The questions below come from real assessment conversations: people from many countries who wrote to Op. Dr. Mehmet Cömert about double jaw surgery, sent photos and scans, and asked the same things almost everyone asks. His answers here are drawn from his own voice notes and messages, edited to remove names and identifying details and to bring together what he said across several conversations. Nothing has been added that he did not say to a patient.

Dr. Cömert is a European Board certified plastic, reconstructive and aesthetic surgeon (FEBOPRAS) practising in Istanbul since 2009, with patients from 48 countries. He plans bimaxillary (bimax) surgery, genioplasty and patient-specific facial implants from CT data, and he often combines them. Every face is decided individually; these answers explain how he thinks, not what any single reader should do.

Key takeaways

  • Bimax suits a short or recessed face, an off bite, a cant or airway symptoms; a good bite alone does not rule it out.
  • If the teeth are aligned, bimax can be done without orthodontics; if not, surgery can come first with orthodontics afterwards. Surgical palatal expansion means orthodontics afterwards.
  • Planning runs on a proper CT and intraoral scans: digital design, custom cutting guides and plates, confirmed by you first.
  • Genioplasty is preferred over a chin implant; a big prosthesis can make you lose chin bone. Implants and bimax are often combined.
  • Recovery is told honestly: after genioplasty with a facelift the chin and lower face will swell and it is not an easy period; there is no fixed bimax timeline here for eating, numbness or the flight home.

Who is a good candidate for double jaw surgery (bimax)?

In brief: I look at three things: the face, the bite and the CT. A short or recessed lower two-thirds, a bite that is off, an occlusal cant or breathing issues point towards bimax. A good bite alone does not rule it out.

What I am looking for in a bimax candidate is the support of the lower two-thirds: is the maxilla retruded, is the face a little bit convex, or short? When both jaws are recessed as a whole, moving the entire upper jaw and lower face can give a better result than a sliding genioplasty alone, cosmetically and maybe even functionally. The same goes for an occlusal cant, where the arc of the dental arch is not symmetric: the only way to correct that is orthognathic surgery.

Then the bite. A good occlusion is not a contraindication; I have recommended double jaw surgery to patients whose teeth close properly, because the improvement was in the skeleton, not in the teeth. And I want to hear about breathing: any restriction, any snoring, any apnea in your sleep is part of the decision.

When the patient has a short face, I like to recommend bimax; but when they have a normal balance of the horizontal thirds of the face, usually I would go forward with facial implants or genioplasty.

The final call is made on the CT scan, not on photos. And I say no when the gain is small: a young man with a good bite and an already wide jawline asked me for bimax, and my answer was that it would be too little of a result for too much of an invasive surgery. That is how I approach double jaw surgery.

Do I need braces before bimaxillary surgery, or can surgery come first?

In brief: It depends on your occlusion. If the teeth are aligned well and we are doing a rotation, downgraft or modest advancement, no orthodontic treatment may be needed. A mild overbite does not block a surgery-first plan. Palatal expansion needs orthodontics afterwards.

There are many ways to sequence this. Sometimes we do the surgery first and the orthodontic treatment later; sometimes orthodontics before the surgery, then the surgery, then orthodontics again after. Which pathway you are eligible for is decided on your CT scan, an intraoral scan of your teeth, and any orthodontic treatment you have had before.

The deciding factor is the occlusion. If your teeth are aligned very well and the plan is a counterclockwise rotation, a downgraft or a slight advancement, orthognathic surgery can be done without any orthodontic treatment. If the alignment is not suitable, a surgery-first approach is possible: we operate first and you continue the orthodontics afterwards. A small overbite that could be treated orthodontically does not stop us preparing a case surgery-first. Genioplasty on its own needs no orthodontics at all.

I do think your case would be an ideal case for the surgery-first approach, so you don't have to wait too long; that is my opinion, of course, and every practice is different.

Palatal expansion is different. Sometimes we can expand the maxilla at the same time without pre-op orthodontics, but when we widen it surgically with a two- or three-piece maxilla, the lower jaw may not match the new palate, so orthodontic treatment afterwards is part of the plan and you need to be prepared for it. If MARPE has been suggested to you, I would like to see your scans first: with a good occlusion I may prefer to go straight to the surgery, with orthodontics after if needed.

Before and after photographs of a 28-year-old patient from Turkey one month after double jaw surgery with genioplasty
Double jaw surgery with genioplasty: a 28-year-old patient from Turkey, photographed one month after surgery, with swelling still settling. Individual results vary.

How is orthognathic surgery planned: CT scan, virtual planning and cutting guides?

In brief: Everything starts with a proper CT scan plus intraoral scans. We run a digital design, decide the Le Fort I, BSSO and genioplasty movements on numbers, then print custom cutting guides and plates. You confirm the design before anything is produced.

Without a CT scan we cannot do the treatment planning, the digital planning. I need the scan itself, not the radiology report; a cephalometric film does not replace it, and a tooth-only CBCT is not enough. Together with intraoral scans of your bite, that gives me the numbers.

All these things are better decided on numbers, so I would ideally check your CBCT and come back with the possible options.

We run a design for your case, either orthognathic, facial implants or both, and I prefer custom-made surgery. We print the plates for the Le Fort I, the mandible is adjusted to that, and the genioplasty is also custom-made with cutting guides and plates, so we can try to have the most perfect symmetry possible. I do not do mono jaw, a BSSO on its own, unless it is highly necessary.

For one combined implant and orthognathic case I prepared two versions of the jaw movement plan. One was more cosmetically enhancing: a greater advancement of the maxilla with advancement and rotation of the mandible, which lengthens and projects the face more, but because the maxilla then does not fully rest against the cranial base it carries a slightly higher risk of relapse, a tendency to shift partially back over time. The second was more stable: slightly more conservative movement with better bone contact. We also check whether the soft tissues will comfortably allow the larger movement. The final numbers are set once you agree to proceed and confirm the design; there is more in my bimax guide.

Bimax, genioplasty or jaw implants: when do you move bone and when do you add an implant?

In brief: If the problem is the chin alone, I move bone: genioplasty over a chin implant nearly every time, because a big prosthesis can make you lose bone. Angle and cheek implants add contour. Bimax is for overall balance and function; often we combine them.

There are two ways to improve facial balance: one is implants, the other is orthognathic surgery. If you just want to improve the lower mandible, angle implants with a genioplasty or a chin implant would be the procedure to pick. If you want to improve the overall facial balance and structure, orthognathic surgery is the option: more naturalness, a better airway, the maxilla a little bit forward. But never forget that bimax is more invasive than implants. In the end it is your decision to make.

Between a chin implant and a genioplasty, if there is a chance for genioplasty I go for the genioplasty. It advances your own bone and improves the muscle imbalance in the neck.

With a chin implant we cannot have a major improvement, because if you use a big prosthesis, in the long run it can make you lose a little bit of the bony tissue around your chin, and that's not what we want, right?

An advancement of 7 or 8 mm is already ambitious for a genioplasty; small gaps may form and may need a small bone graft, and I would not recommend more than that. A mild Class II bite with no functional issues, in someone who does not want full jaw surgery, can be treated with genioplasty plus implants designed to address the asymmetry. And most of the time we do orthognathic surgery and facial implants together; for some skeleton types, subtle midfacial implants with the bimax can probably be used as well for the best possible result.

Can double jaw surgery help breathing, snoring and sleep apnoea?

In brief: Yes, jaw position is about function too. I want to hear about any breathing restriction, snoring or apnea in sleep before we decide. Orthognathic surgery puts the maxilla forward and can improve the airway; even genioplasty can improve sleep quality and breathing.

When I evaluate a double jaw case, I look at facial proportions, the occlusion and the airway relation together. So I want to hear whether you have any restriction in breathing, any snoring, any apnea in your sleep. A patient in his late teens concerned about a recessed midface asked me about bimax: considering his bite, it was not going to be a functional type of bimax, but depending on his sleep and breathing issues we could discuss it, and the CT would decide.

Orthognathic surgery puts the maxilla a little bit forward and improves the airway along with the balance of the face. In a patient whose lower two-thirds lacked support, my vote was bimax, maybe trimax, and I told him the airway would benefit from that too. Even a genioplasty tightens the tongue muscles and the neck, improves the muscle imbalance there, and can improve sleep quality and breathing.

At the same time, if you have symptoms regarding your airway, if you have snoring issues, if you want to improve your lung capacity, it may also be the approach to pick.

One honest limit. I do not do an unnecessary operation for a small improvement that could be achieved, maybe more so, with implants; breathing and sleep are what can make the case for bimax stronger.

What realistically changes after bimax surgery, and what does not?

In brief: Bimax changes the skeleton: the face lengthens or projects, the upper lip is supported, a cant is corrected. The movement may not be big, and it does not give perfect symmetry or width by itself; soft tissue and the neck still count.

What changes is the structure. With a bimax we can lower the jaw, push it forward and elongate it slightly, and with a trimax also drop down the chin. A counterclockwise rotation supports the upper lip and improves a flat philtrum; a greater advancement lengthens and projects the face more. An occlusal cant, which only orthognathic surgery corrects, is corrected. A double-chin look caused by a recessed jaw can improve because the cause is treated.

I do think with orthognathic surgery you can have a big improvement, although the movement wouldn't be too big.

It has to stay within aesthetic limits. Perfect symmetry is not something I can promise; with custom cutting guides and plates we try to have the most perfect symmetry possible, and implants can be designed to address a remaining asymmetry. Width is not only bone: masseter muscle, soft tissue, thin skin and low body weight all contribute, and chasing width with big implants can give an unnatural result or visible implant edges. Some faces are naturally more oval than square, and that does not stop them looking masculine, attractive and refined.

One more honesty: a Le Fort I advancement can create a bit of a mismatch between the upper face and the upper jaw. Subtle patient-specific midface implants can address that, with the bimax or later. And a man's jawline cannot be shaped by implants alone; the neck can need its own work, which can also be done later.

What is recovery like after double jaw surgery?

In brief: When genioplasty is combined with a facelift, I warn that the chin and lower face will swell and it is not an easy recovery; some preparation is needed before double jaw surgery. There is no fixed timeline here for eating, numbness or flying home.

When a patient asked me to combine a genioplasty, bone surgery on the chin, with a facelift, my answer was yes, we do these surgeries together, but I could not leave one thing out.

But I cannot go without saying: both the chin and the lower face will swell; it is not an easy recovery period.

Many patients accept this and we perform it. Some preparation is of course needed before double jaw surgery. On eating, the closest thing to a rule in my answers comes from a different operation: after custom jaw-angle implants, which can be placed in the same surgery as the bimax, I asked a patient to put the muscle on full rest: soft diet only, nothing that needs chewing, no gum, no wide mouth opening, no clenching, and a firm compression band day and night while the swelling settled and the capsule formed around the implant. When he wrote to me on day 14 about something that looked unusual, I told him that was exactly the kind of message I want to receive early rather than late. The practical side of soft eating is in my soft-food guide.

Numbness, hospital nights and the flight home are not covered in my answers here. Once your photos and records are in, we arrange a short online consultation to discuss the plan and your expected outcome.

I want jaw surgery in Istanbul: what do you need before anything is booked?

In brief: Before we plan anything in detail I need photos of your bite in full closure, front and both sides, your smile, relaxed and profile views, a proper full-head CT to our specification, intraoral scans and your orthodontist's records. Then a short online consultation.

Photos first, because a panoramic X-ray does not let me judge the occlusion. Send pictures of your teeth and bite in full mouth closure, from the front and both sides, an open-bite view if possible, your smile, and a resting face with the mouth open. Add frontal and profile photos of your face, relaxed and smiling.

I would be happy to assess your bite when you send me pictures of your bite in full mouth closure.

I need a proper CT scan, a full-head-to-collarbone type of scan; the consultant sends you what I mean, because a tooth-only CBCT is not enough. Send the data, not the report. Intraoral scans of your teeth complete the set. From your orthodontist I want the records or recent dental scans, to see whether the teeth are aligned or preparation is still needed. To one patient already sitting with a surgeon and an orthodontist at home, my advice was to do that locally and be in touch later for implants.

With those in hand we evaluate proportions, occlusion and airway, decide whether single or double jaw surgery is required, and arrange a short online consultation to discuss the plan and your expected outcome. If you come to Istanbul a little earlier, the CT can be taken here and we do a proper evaluation and a design for you. Tell me if you are talking to another designer; it matters for scheduling. You confirm the design before anything is produced, and then we come up with the treatment plan; how quotes are prepared is explained separately.

The next step

If you are thinking about double jaw surgery, genioplasty or facial implants, the best first step is to let me see your photos and, if you have it, your CT. Start with a free online assessment and let me know what you think; every face is decided individually.

About these answers. They are edited from Dr. Cömert's own consultations and the voice notes he records for patients, condensed for reading. Every case is described as a pattern; no individual patient is identifiable. Nothing here replaces an assessment of your own photographs and history.