Bimax Before and After: What Actually Changes

Bimaxillary osteotomy, almost always shortened to “bimax,” is one of the most significant operations performed on the face. It cuts and moves both the upper jaw (maxilla) and the lower jaw (mandible) at once, which is why before and after photos can look striking, sometimes almost like different people. That is also why they draw so much attention in looksmaxxing spaces.

The photos leave out most of what matters: why the surgery was done, what the recovery involved, and what can go wrong. This article covers what bimax actually changes, the risks that come with it, and how to read before and after comparisons without being misled.

What Bimax Surgery Actually Does

Bimax is a form of orthognathic surgery, meaning it corrects the skeletal structure of the jaws rather than soft tissue alone. The surgeon cuts the maxilla (Le Fort I osteotomy) and the mandible (bilateral sagittal split osteotomy, or BSSO), repositions both jaws into a new relationship with each other and with the skull base, and fixes them with titanium plates and screws.

It is meant for:

• A severe malocclusion (misaligned bite) that braces alone cannot fix
• Problems with breathing, chewing or speech caused by the position of the jaws

Because both jaws move together, the whole lower face changes with them. The chin may appear more or less prominent, the lip posture changes, and the nasolabial angle (the angle between the nose and upper lip) often shifts noticeably. Those visible changes are a consequence of correcting the skeleton, not the purpose of the operation.

The Risks, Including the Permanent Ones

Bimax has a solid record in experienced hands for the problems it is designed to treat. It is still major surgery under general anesthesia, and an honest look at the risks belongs before any look at the results.

• Nerve injury and lasting numbness. The inferior alveolar nerve runs through the lower jaw and supplies feeling to the lower lip and chin. The BSSO cut puts it at risk. Moving the upper jaw can also affect the infraorbital nerve, which supplies the cheeks, upper lip and upper teeth. Altered sensation right after surgery is common. Most people improve over months, but a minority are left with numbness, tingling or changed sensation that does not go away.
• Relapse. Bones can drift partway back toward their original position, especially after large movements. That can bring back part of the original problem.
• Bite problems. The new bite may need more orthodontic work afterwards, and occasionally further surgery.
• Jaw joint (TMJ) symptoms. Some people’s jaw joint symptoms improve. Others develop new clicking, pain or stiffness.
• Airway changes. Setting the lower jaw back can narrow the space behind the tongue. Surgeons plan around this, particularly in people who snore or have sleep apnea.
• Nasal changes. Moving the maxilla can widen the base of the nose or tilt the tip upward. These changes are not always fully controllable.
• Bleeding, infection and hardware. Significant bleeding and infection are uncommon but possible. Plates and screws sometimes have to be removed in a later operation.
• The recovery itself. Expect weeks on a liquid or soft diet, months of swelling, and a long period of orthodontic treatment before and after surgery. The whole process often runs to several years.
• Psychological adjustment. Seeing a clearly different face in the mirror can be harder than expected, even when the result is technically good. If you find yourself fixating on small flaws, talk to a mental health professional before talking to a surgeon.

What Changes in Bimax Before and After Photos

Looking at bimax before and after cases, the most consistent changes fall into a few categories.

Jaw Projection and Profile

The most visible change in profile view is jaw projection. If a patient started with a retruded maxilla (sunken midface) and a compensating forward lower jaw, advancement of the maxilla and setback of the mandible can dramatically alter the profile. Conversely, for patients with a skeletal Class II pattern (weak chin, recessed lower jaw), both jaws may be advanced, pushing the entire lower face forward.

In before and after images, this typically shows up as:

• A straighter, more balanced profile line
• Changes in the depth of the philtrum and lip support
• A less convex or less concave facial profile depending on the correction direction

Lip Posture and Support

The maxilla is the structural support for the upper lip. Move the maxilla forward and the upper lip comes with it, appearing fuller and more supported. Move it up (impaction) and the amount of gum showing when smiling decreases. These changes are often subtle in frontal photos but obvious in profile.

Chin Projection

Bimax does not cut the chin bone itself (that would be a genioplasty), but repositioning both jaws changes the apparent projection of the chin. Surgeons sometimes add a genioplasty, which brings its own nerve risk.

Airway and Facial Width

Some patients who undergo maxillary advancement for sleep apnea or airway restriction notice a slight broadening of the midface, since the maxilla is moved forward and its relationship to the cheekbones changes. This is not always visible.

The Recovery Timeline and How It Affects Results

Bimax before and after comparisons are often taken at very different recovery stages, which creates unrealistic impressions online.

Week 1 to 4: Significant Swelling

Immediately post-surgery, swelling dominates. The face can look very different from the final result, often puffier and sometimes asymmetric as swelling resolves unevenly. Patients are on a liquid or soft diet, jaw movement is limited, and fatigue is significant.

Month 1 to 3: Early Settling

Most acute swelling resolves in the first six to eight weeks. The bones are still consolidating and the soft tissue is still adapting. Numbness in the lips, chin and cheeks is common during this period.

Month 3 to 12: Final Result Emerges

Full swelling resolution can take up to a year, and so can the return of sensation, where it returns at all. Photos taken at three months will still look different from photos at twelve months. The most accurate “after” photos are taken at least nine to twelve months post-operation.

When you see a bimax before and after comparison with a two-week post-op photo presented as the result, the image is not representative of the final outcome.

How to Evaluate Bimax Before and After Photos Critically

Not all before and after images are created equal. Here is how to read them without being misled.

1. Check the time post-op. A result at three months is not a final result. Look for images labeled nine to twelve months or later.
2. Check lighting and angle consistency. A slight head tilt or different lighting can make a result look dramatically better or worse than it is.
3. Look at the bite, not just the profile. The primary goal is functional bite correction. A good-looking profile with a compromised bite is not a successful outcome.
4. Consider the starting point. A dramatic transformation usually means the starting anatomy was genuinely severe. That is exactly the group the surgery is designed for.
5. Remember what photos cannot show. Numbness, joint pain and relapse are invisible in a picture.

If Your Goal Is Appearance: Start Without Surgery

No non-surgical method moves bone, and anyone who claims otherwise is selling something. But a large part of how the jaw and lower face look comes from things that carry no surgical risk at all:

• Body fat. A few percent less body fat often changes jawline definition more than people expect, because fat under the chin and along the jaw hides the bone that is already there.
• Posture. Head-forward posture compresses the neck and softens the jaw line in photos and in person.
• Facial hair and hairstyle. A well-shaped beard can add visual width and definition to the jaw. A haircut that suits your face shape changes overall balance.
• Orthodontics. For milder bite problems, braces or aligners alone may be enough. That is a question for an orthodontist, not a surgeon.

These are slower and less dramatic than surgery, and they will not turn a severe skeletal discrepancy into a different face. They are also reversible, cheap and free of permanent risk, which is why they come first.

Bimax vs. Other Jaw Procedures

Bimax is sometimes confused with single-jaw surgeries or other procedures. All of them are surgery with their own risks.

Procedure	Jaws Moved	Typical Indication
Bimax (BSSO + Le Fort I)	Both	Severe skeletal discrepancy, complex malocclusion
BSSO alone	Lower only	Mandibular prognathism or retrognathia
Le Fort I alone	Upper only	Isolated maxillary problem
Genioplasty	Chin only	Chin position, sometimes combined with bimax
SARPE	Upper (expansion)	Narrow palate, crossbite

Bimax has the largest scope of change because both jaws are addressed at once, which also makes it the most involved recovery.

If a Doctor Has Recommended Bimax for a Functional Reason

If your orthodontist or a surgeon has raised bimax because of your bite or breathing, these points will help you make a careful decision:

• Make sure the functional diagnosis is clear. Ask what problem the surgery solves and what happens if you do not have it. Insurance coverage in many regions depends on this diagnosis too.
• Get at least two surgical opinions. Treatment plans for bimax differ, and a second opinion may suggest a smaller procedure.
• Ask for the surgeon’s own complication rates. Specifically: nerve injury, relapse, and how often hardware has to come out.
• Ask about less invasive alternatives. For some bite problems, orthodontics alone or a single-jaw operation may be enough.
• Plan for the full timeline. Pre-surgical orthodontics, the surgery, post-surgical orthodontics and possible revisions can take three or more years.

Bimax is not a shortcut, and it is not a cosmetic procedure. For people with a genuine skeletal problem it can meaningfully improve function, and the face changes along with it. For people whose bite and breathing are fine, the permanent risks are hard to justify for a change in appearance.