Class 3 Underbite Jaw Surgery Case Study

“Jaw surgery.” What’s the first thing that pops into your head? For me, it was the thought of someone breaking their jaw through some kind of accident or fight, then having a surgeon bolt them back together.

Little did I know that on Halloween Eve 2007, I would be lying on an ice cold, metallic operating table, staring up at lights bright enough for an alien probing scene, drifting in and out of consciousness, hoping I would be waking up several hours later when the surgery was over.

I’m Brandon, and as you may have guessed, I made it, and I’m here to clear the confusion and worries that many of you potential jaw surgery patients may have. I had no idea that our world and community of intentional “jaw surgeristas” was so huge.

Since my surgery only a little over two years ago, I have encountered and answered thousands of questions from hundreds of people that have had or are going to have jaw surgery all over the world.

It never ceases to amaze me how many of us there are and how relatively common this surgery is, so just in case you feel like a freak, you’re not alone!

Before continuing, please be aware that much of the following content is based on my own personal experience. I am not a doctor, and you should always check with a medical professional if you have any questions or concerns about anything related to this or any other matter.

The first question most people have is…

“Why would you get jaw surgery?”

There are several reasons for jaw surgery other than the accidental/fighting causes that spring to mind first, and they fall into two categories: functional and cosmetic.

The great news is you’re going to benefit functionally and cosmetically, so it’s a win/win.

Some people have a jaw deformity that comes in two flavors: underbite and overbite.

An underbite is when the lower jaw juts out farther than the upper jaw a la Jay Leno.

The geniuses in the crowd may have surmised, then, that an overbite is when the lower jaw is retracted and dominated by the jutting upper jaw.

In addition to these simple horizontal movements, it’s also possible to have a crossbite, where the misalignment isn’t just forward/back, but also side-to-side.

I was “lucky” enough to have an extreme underbite AND crossbite:


Some people can get through life just fine, without ever noticing any functional or medical differences, especially in less severe cases.

For these people, they may just want a more symmetric face for cosmetic reasons.

For others, however, misalignment of the jaws can cause several issues including, but not limited to: inefficient chewing, clicking/popping, joint pain, sinus problems, self-esteem issues, headaches, and more…

In either case, a successful jaw surgery can improve and/or completely eliminate all of these issues, while also providing a more symmetric and attractive appearance.

What was my reason? As you can see here, my teeth only actually came together in two small places, not the greatest design for a carnivore (although I’ve since become a vegetarian — go figure!).

Through the miracle and magic of jaw surgery, my teeth now fit together in about 28 places (32 total teeth minus 4 removed wisdom teeth):


I’m the one without the long white beard or the flowing blond hair. I know you’re just ready to hear the details, so let’s break it down in the simplest, shortest terms possible, then I’ll delve into each piece in more detail below.

What happens when you decide to get jaw surgery?

  1. Realize your jaws are misaligned and/or you want a more symmetric face and profile
  2. Go to the orthodontist and/or surgeon and learn that surgery is the best and/or only option
  3. Take the initial X-rays and determine proper treatment plan
  4. Get braces put on by orthodontist
  5. Continue adjusting braces for anywhere from 3 months to 2 years pre-surgery
  6. Have actual jaw surgery for about 3 to 10 hours
  7. Continue to adjust braces for another 3 months to 2 years post-surgery
  8. Enjoy your new smile for the rest of your life!

Your First Consultation

Usually, a dentist or orthodontist will recommend jaw surgery, if they can’t fix your misalignment through braces or less intrusive methods.

In that case, you’ll need to find a maxillofacial surgeon, which is just a fancy name for jaw surgeon.

Sometimes, my case included, the orthodontist will already have a surgeon that they have worked with before, so they’ll send you there for your first consultation.

This is always a good sign, as the relationship between the orthodontist and surgeon is very important, since they will need to communicate and work together throughout your entire jaw surgery process, which usually lasts at least a year or more.

The only relationship more important than theirs is the one between you and your surgeon. Having complete confidence and comfort with your surgeon is one of the most important things to ensure a quick and successful surgery.

At the initial consultation, you’ll take several X-rays, measurements, etc. to fully diagnose the problem and determine a treatment plan.

Do not be afraid to ask questions! Ask any question that pops into your head at any time, as any competent surgeon will be more than willing to ease your worries and provide you with as much information as possible.

Mr. and Mrs. Metal Mouth

Once it’s official that you do, in fact, need jaw surgery and you’ve been deemed a suitable candidate, it’s time for the braces.

“But my teeth are already straight,” you say?

That’s great, but you’re still not getting out of the braces.

See, the braces are used in a seemingly counterproductive way, since they actually make your bite worse in most cases before the surgery.

They align your teeth for your new bite, the one you’re going to have after your jaws are realigned, so, until then, your teeth are going to be a little more out of whack than usual.

Don’t worry though, it’s a gradual change and one that you will hardly notice over time.

And just in case you’re still trying to weasel your way out of getting braces, they are also used as bases for your surgical hooks, which you’ll get put on about 2 weeks before the actual surgery.

These hooks are used when you are wired and/or banded together, which we’ll talk about later.

Over the next several months, your orthodontist and surgeon will work together, continuing to adjust your braces, until your teeth are in the proper position and ready for surgery.

This pre-surgery phase can take anywhere from about 3 months to over 2 years, depending on a variety of factors and your specific case.

I had braces for just over a year before my surgery.

It’s Game Time!

Ok, so you’ve stuck it out with the braces, and it’s finally time for the main event… jaw surgery!

My surgery was scheduled for about 6am, which was great, because I figured I’d still be half asleep anyway.

I had complete confidence in my surgeon, but I was still understandably terrified, and my heart rate was through the roof when they took my pre-surgery measurements.

It’s completely normal to be nervous right before a big surgery, and I just kept telling myself that it would be over before I knew it.

My surgery took about 6 hours, which is average for upper and lower surgery. Single jaw surgeries usually take less time and have a quicker recovery period.

I’ll spare you the details of the actual surgery, as I’d advise you to wait until after you’ve already had it, since it will only make you more nervous.

Upon waking up, I was still pretty out of it, but there wasn’t any pain at all, since I was still completely numb. Surprisingly, I didn’t experience much pain throughout the entire process, even without taking the pain medication.

I stayed in the hospital for two days after just to ensure everything was healing properly. Some people are sent home the same day, depending on the severity of the surgery.

Locked Down

I was banded completely shut with dozens of tiny rubber bands wrapped tightly around each surgical hook on my braces. I often refer to this as “wired shut,” because it’s essentially the same, but actual wires aren’t used as much any more.

In fact, some less severe cases don’t have to be wired or banded shut at all now, but I was locked up for five full weeks.

A lot of people think they’re not going to be able to talk for the full time they’re closed shut, and while it’s a little more difficult, it’s far from impossible. To practice, just clench your teeth together tightly right now, and you’ll see you can still talk pretty clearly, thanks to your lips still being able to move.

Like I said, I didn’t experience hardly any pain throughout the entire process, but those 5 weeks of being banded shut were definitely the toughest part.

I was on an all liquid diet during that time, and I had to “eat” using a syringe. Before you cringe, it doesn’t involve poking myself at all. It’s a plastic syringe connected to a small plastic tube that can be found at most pharmacies, or your surgeon might have them too.

For example, with apple sauce, I would stick the tube in the jar, pull the syringe to fill it up, then feed the plastic tube along the outside of my clenched teeth, between them and my cheek, to the gap at the back behind my last teeth.

Once in position, squeeze the sweet goodness out, rinse and repeat. And yes, it was as frustratingly tedious as it sounds to continue dipping and squeezing, dipping and squeezing.

Brace Off

Once my 5 weeks were up, it was finally time to loosen the reigns. Upon first being unbanded, it was a very weird feeling.

After not using my jaw for so long, the muscle had become stiff and awkward. While this is completely normal, it makes it feel like your jaw is going to fall right off of your face, and you can barely open your mouth at all.

It’s strange to feel like you’re opening as wide as you can, only to see in the mirror that your lips are barely separated.

I graduated to slightly harder foods over the next several weeks, while the swelling went down.

Swelling is another hot topic, and, like the rest, can vary wildly from person to person. I was swollen like a bowling ball immediately after surgery:

The biggest part of the swelling went down after only a few weeks, but it took several months for the last bits to dissipate.

The process isn’t over yet though, as your orthodontist still has to do the final tweaks on your teeth to perfect your new alignment even more.

Again, this tweaking process can take anywhere from a few months to a year or more. For me, it was about the same as pre-surgery. I wore braces for a little over a year before surgery and a little over a year after surgery.


A little over two years after surgery, I couldn’t be happier with the results.

Sure, I appreciate the cosmetic improvements, as I have a fuller profile and more symmetric face, but the functional benefits are astonishing.

I had no idea how inefficient my chewing had become, since it had been getting worse and worse so gradually over many years.

Once I could finally eat normal solid foods again after surgery, it felt like I had a blender in my mouth. I can only imagine how much easier it is on my digestive system too!

I hope this article has answered at least some of your questions about the mysterious world of jaw surgery.

I love helping others who are going through the same thing I did, so I’m constantly answering questions and putting together more resources for all of us.

You can view my entire jaw surgery video log to see exactly how I looked and felt at each stage of the process, as well as join our community of other jaw surgeristas to get even more perspectives at