Bimaxillary Surgery

Q: Dr. Eppley, I had braces when I was about 18 years old and that was my second time for them. My first time was a few years before my second time. The reason I went back again was because I had a problem closing my mouth. It’s either because I didn’t really wear my retainer or because of my protruding jaw. So I went to the doctor and what I had in mind was just that I wanted to close my lips without looking like they are protruding. The doctor took off 4 of my teeth, 2 upper and 2 lower on each side. And as a result, now I realized that it’s been narrowed down too much. Both front part and side part being forced inwards and so I find that when I smile, my cheekbone is more obvious, I have lines besides my nose, and my teeth doesn’t look as good since it’s way inside, not showing like before. Also, the part above my upper lips under my nose look like it’s went further inside and I think it’s because the orthodontist pushed it backwards quite a lot. 

I’m not sure if the solution years ago about my protruding lips was to rearrange my teeth without extracting those 4 teeth or there is actually the need to take them off. (I went to the first dentist and he insisted that he wouldn’t take off my teeth, since I didn’t want my lips to look like that I went to other dentist and he said it was fine to take them off). 

So the bottom line is, is there any solution to this ? Is it possible to move my upper jaw a bit forward so that I don’t look like an old lady whose teeth’s all gone since they are way hidden inside?

A: What you had done was extraction of four premolars to allow all remaining front teeth to be moved back, thus reducing the prominence of the lips. You are correct in that is a source of premaxillary/midface retrusion. While doing a maxillary advancement would reverse these effects it is important to realize that if you move the upper jaw forward you must move the lower jaw forward as well.  (bimaxillary surgery or double jaw surgery) This will maintain the occlusion you now have. Otherwise you will create a substantial bite discrepancy.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry L. Eppley
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Board Certified Plastic Surgeon