Orthognathic (Jaw) Surgery in San Francisco & Sonoma County

Orthognathic surgery, or jaw surgery, is a complex procedure that can improve both the shape and function of your jaws.

• An ideal esthetic outcome helps bring your teeth and jaws into harmony with the rest of your face, and in some cases can help you look younger or more masculine / feminine.
• An ideal functional outcome improves your ability to have your teeth line up properly (occlusion), which can relieve abnormal wearing of teeth, improve chewing, improve speech, and minimize problems with the joints (TMJ). TMJ disease can become very painful and progressive, and may lead to lockjaw or triggering headaches if left untreated. In some cases jaw surgery may also relieve airway obstruction or cure sleep apnea.

• Dr. Pourtaheri is an Orthognathic surgery specialist with an advanced understanding of facial esthetics. Jaw surgery is one of the most gratifying procedures that he performs.
• While many jaw surgeons focus on correcting the way your teeth line up, Dr. Pourtaheri devotes additional effort and attention to optimize your overall facial balance and appearance in line with your goals.
• Dr. Pourtaheri has a PhD in medical modeling and imaging. He performs extensive 2-D and 3-D photography and low-dose x-rays to analyze your face, teeth, and jaws from every angle. He also uses state-of-the-art 3-D virtual surgical planning to provide you with a safer, more accurate, and lasting outcome.
• Dr. Pourtaheri systematically evaluates your airway before and after surgery so that surgery does not worsen your breathing but can make it better in many cases.
• Dr. Pourtaheri is one of the few plastic surgeons who received extensive training in jaw surgery. During his six years of residency, Dr. Pourtaheri trained with oral and plastic surgeons learning dental anatomy and extraction; cephalometrics; and jaw surgery techniques including orthognathic surgery, TMJ treatment, joint replacement, jaw distraction, and jaw reconstruction. Dr. Pourtaheri completed a craniofacial fellowship and trained with one of the world’s leading experts in jaw surgery and virtual surgical planning, Dr. Derek Steinbacher. He learned how to perfect his approaches for evaluating, planning, and correcting the jaws in context of the rest of the face and for optimizing breathing through jaw surgery.
• Dr. Pourtaheri has given numerous national and international presentations himself, and has published several articles on the subject in peer-reviewed scientific journals.
• Dr. Pourtaheri was the former Director of Craniomaxillofacial Surgery at Indiana University, providing care to patients with jaw deformities from all over the state.

Jaw surgery can help you feel more comfortable and confident and pay dividends down the road by protecting your teeth and joints. Please contact us online or call 415-523-5235 to schedule a surgical consultation with Dr. Pourtaheri.

Orthognathic surgery is best performed after facial growth is complete, around 16 to 18 years of age. There are gender differences in facial growth and reasons to perform surgery sooner or later. If you are also interested in rhinoplasty, we recommend that you undergo jaw surgery first, since changes to the jaws can affect the nose. If you recently underwent surgery to fix a broken jaw or facial bones, it is best to wait at least 3 months before we perform jaw surgery. If you have any questions about your eligibility for the procedure, please request a consultation.

Common reasons why patients pursue jaw surgery include having:

• A gummy smile
• Teeth that are not showing when you smile
• Teeth that do not line up or do not come together (open bite)
• An overbite or underbite
• A chin that is too prominent, too small, or off-center
• Jaws that are asymmetric
• A jaw line that is too masculine or feminine
• Inability to open or close the jaw fully
• Grinding or clenching the teeth
• Joint pain, joint clicking, or difficulty opening / closing the jaw
• Difficulty breathing (sleep apnea)

A history of prior jaw or facial trauma can explain certain deformities. Other concerns may be due tounder- or over- development of certain jaw structures.

Before your first visit, you will be asked to complete an intake form to document your personal and medical history, prior surgeries, dental work, medications, and allergies.

At your visit we will review your concerns and goals. We will also want to learn more specifically about any prior facial or dental procedures and orthodontic work performed. We will examine your overall face and jaws from various angles, including the inside of your mouth. The examination will not be uncomfortable. A CT (computed tomography) scan and dental impressions will be used to plan your surgery.

We will work closely with your orthodontist to obtain your records and discuss the plan, or refer you to one of our preferred orthodontists if you do not have one. Orthodontists are a vital team member when it comes to setting you up for jaw surgery and caring for you afterwards. We will also take photographs that will be used to plan your surgery and track your changes after. You will have a chance to review your images and X-rays and discuss the plan with Dr. Pourtaheri prior to surgery.

Dr. Pourtaheri is meticulous and scientific when it comes to planning and performing your jaw surgery. He spends time before surgery making numerous measurements and performs 3-D virtual surgical planning to make your surgery safer, quicker, and more accurate. Your procedure can generally take a few hours depending on the approach, number, and complexity of necessary changes.

Dr. Pourtaheri offers orthognathic surgery to set your dental alignment (occlusion), while leaving room for surgical judgment to optimize your tooth show / smile, cheek contour, and chin position. This may require adjustments made on the upper and lower jaw and/or chin. During this procedure Dr. Pourtaheri will also be able to make adjustments to your nasal and oral airway if necessary. Orthognathic surgery can also change your nasal appearance. We offer a variety of techniques that may include minimally invasive (small incisions), mini-plates, screws, custom-printed plates, surgical splints, or cutting guides. Dr. Pourtaheri has experience with the latest techniques and will customize the approach for your situation.

Dr. Pourtaheri is happy to remove your wisdom teeth at the time of your orthognathic surgery. He can also combine your jaw surgery procedure with other facial esthetic procedures like facial fat grafting, buccal fat pad reduction, neck liposuction, or chin / cheek augmentation. Offering these options helps provide our patients with a one-stop shop to address many of their concerns in one surgery and recovery period.

Dr. Pourtaheri also provides revision orthognathic surgery. This refers to corrective jaw surgery performed on patients who have had a previous jaw surgery and requires careful planning to remove prior hardware and correct the jaws while minimizing the risk of complications.

Dr. Pourtaheri offers chin reshaping as a stand-alone procedure or in combination with orthognathic surgery. This can be achieved using in a variety of techniques. Dr. Pourtaheri’s preference is to use your own tissues instead of implants to maximize your long-term results. This entails adjusting the chin bone itself and may also involve use of plates and screws to maintain your new chin position. If performed in combination with fat grafting or liposculpting, it can help balance your chin and smooth your jaw line even further.

Dr. Pourtaheri offers jawline reshaping by adjusting the bone of your jawline. This can be beneficial in men who would like a more masculine or square jaw, or in women who would like a narrower and more feminine jaw. Adding to the jaw line can be performed using your own tissue or implants. This procedure can be combined with other jaw or facial procedures to complete your look. This procedure is an integral part of facial feminization and facial masculinization for transgender patients.

Dr. Pourtaheri offers a full range of temporomandibular joint assessment and corrective procedures for patients with TMJ concerns. Minimally invasive options for the relief of TMJ problems can involve joint manipulation, injection, aspiration, or wash out. More severe cases with arthritis affecting the bones or cartilage of the joint may require an open procedure to reshape the bones and reconstruct or reposition the joint disc. Last resort options may include jaw joint replacement with either your own tissues (bone / cartilage) or a prosthetic joint. In some instances, it may be beneficial to combine your TMJ procedure with orthognathic surgery to prevent further wear and tear of the joint and realign the teeth when there is loss of jaw height. In other circumstances it may be beneficial to correct the jaw joint first before performing orthognathic surgery.

We can perform your jaw surgery procedure in San Francisco or Sonoma County based on your preference. Immediately following surgery you will move to a recovery area to be cared for. Most patients spend 1 or 2 nights in the hospital to recover from anesthesia and ensure they are eating well. We may leave heavy elastics or wires to hold/guide your teeth into their optimal position as you heal. These are generally changed out for light elastics when you come to see us after surgery.

You will be given antibiotics on the day of surgery and you may also need to take them after surgery. We also prescribe pain medications to limit your discomfort. We will recommend a modified diet for several weeks to help you heal. You will receive care instructions before and after surgery and have plenty of time to ask questions. If you anticipate having a friend or family member care for you after surgery, it is helpful to have them come to your visits before and after surgery to review these instructions.

After surgery, your face and neck may be bruised, swollen, and sore for a couple weeks. It is best to sleep with your head elevated on 2 or more pillows and not strain yourself to reduce swelling during this time to minimize swelling. Regular walking is encouraged to prevent blood clots, starting the morning after surgery. You can shower the day after surgery.

We will examine and check on you the day after surgery, and plan to see you again in 1-2 weeks after surgery. We recommend that you take off from work for that period of time. We will schedule additional visits to check on your healing progress; some of these can be done virtually if you live out of town. The bulk of the swelling resolves within several weeks and you should be able to appreciate your final results around 3 months after surgery. If you are ready to take the next step and learn more about jaw surgery to improve your function and appearance, please contact us online using our confidential form or call / text 415-523-5235 to schedule a consultation with Dr. Pourtaheri.