“Should My BSSO Have Been Double Jaw?”: How Surgeons Plan BSSO vs Bimaxillary Surgery

Jaw surgery: recovery, complications and your rights · Part 3 · 15 min read · Published 10 November 2026 · Reviewed 10 November 2026 · Next review May 2027

By Dr Rosemary Listing, PhD (Law) · Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates

If you are lying awake trying to work out whether your plan is the right one, or whether the surgery you had was the right choice, your questions are completely reasonable. Jaw surgery changes your bite and your face. You are allowed to understand how the decision was made.

This guide is for anyone facing or recovering from orthognathic surgery in Australia. It covers the difference between BSSO and bimaxillary surgery, how surgeons decide, what you should be told about options, whether a plan can change, the risks, what your records should show, and how the law looks at it.

Start with your question

• What is the difference between BSSO and double jaw surgery?
• How do surgeons decide between single and double jaw surgery?
• Should I have been offered more than one option?
• Can my surgical plan be changed?
• Is double jaw surgery riskier than BSSO?
• How much does BSSO cost in Australia?
• Could a planning decision be medical negligence?

BSSO and bimaxillary surgery

Corrective jaw surgery realigns jaws that don’t fit together properly, to improve the bite, chewing, speech and facial balance. It is usually done together with orthodontic treatment, under general anaesthetic, almost always through the mouth, with the bones held in their new position by plates and screws.¹ In Australia, oral and maxillofacial surgeons hold qualifications in both medicine and dentistry.²

How surgeons decide

Planning brings together your bite, the position of each jaw relative to your skull, your facial proportions, your teeth, your airway and your own goals. Your orthodontist and surgeon usually plan together, using records such as X-rays, photographs, models or 3D scans.

Several things can push the decision one way or the other:

• Where the problem is. If only the lower jaw is out of position, BSSO may be enough. If both jaws contribute, moving both may give a better result.
• The size of the movement. Sharing a large correction between two jaws can sometimes be more stable or look more balanced.
• Facial appearance. Moving the upper jaw affects the nose, lips and how much tooth shows when you smile.
• The airway. Moving the lower jaw back can narrow the airway behind the tongue. One study in people with an underbite found that lower-jaw setback narrowed the airway most, and that double-jaw surgery reduced this effect. The authors preferred double-jaw surgery when planning these cases.³
• Your goals and your risks. What matters most to you, and your general health, should shape the plan too.

Satisfaction after jaw surgery is generally high. A 2024 systematic review found satisfaction rates between 83 and 100 per cent across studies, generally better outcomes after double-jaw than single-jaw surgery, and that unmet expectations were a key reason for dissatisfaction.⁴ That last point matters. A plan you don’t understand is more likely to leave you disappointed, even if it was technically sound.

Should you have been offered more than one option?

For some people there is only one sensible plan. For many, there is more than one reasonable option, each with different trade-offs in appearance, stability, airway, recovery and risk. You are entitled to hear about reasonable alternatives and why one is recommended over another, so that the choice is genuinely yours.

Questions to ask at your planning appointment

• Why single jaw (or double jaw) for me? What would the other option change?
• How will each option affect my profile, nose, lips and smile?
• How will each affect my airway and breathing at night?
• Can I see the planned movements on my scans or a simulation?
• What are the risks of each, including numbness and relapse?
• What happens if I’m unhappy with how I look afterwards?
• Can I take time to think, or get a second opinion?

Can the plan change?

Yes. Plans are sometimes revised after new records, further orthodontic movement, or a better understanding of what you want. You can also ask for a plan to be reconsidered. If the plan changes, the reasons should be explained and your consent should cover the operation you are actually having, including any extra procedures such as a genioplasty. If you are unsure, it is reasonable to ask for a second opinion before surgery. This series covers that in second opinions and revision jaw surgery.

The risks

Both operations carry risks, and moving two jaws means two sets of bone cuts. An NHS patient guide says that after lower-jaw surgery about 1 in 10 people have tingling or numbness lasting several weeks, and fewer than 1 in 100 have sensation problems lasting more than a year. It notes that plates occasionally become infected and need removal, usually months later, that rarely the new bite isn’t quite right and a second small operation is needed, and that most people need about three weeks off work.⁵ Queensland Health publishes a standard consent form for orthognathic surgery, which reflects how seriously these risks are taken.⁶

Other articles in this series look at specific risks in detail: restricted mouth opening, numbness, relapse, plate infection and jaw joint problems. For nerve injury after other dental and facial procedures, see lower lip numbness.

Cost

Costs vary with the operation, the hospital and your cover. The professional association for oral and maxillofacial surgeons notes that Medicare rebates may be available for many of the procedures they perform, but that private cover varies and some policies may exclude procedures listed as plastic and reconstructive.⁷ Check with your surgeon and your fund before agreeing. This series covers costs in Medicare, private health and jaw surgery.

Thinking about your plan

What to look for in the records

Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.⁸ Our step-by-step guide to getting your medical records in Australia walks you through it.

How the law looks at it

Being unhappy with the result of jaw surgery is not, on its own, negligence. There can be more than one reasonable plan, and a reasonable plan can still produce a result you don’t like. The legal questions are whether the planning, surgery and consent met the standard expected, and whether any shortfall caused harm.

A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))⁹, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)¹⁰, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)¹¹¹². Our guide to how a medical negligence claim works explains each one in plain terms.

In a planning case, the questions might be: was the chosen operation one that a body of competent oral and maxillofacial surgeons would accept for your bite and face? Were the movements planned and carried out properly? Were airway, appearance and stability considered?

In plain terms, the question is whether a different plan, or better care, would probably have given you a better result. In consent cases, it can also be whether you would have chosen differently if you had been told about the alternatives.

For jaw surgery, that would usually include the reasonable options, such as single-jaw or double-jaw surgery, and how each would affect your bite, appearance and airway, as well as the risks of the chosen plan.

Who can claim, and when

The person who had the surgery can claim. If they were under 18, a parent or guardian can usually act for them. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.

More: complaint or claim? · how a claim is paid for · what a claim can cover

In my practice

In files about jaw surgery planning, the surgery itself is often technically sound. What I find instead is a planning conversation that happened mostly on paper. A single option documented. A patient’s question about the other jaw answered in a sentence. A consent form signed on the morning of surgery. When the result doesn’t match what the patient imagined, there is nothing in the records to show they understood the choice. Many of these patients are young, and many have spent years feeling self-conscious about their face. They deserve a planning process that treats their questions as part of the plan, not an interruption to it.

Both things can be true

Your surgeon may have chosen a perfectly reasonable plan, and you may still not have been told enough about the alternatives. Your bite may be much better, and you may still grieve the face you hoped for. You can be pleased with parts of your result and still want to understand how the decision was made.

The bigger picture

Research on jaw surgery outcomes suggests most patients are satisfied, but that unmet expectations are a common reason when they are not.⁴ That makes the planning conversation one of the most important parts of care. Queensland Health’s standard consent form for orthognathic surgery is one example of how public health services try to make sure risks are explained consistently.⁶

You can check your surgeon’s registration on the Ahpra public register,¹³ and complaints about care in NSW can go to the Health Care Complaints Commission.¹⁴ Our oral, maxillofacial and dental negligence page brings together our guides in this area, and if you are thinking about the appearance side of your result, our cosmetic surgery page may also help.

Support

You don't have to work through this alone. These services can help:

• Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)¹⁵
• Beyond Blue, anxiety and depression support: 1300 22 4636
• Medicare Mental Health, help finding mental health support: 1800 595 212
• healthdirect, 24-hour nurse advice: 1800 022 222
• Health Care Complaints Commission (NSW): 1800 043 159

A young woman who scrolled before-and-afters at 2 am finally sat with someone who explained her scans, and her question. You deserve the same.

With care,
Rosemary

Frequently asked questions