**4. Bimaxillary surgery**

The sequence of these surgeries may vary from surgeon to surgeon. My traditional way to do double jaw is to start with the maxilla first then complete the mandible. But in one indication, one should always start with mandible first which is the double-jaw counterclockwise surgery. Especially Class II with maxillary excess with gummy smile cases associated with OSAS or airway limitations, there is indication for counterclockwise double surgery. The surgical strategy should be mandibular advancement surgery with posterior inferior repositioning and anterior superior rotation. The space created at posterior occlusion is then filled with inferior rotation of the posterior maxilla with anterior maxillary impaction with Le Fort I osteotomy. The pivot point to perform this maneuver is premolar and zygomatic buttress region.
