Deciding to undergo maxillofacial surgery is an important step—one that bears equal measures of anticipation and uncertainty. Patients often arrive at that decision after months or even years of living with jaw misalignment, chronic pain, breathing difficulties, or bite problems that cannot be resolved through orthodontics alone. Once surgery is recommended, the questions begin: What tests will I need? How long will I be in the hospital? What does recovery actually look like?
The good news is that orthognathic surgery has a success rate of approximately 93.9%, and most patients report a meaningful improvement in their quality of life (Cleveland Clinic). That outcome, however, depends heavily on how well both the surgical team and the patient prepare. Detailed preparation reduces complications, shortens recovery time, and makes certain that the surgical plan is done with precision.
This guide covers everything you need to know before, during, and after maxillofacial surgery—from your first imaging appointment to the final follow-up visit. At every step, Dr. Larry M. Wolford and his team are committed to delivering expert guidance and caring support to help you achieve the best possible result.
Pre-Surgery Steps: Establishing the Base for a Successful Outcome
Orthodontic Preparation
Maxillofacial surgery is not a standalone procedure—it is one component of a comprehensive treatment plan that commonly spans two to three years. For most patients, the process starts with orthodontic preparation. Braces are placed to level and align the teeth in advance of surgery, a process that generally takes between 12 and 18 months (Mayo Clinic).
This step is critical. Without proper pre-surgical orthodontic alignment, the jaws cannot be repositioned accurately during surgery. Your orthodontist and oral and maxillofacial surgeon must work in close coordination throughout this phase to ensure that the treatment plan remains on track.
If you have wisdom teeth, your surgeon may recommend extracting them at least six months before surgery. Wisdom teeth can interfere with the surgical cuts made in the jawbone, and the gum tissue in extraction sites needs adequate time to heal before the procedure.
Medical Assessments and Pre-Operative Testing
As your surgery date nears—typically four to six weeks out—your surgical team will order a series of pre-surgical evaluations. These evaluations allow your anesthesiology team to review your complete medical history, assess any risk factors, and determine whether additional preparation is required.
Pre-operative testing commonly includes:
- Blood work: To assess your general health, clotting ability, and organ function
- CT/CBCT scan: A three-dimensional CT or cone beam CT (CBCT) scan of your jaws and face, taken approximately four to six weeks before surgery, provides the imaging data required for virtual surgical planning (Children’s Hospital of Philadelphia)
- Dental impressions and records: Models of your teeth, along with X-rays and clinical photographs, allow your surgeon and orthodontist to plan precise bone movements—often to a fraction of a millimeter
At this stage, your anesthesiology team will also review your current medications. You will receive specific instructions on which medications to continue and which to pause before surgery. Certain blood-thinning medications, anti-inflammatory drugs, and immune-modulating therapies may need to be stopped in advance. Always follow your surgical team’s instructions precisely.
Virtual Surgical Planning
One to four weeks before your procedure, your surgeon will use the CT scan data and dental models to complete virtual surgical planning. This technology allows for precise simulation of bone movements before a single incision is made—enabling the creation of custom titanium plates and surgical cutting guides that are uniquely fabricated for your anatomy.
Virtual surgical planning is a foundation of contemporary orthognathic surgery. It increases precision, reduces operating time, and gives your surgical team a clear, data-driven roadmap for the day of your procedure.
Practical Preparation at Home
Beyond health examinations, there are multiple practical steps that will make your recovery considerably easier:
- Stock your kitchen: You will be on a liquid or soft diet for several weeks after surgery. Before your procedure, prepare a supply of soups, smoothies, protein shakes, yogurt, and soft fruits. A good blender is an essential investment.
- Fill your prescriptions in advance: Ask your pharmacy to fill post-operative medications before surgery day so they are prepared when you return home.
- Arrange transportation and support: General anesthesia means you will not be able to drive yourself home. Arrange for a trusted family member or friend to accompany you and plan for support during the first week or two of recovery.
- Stop smoking: Tobacco use—including cigarettes, vaping, and marijuana—constricts blood vessels and significantly impairs healing. Stopping well in advance of surgery is strongly recommended (CHOP Jaw Surgery Handbook).
- Follow fasting instructions precisely: Your anesthesiology team will provide specific guidelines on when to stop eating and drinking before surgery. These must be followed without exception to ensure anesthesia safety.
What to Expect During Surgery
Anesthesia and the Operating Room
Maxillofacial surgery is performed under general anesthesia, meaning you will be fully asleep and will have no awareness or memory of the procedure. Your anesthesiology team will monitor you continuously throughout the operation to ensure your comfort and safety.
The procedure itself typically takes between one and four hours, depending on the complexity of your case. Whether you require upper jaw surgery (maxillary osteotomy), lower jaw surgery (mandibular osteotomy), or double jaw surgery (bimaxillary osteotomy), your surgeon will make precise cuts in the jawbones, reposition them according to the virtual surgical plan, and secure everything in place with custom titanium plates and screws. In most cases, incisions are made inside the mouth, leaving no visible external scarring.
Dr. Wolford’s extensive experience with complex and revision cases—including more TMJ Concepts® total joint prostheses than any other surgeon in the United States—means that even the most challenging presentations are approached with accuracy and confidence.
Hospital Stay
Following surgery, you will be transferred to a recovery room where your vital signs and comfort are closely monitored. Most patients remain in the hospital for one to two nights. During this time, your surgical and nursing teams will manage pain, manage any nausea, and ensure you are able to tolerate fluids before discharge (CHOP Jaw Surgery Handbook).
It is completely normal to wake up from surgery feeling disoriented, swollen, and sore. Nausea is also common in the immediate post-anesthesia period. Your care team is experienced in managing all of these effects and will keep you comfortable. Importantly, note that in Dr. Wolford’s practice, your jaws are not wired shut after surgery—elastic bands are used to guide jaw positioning while allowing necessary movement for eating and speaking.
Post-Surgery Recovery: A Week-by-Week Guide
The First 72 Hours
The initial days after surgery are centered on rest and inflammation management. Swelling usually peaks between two and five days after the procedure and will be most noticeable in the cheeks, chin, and neck. Bruising is normal and usually resolves within the first few weeks.
Key steps during this phase include:
- Apply ice packs to the outer jaw for the first 24 to 48 hours to reduce swelling. Always place a cloth between the ice pack and skin to prevent cold burns, particularly as temporary facial numbness is common
- Keep your head elevated, even while sleeping. Propping yourself up with pillows reduces fluid accumulation and swelling in the face
- Take prescribed medications on schedule. Being ahead of discomfort rather than waiting for pain to intensify is far more effective. Most patients require prescription pain relief for approximately four to five days, transitioning to over-the-counter options such as acetaminophen or ibuprofen thereafter
Weeks One Through Three: Adapting to a New Routine
During the first week, a liquid diet is necessary. Protein shakes, blended soups, smoothies, and yogurt supply essential nutrients without placing strain on healing bone. Use a syringe or squeeze bottle if standard cups are difficult to manage.
Light walking is encouraged from the first week to promote circulation. Strenuous exercise, heavy lifting, and any activity that significantly raises your heart rate must be avoided.
Oral hygiene calls for careful attention throughout recovery. You will be given a prescription antiseptic mouthwash to use after meals and before bed. Keeping the surgical sites clean is necessary for preventing infection and supporting wound healing (AAOMS: Recovery from Orthognathic Surgery).
Most patients feel ready to return to work or school around two to three weeks after surgery, provided their position is not physically demanding.
Weeks Three Through Six: Progressing to Soft Foods
Around the two-week mark, your surgical team will typically clear you to advance from a full liquid diet to a no-chew soft food diet. This phase includes foods such as scrambled eggs, oatmeal, mashed potatoes, soft pasta, and yogurt—anything that can be mashed with the tongue without actual chewing.
Orthodontic adjustments to your elastic bands will begin seven to ten days after surgery and continue at regular intervals as your bite is refined. Prescription pain medication is generally no longer needed by this stage.
Residual swelling can persist for months. Some patients notice increased swelling subsequent to a particularly active day—this is normal and expected. Full resolution of swelling can take anywhere from six to twelve months.
Long-Term Healing: Three Months and Beyond
By the six-week mark, significant healing has occurred and the jawbones are stabilizing in their new positions. Bone healing is generally complete around the three-month mark, though total jaw healing—including full resolution of numbness and residual swelling—may take nine to twelve months (AAOMS).
Braces are typically removed six to nine months after surgery, once your orthodontist is satisfied with final tooth alignment. A retainer will then be fitted to maintain the results long term.
When to Call Your Surgeon
Patients should contact their surgical team immediately if any of the following occur during recovery:
- A fever exceeding 100.4°F (38.3°C)
- Pain that worsens rather than improves over time
- Shortness of breath
- Signs of infection, including discharge from surgical sites or skin that feels hot to the touch
- Persistent vomiting or diarrhea
These symptoms warrant prompt evaluation. Most are manageable when addressed early (Cleveland Clinic).
You Are Not Dealing With This Alone
Maxillofacial surgery is a life-changing procedure that calls for considerable commitment from the patient—but also from the surgical team. The months of orthodontic preparation, the accuracy of virtual surgical planning, the post-operative diet, the follow-up appointments: every element of this process exists to protect your outcome and your health.
Dr. Larry M. Wolford has committed over 40 years to developing orthognathic and TMJ surgery, having performed many thousands of successful procedures and trained hundreds of surgeons worldwide through fellowships at Baylor and Texas A&M. With more than 185 scientific publications to his name and recognition as one of the leading maxillofacial surgeons in the world, Dr. Wolford brings an unmatched depth of proficiency to every patient he treats.
If you are preparing for jaw surgery—or still in the process of deciding—a consultation with Dr. Wolford’s team is the most important first step you can take. Contact our office today to schedule a complimentary initial telephone consultation and get the answers you need to move forward with confidence.
Office Location:
Larry M. Wolford, DMD
Baylor University Medical Center, Worth Street Tower
3409 Worth Street, Suite 400, Dallas, TX 75246
📞 214.828.9115 | Schedule an Appointment
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