How to Choose an Orthognathic Surgeon in India: Questions Every Patient Should Ask

By Dr Dipesh Rao, Craniofacial and Orthognathic Surgeon, Bengaluru. Orthognathic surgery, corrective jaw surgery, is one of the most consequential decisions a patient will make. The outcome depends almost entirely on who performs it and how it is planned. This guide answers the questions patients and families most commonly ask when trying to find the right surgeon.

What is orthognathic surgery and who actually needs it?

Orthognathic surgery repositions one or both jaws to correct skeletal imbalances that orthodontics alone cannot fix. Patients who may benefit include those with:

• A recessed or protruding jaw affecting the bite and facial balance
• Facial asymmetry where one side of the jaw is higher or further forward than the other
• An open bite, where the front teeth do not meet when the mouth is closed
• A deep bite, where the upper teeth excessively overlap the lower teeth
• Obstructive sleep apnoea caused by a small or recessed lower jaw
• A short face or long face deformity
• Failed or unsatisfactory prior jaw surgery requiring revision

The decision to operate should always follow a thorough assessment by both an orthodontist and a surgeon working together, not one in isolation.

What qualifications should I look for in an orthognathic surgeon?

This is the most important question a patient can ask, and the one most rarely asked. Orthognathic surgery sits at the intersection of oral and maxillofacial surgery, craniofacial anatomy and orthodontics. A surgeon who performs it well must have:

Dedicated subspecialty training in orthognathic surgery. General maxillofacial training covers jaw surgery as one of many competencies. Subspecialty training, through fellowships at high-volume international centres, teaches the nuances of surgical planning, cephalometric analysis and intraoperative decision-making that define outcomes.

The right training pathway. Dr Dipesh Rao's training in orthognathic surgery includes a fellowship in Paediatric Maxillofacial Surgery at the Royal Children's Hospital, Melbourne, one of the world's highest-volume centres for jaw and craniofacial surgery in children, and a Royal College of Surgeons supported fellowship at the Oxford Craniofacial Unit, globally recognised for its integrated, multidisciplinary approach to complex jaw and facial surgery. He is also an AO CMF Fellow (Hannover), the international standard-setting body for evidence-based craniofacial surgical training.

Dual medical and dental qualification. Very few surgeons in India hold both an MBBS (medicine) and an MDS (oral and maxillofacial surgery). This dual qualification provides a depth of understanding of both craniofacial growth and occlusal function that underpins every orthognathic decision. Dr Rao is one of a small number of surgeons in India with this combination.

How should jaw surgery be planned, and why does planning matter so much?

In orthognathic surgery, the outcome is determined before the first incision. Surgical planning is where cases succeed or fail. Modern orthognathic planning should include:

Virtual surgical planning (VSP). Three-dimensional simulation of the jaw movements before surgery, allowing the surgeon and orthodontist to agree on precise millimetre-level repositioning of each jaw segment. VSP eliminates guesswork and allows the outcome to be visualised and discussed with the patient before the operating room. Dr Rao's practice offers in-house VSP, planned, reviewed and refined by the operating surgeon himself, not outsourced. The surgeon who plans the case is the surgeon who executes it, using medical-grade software from Materialise, one of the global leaders in the field.

3D CT scanning and facial analysis. Accurate three-dimensional imaging of the facial skeleton is essential for understanding the true nature of a deformity. Two-dimensional X-rays cannot capture the three-dimensional reality of facial asymmetry.

Trios intraoral scanning. Digital impressions replace traditional plaster models for greater accuracy and direct integration with virtual planning software, removing one of the most common sources of planning error in older workflows.

3D facial scanning. A facial surface scan captures the soft-tissue envelope, the face as it appears, and overlays it with the skeletal plan, so the surgeon can predict not just where the bones will move but how the face will look after surgery.

Piezoelectric bone surgery (piezosurgery). Ultrasonic vibration cuts bone with significantly greater precision than a drill and, critically, does not damage adjacent soft tissue, nerves or blood vessels. Where cuts are made close to the inferior alveolar nerve, piezosurgery reduces the risk of nerve injury and produces cleaner cuts that heal more predictably. Dr Rao uses piezosurgery as a primary cutting tool.

Custom titanium plates, KLS Martin IPS Case Designer. Once the jaws are repositioned they must be held in place with precision fixation. Standard off-the-shelf plates require intraoperative bending, introducing the possibility of error. Custom-milled titanium plates, designed from the virtual plan and arriving pre-formed, confirm that the jaw is in the correct position rather than approximating it. This is the highest current standard in orthognathic fixation.

Cephalometric analysis. The precise measurement of facial proportions, the angles and distances that define normal and abnormal skeletal relationships, remains the foundation of all orthognathic planning and is a non-negotiable competency. In Dr Rao's practice all of these planning tools are available in-house, so patients do not need to attend multiple external facilities for imaging and planning before their surgical consultation.

How many jaw surgeries should my surgeon have performed?

Volume matters in orthognathic surgery more than in almost any other elective procedure, because the reason is judgement, and judgement is built through repetition. Jaw surgery involves decisions that cannot be fully anticipated in planning: the precise position of a nerve, the stability of a bone segment, the tension in soft tissue when a jaw is moved. A surgeon who operates at high volume has met these situations repeatedly and responds with calibrated confidence. A low-volume surgeon is, by definition, encountering them for the first time more often. There is no universal threshold, but a surgeon who performs jaw surgery as a primary subspecialty focus accumulates experience at a fundamentally different rate. Dr Rao's practice at Bhagwan Mahaveer Jain Hospital, a designated Cleft and Craniofacial Leadership Centre, is one of the highest-volume subspecialty centres in South India.

What is the relationship between orthodontics and jaw surgery?

Orthognathic surgery cannot be performed in isolation. It requires close coordination with an orthodontist before and after surgery, and the quality of that coordination directly affects the outcome. Pre-surgical orthodontics decompensates the teeth, moving them into the position they will occupy after the jaws are repositioned. This is counterintuitive, because it often makes the bite temporarily worse before surgery, and it requires the orthodontist to fully understand the surgical plan. Post-surgical orthodontics fine-tunes the bite after the jaws have healed. When choosing a surgeon, ask whether they have an established working relationship with a specific orthodontist, how frequently they communicate during treatment, and whether they plan the case together or separately.

What are the most common reasons orthognathic surgery is repeated or revised?

Revision jaw surgery, performed to correct an inadequate result from a prior procedure, is more common than patients realise. The most frequent causes are inadequate planning (cases planned without VSP, 3D imaging or proper cephalometric analysis), relapse (jaws returning toward their original position when movements were large, soft-tissue tension was not managed, or fixation was inadequate), asymmetry not fully addressed (correcting the front-to-back relationship without fully addressing vertical and transverse asymmetry), and low-volume practice, where intraoperative complications are more likely to be mismanaged. Dr Rao manages a significant volume of revision cases, patients who have had jaw surgery elsewhere and need re-planning and correction. Second opinions are available.

Can patients from outside Bengaluru or outside India be treated?

Yes. Dr Rao's practice sees patients from across South India, the rest of India, and internationally, including from the Middle East, South Asia and the Indian diaspora. For patients travelling from a distance, the pathway is structured to minimise trips: an initial virtual consultation allows assessment of records, photographs and imaging before travel; planning, surgery and early follow-up are coordinated within a defined window; and ongoing orthodontic care can be managed locally with communication back to the practice. Virtual second opinions are available. Patients should bring their most recent panoramic X-ray, lateral cephalogram and orthodontic records.

What questions should I ask at my first consultation?

Use these as a checklist:

1. How many orthognathic surgeries do you perform per year, and what proportion of your practice is dedicated to jaw surgery?
2. Do you use virtual surgical planning for every case, and is it done in-house?
3. What imaging technology do you use for planning? Do you have 3D CT, intraoral scanning and facial scanning in-house?
4. Who is the orthodontist you work with, and how do you plan cases together?
5. What is your approach to managing relapse?
6. Have you performed this specific type of jaw movement (single jaw, bimaxillary, asymmetric) before, and at what volume?
7. What happens if the outcome is not what was planned?

A surgeon who cannot answer these questions clearly, or who becomes defensive when asked, is telling you something important.

Why does the choice of orthognathic surgeon matter more than patients often realise?

Because the consequences of a poorly executed jaw surgery are not cosmetic inconveniences. They are structural, functional and often irreversible without significant additional intervention. Nerve damage, persistent relapse, asymmetry, airway compromise and the need for repeat surgery are all real outcomes in the hands of an inadequately trained or low-volume surgeon. Recovery from orthognathic surgery is substantial, weeks of restricted diet, swelling and adaptation, and patients who undergo that process deserve to do it once, correctly. The surgeon you choose for your jaw surgery is one of the most consequential clinical decisions you will make. Ask the questions. Seek a second opinion. Do not choose based on proximity or price alone.

About Dr Dipesh Rao

Dr Dipesh Rao is a craniofacial and maxillofacial surgeon based in Bengaluru, with subspecialty training from the Royal Children's Hospital Melbourne, the Oxford Craniofacial Unit (Royal College of Surgeons Fellowship) and AO CMF Hannover. He is a dual-qualified surgeon holding both MBBS and MDS qualifications, and one of a small number of surgeons in India trained in both Paediatric Maxillofacial and Craniofacial Surgery. His practice offers in-house virtual surgical planning, 3D CT imaging, Trios intraoral scanning and 3D facial scanning for all orthognathic cases. He is Consultant Craniofacial Surgeon at Bhagwan Mahaveer Jain Hospital, a designated Cleft and Craniofacial Leadership Centre, and a member of IAOMS, AOMSI, ISCLPCA and AO CMF. Read more about Dr Dipesh Rao or explore cleft and craniofacial care and all the conditions we treat.

This article is intended for patients and families considering orthognathic surgery. It does not constitute medical advice. A formal consultation with a qualified surgeon is required before any treatment decision.

Frequently Asked Questions

What qualifications should an orthognathic surgeon have?

Look for dedicated subspecialty fellowship training in orthognathic or craniofacial surgery at a high-volume centre, and ideally dual medical and dental qualification (MBBS and MDS). General maxillofacial training alone covers jaw surgery as only one of many competencies.

Why is virtual surgical planning important for jaw surgery?

Virtual surgical planning simulates the jaw movements in three dimensions before surgery, allowing millimetre-level repositioning to be agreed and the outcome visualised in advance. It removes guesswork. Ideally it is done in-house by the operating surgeon rather than outsourced.

Why does surgical volume matter in orthognathic surgery?

Jaw surgery involves judgement built through repetition. A high-volume surgeon has met the intraoperative decisions repeatedly and responds with calibrated confidence, while a low-volume surgeon encounters them for the first time more often. Volume correlates strongly with outcome.

Can jaw surgery done elsewhere be revised?

Yes. Revision orthognathic surgery corrects an inadequate result from a prior procedure. Common reasons include inadequate planning, relapse, asymmetry not fully addressed, and low-volume practice. Re-planning and second opinions are available for patients who had surgery elsewhere.

Can patients from outside Bengaluru be treated?

Yes. Patients from across India and internationally are seen. An initial virtual consultation assesses records and imaging before travel, planning and surgery are coordinated within a defined window, and ongoing orthodontics can be managed locally with communication back to the practice.

What questions should I ask at my first jaw surgery consultation?

Ask how many orthognathic surgeries the surgeon performs a year, whether virtual surgical planning is used in-house, what imaging technology they use, who their orthodontist is, how they manage relapse, whether they have done your specific jaw movement, and what happens if the outcome is not as planned.