume, performing many of these procedures each week.

He is a member of several maxillofacial, craniofacial, and aesthetic plastic surgery societies, and is a frequent invited speaker to share his concepts, techniques, and results nationally and internationally. Dr. Steinbacher authored the book “Aesthetic orthognathic surgery and rhinoplasty” showcasing his vast experience and philosophy. Dr. Steinbacher uses his aesthetic eye and artistic judgment, together with meticulous technical skills and attention to detail to give you the best jaw and facial results in line with mutual goals and objectives.

The Procedure

Jaw (Orthognathic) surgery and jawline/facial contouring is performed to enhance facial balance, optimize function (breathing), improve smile/occlusion, and achieve the most cosmetic and aesthetic result possible. We have new pathways and protocols reducing overall treatment time, including “surgery-first” philosophy, and “Invisalign” or clear-aligners as part of the treatment (with your orthodontist). These procedures greatly enhance quality of life, improve appearance, and lead to the most satisfied patients.

Click here to see the extended photo gallery.

Orthognathic (Jaw) surgery will correct jawbone/facial irregularities and imbalances. With properly aligned and repositioned jaws and teeth – function (eating, speaking, smiling, breathing) and facial aesthetics are optimized. Self-confidence, and positively perceived personality traits result from the overall improvement in facial balance and appearance. The typical jaw procedures include: Le Fort osteotomy (to address the maxilla, upper jaw), bilateral sagittal split osteotomies (BSSO) (to address the mandible, lower jaw), genioplasty (to address the chin). A number of adjuncts are readily used in our practice if necessary (jawline contouring or implants, cheekbone reduction or implants/augmentation, chin/neck liposuction, fat grafting, nasal procedures (rhinoplasty), skin treatments, eyelid surgery (blepharoplasty), chemical peel / tightening), among others.

We typically perform this surgery following an initial treatment phase with your orthodontist. We have worked with orthodontists all over the country and world – and will be happy to work with your existing orthodontist. If you do not have an orthodontist, and/or prefer “Invisalign” or “Surgery-first” protocols we will have you see one of our excellent collaborative orthodontists.

Conventionally, orthognathic surgery is performed when an individual has completed growth – However, this is not always the case, contact us for more information.

Condylar hyperplasia

Abnormal growth of the lower jaw, called Condylar hyperplasia, may cause a facial shift or asymmetry in early adulthood or later. We commonly treat this condition and have some of the most refined protocols to stop the shifting, and create a balanced, symmetric face.

Condylar resorption

This can be caused by arthritis, rheumatic disease, Lyme disease, or idiopathic condylar resorption, can lead to a shifting of the bite (open bite – where the front teeth do not meet), and a “shrinking chin.” We have vast experience with these conditions as well, and treat you with orthognathic, possibly coupled with your own bone, or additional joint surgery, or joint replacements, depending on your age, and specifics of the diagnosis. If you have ankylosis (TMJ/jaw joint is fused, and you cannot open your mouth), from trauma or chronic disease, we will address this as well. A jaw joint replacement may be necessary with orthognathic surgery.

Revision or redo orthognathic surgery

Another area we have significant experience. If you have undergone orthognathic surgery in the past and have new discrepancies, deformities, or imbalances, we will address and correct the problems. Our goal is to give you the best aesthetic, functional, and positional result possible – with the quickest recovery.

3D planning, VSP, CAD/CAM. 3D planning, VSP, CAD/CAM

We utilize the most sophisticated tools for planning and positioning of your jaws and facial structures. Your patient specific renderings are digitized, and can be virtually moved and repositioned in space, based on cosmetic goals, functional goals, and a number of measurements and other variables. This transfer to the “real surgery” ensures the best possible positioning with accuracy and precision.

Asian, Korean, Chinese V-Line

The facial cosmetic goals in many east Asian patients is to create a less “boxy” (or brachiocephalic) face. The term “V-line” means a narrower, tapered chin, and less width (or boxy) angles of the mandible (the portion back by the ear). Additionally, the chin and lower lip are desired to be less prominent, while the upper lip and mid-cheek require definition. Orthognathic surgery together with genioplasty, and angle reduction or contouring will achieve this. Additionally, cheekbone reduction, additional contouring, and nasal procedures (rhinoplasty) may be warranted. In addition to other procedures sought.

Nasal reshaping, function (rhinoplasty)

We have studied the change in nasal morphology 3-dimensionally in concert with orthognathic surgery. The nasal form may improve, stay constant, or require future manipulation (rhinoplasty). The maxilla (upper jaw) is the platform on which the nose rests, alterations of the nasal floor can greatly improve breathing, and support of the nasal base can be achieved through orthognathic surgery.

Sleep apnea and snoring

Orthognathic surgery, performed in the appropriate manner and magnitude, is the most powerful surgical means to treat obstructive sleep apnea. If you cannot tolerate CPAP and have sleep apnea, orthognathic surgery will be the most effective treatment. Jaw surgery also treats snoring. We may wish to address any/all sites of obstruction, including the nose as mentioned above. Orthognathic for OSA is an instance when presurgical orthodontics MAY not be needed. However, this is case dependent, and we will advise you of the pros and cons each way.

Cosmetic, Aesthetic problems

Orthognathic surgery is one of the most powerful and effective facial cosmetic procedures. This can address an excessively small chin or lower jaw (microgenia, migrognathia), an excessively prominent chin, lower jaw (or weak upper jaw) (microgenia, mandibular prognathism ([Hapsburg], maxillary hypoplasia). Your orthodontist or dentist may refer to dental / occlusal/ bite issues accompanying these jaw discrepancies (class II, class III, crossbite, open bite deformities). Additionally, significant facial asymmetry or jaw narrowing may be present and can be addressed.

Adjunctive cosmetic, contouring, or manipulation may be performed in concert with orthognathic, to create and even more balanced, aesthetic face, with optimized appearance. Lip procedures, fillers, fat grafting, facial bone contouring or reduction, facial bone implants or augmentation, jowl manipulation, double chin liposuction or tightening, skin tightening, cheek implants, blepharoplasty (eyelid surgery; double-eyelid surgery), rhinoplasty, and so forth.

Results

Click on the images below to see the animated sequences. Note that these are actual results, not simulations.

Benefits of orthognathic (jaw) surgery include:

  • Improved biting and chewing
  • Improved swallowing and speech
  • Smile and dental function
  • Corrected facial imbalance and lip closure
  • Corrected asymmetry such as underbites, overbites, crossbites, and small chins
  • Correction of temporomandibular joint (TMJ) problems
  • Breathing (while limiting snoring)
  • Cure for sleep apnea
  • Corrected facial injury and birth defects
  • Improved aesthetics / cosmetics
  • Jawline definition

Before the Procedure: What to Expect

You may undergo a “pre-surgical” orthodontic phase where your orthodontist lines up your teeth with respect to the individual jaw (so that when the jaws are moved in space the teeth meet well together). At least a month before surgery the orthodontist stops tooth movement and has a passive wire in place. Just prior to surgery the orthodontist may place small hooks on the wires and/or brackets. This protocol may be different with “surgery-first,” Invisalign, sleep apnea, and purely cosmetic cases, ask us at your consultation.

7-14 days prior to the procedure. We will see you to obtain a “final” set of dental models (or scanned dental occlusal arches), a cone-beam CT scan, and to look at your 3D facial image. This data will all be compiled and fused together to perform the CAD/CAM virtual analysis and manipulation of your jawbone positions. Guides, splints, and/or plates are generated to transfer the plan in a precise, reproducible way to your actual surgery. The splints are removed by the end of surgery in most cases. Occasionally, if your jaw needs an expansion or narrowing concurrently we may leave a “retainer-type” splint on your palate. This is unobtrusive and typically is not even noticed by the patient.

Basics About The Procedure

There are no scars/incisions on the outside. The surgery HIDDEN and is done from inside your mouth. So, there are no visible external scars. In rare cases there may be a small needle sized incision under the angle of the jaw – but this is exceedingly rare. When present this heals to become near invisible. Additionally, if submental liposuction is performed, a small 2mm incision may be present hidden underneath the chin.

You are not wired shut. The stories of jaw surgery from 20-30 years ago of having ones teeth wired shut does not hold true today. The bones are held together with small plates and screws and do not require complete immobilization. That said, we prefer tighter elastics the first week (similar to splinting a sprained ankle), allowing you jaw and facial muscles to relax (not need to activate).

After the Procedure: Recovery

After the procedure you may stay in observation for a short period of time. We will discuss this during your consultation.

Several advances have made the recovery simpler and easier. Each patient is individual and unique, and each case, and case complexity if different. As such a range of recovery periods can be experienced. Depending on your school or work specifics, and activities will inform the return date. Some patients have returned as soon as 7-10 days to school. Whereas others have elected longer period of recovery prior to returning to work if strenuous activity is expected of them.

Swelling: Reaches its peak, together with some bruising, at 2-3 days after surgery. Ice, light compression, and head elevation can help minimize, and hasten return to baseline.

Diet: No straws first week; first 2-3 weeks, soft-blenderized food; next 2-3 weeks, soft light-chew diet; by 6 weeks, can return to any food, eating habits.

Oral hygiene: is critical, mouth rinses (immediately), brushing (after first week)

Activity: Full sports or heavy lifting, by 6-weeks postoperatively.

Return to orthodontist: depends on the individual case: as soon as 2-3weeks postoperative, always by 6-8weeks postoperative.


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Comprehensive in scope, Aesthetic Orthognathic Surgery and Rhinoplasty presents orthognathic surgery from an aesthetic perspective, encompassing analysis, diagnosis, treatment, 3D virtual planning, and adjunctive procedures.

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