Should I Have Jaw Surgery To Correct Lip Incompetence And My Gummy Smile?
Q: Dr. Eppley, I am considering having jaw surgery. We have email conversed before and I am impressed with your perception and knowledge. I hope you will help me in my search for answers. I have attached photos for you to review if you so choose. I wore braces in the past and had no teeth extracted. My orthodontist says I have a Class I occlusion. As you can see, I show 1-2 mm of upper teeth at rest. When I smile, I show all of my upper teeth. When I laugh, I show 2-3 mm of gum. When my teeth come together, my lips don’t, so I have have to strain to close them. This seems to have resulted in my chin having a dimpled look almost as though there is a “fullness” of something. What bothers me is the protrusion of my mouth above and below the lip area, the crease under my lower lip, and the straining of and dippled look of my chin. I like the position of my chin and don’t want it pushed back if my jaws are moved back. I’m not sure if I would aesthetically look better if my jaw were moved back 2-3 mm. I don’t desire that my lips look a lot smaller. Do you have any thoughts???
A: My overall thought is you are not a candidate for major orthognathic surgery. You have a Class 1 occlusion and the aesthetic skeletal maxillary and mandibular problems that it is causing does not justify bimaxillary (maxillary and mandibular setback) surgery. While it can be done it is, so to speak, a long slide for a short gain…and not without some significant risks of morbidty. The magnitude of the problem and its potential benefits does not justify the effort for what is to be achieved. In short, the balance of benefits vs risk is not favorable.
I think there are some other alternatives, however, that are more appropriate for your facial problems. You have a horizontally short chin and mentalis muscle strain. That would be better treated by a sliding genioplasty to move the chin bone forward and give you lower lip conpetence. That would also improve the mentalis muscle strain and perhaps some of the dimpling. As for the upper lip, I question whether anything should be done for just a few millimeters of a gummy smile at maximal smile excursion. I might consider a simple levator superioris muscle release and vestibuloplasty only to blunt the upper lip excursion seen on maximal smile.
Dr. Barry Eppley
A detailed description and pictures of your concerns allows for the most informed response.