The Aesthetic Effects of Orthodontic Treatment: Surgical Jaw and Chin Advancement

Orthodontic treatment does not just pertain to teeth alignment with one another (a nice, straight set of teeth).  The jaw position is also of paramount importance, and unfortunately, my first orthodontist ignored this factor.

I am currently 24 years old.  I was a cute kid.  I wore braces from age 12-14 to correct misalignment.  As part of my treatment, I wore a headgear for almost two years.  It pulled the teeth of my upper palate back (posterior shift) a tremendous amount.  Because I was young, I didn't question the treatment.

I developed a nasty case of TMJ as a result of having to force my jaw back (to the extreme) to accommodate my upper palate.  This, however, was only one side effect of this odd orthodontic decision.  By the time I got my braces off, I noticed that I was treated differently in regard to appearance.  Subtle things, but I was generally made aware that I was no longer good-looking, by both friends and family.  I didn't think much of it, but at the end of high school, I caught my profile in a mirror, and damn!  I had no chin!  What happened is that the orthodontic treatment had forced my lower jaw waaay back, resulting in a less pronounced chin and jawline.

I went to college, and fussed over it for 4 years.  It really bothered me. I was otherwise attractive in all ways, plus 4.5% bodyfat with a very nice build, but I hated having a small chin and jaw that seemed to almost push into my neck.  But I was busy with college and didn't do anything about it.

After college, I immediately sought orthodontic treatment (from a different orthodontist) to move my upper palate forward (also move the teeth in the lower mandible anteriorily) to create a new jaw position and more pronounced chin.  The orthodontist was a bit confused at first, because my teeth were perfectly straight and fit together well.  I told him that my jaw position was uncomfortable.  X-rays proved that I had done quite some wear and tear on my jaw joint, and we started treatment, which basically consisted of CLASS 3 elastics (rubber bands connecting upper palate anterior teeth to lower mandible front canines) to pull my upper palate forward and shift my lower teeth back, both shifts which made my jaw position more forward, creating a more prognathic look.

The result, after two years, was astounding.  My jaw position was shifted forward about 9/16 inch (that's a lot!).  I look so much better.  I suddenly have a nice chin and pronounced jawline.  I not only look better from profile, but from the front too.  My jaw looks bigger and more masculine. Everything- the relation of my chin to nose, cheekbones, the way my lips fit together, all look much better.  My bite is more comfortable too!

I had originally considered oral surgery to make this shift happen (I had also considered a chin implant).  I am VERY happy I went with traditional orthodontic treatment.  It sucked wearing braces for over two years, but the end result is fabulous.  With surgery I doubt it would have been as good or healthy (nerve damage, no time for jaw joint to slowly adjust, possible other complications, etc)

This orthodontic treatment has done wonders for me.  I look and feel so much better.  I feel very angry at the first orthodontist for robbing me of a more attractive appearance during my crucial high school and college years. But at least it's fixed now.

So to summarize:

• jaw position plays a crucial role in facial beauty.  If anything, more prognathism seems better than less (I know, balance is key, but in the case of lower jaw I rarely see someone whose lower jaw seems TOO far forward).

• orthodontists should be aware of the importance of jaw position -not just how the teeth fit together.  I think orthodontists would do well to take some courses in aesthetics.

• orthodontic treatment, while tedious and sometimes painful, is safer and leaves a better end result.  But oral surgery would be better than nothing at all.
  

...I think we all tend to scrutinize others based upon what we dislike about ourselves, and for years now I have noticed weak jaws and chins, especially when I think the lower jaw is too far to the posterior in position.  I see MANY people that I think could benefit from having the kind of treatment I had. 

Oh, two other things that I have discovered regarding orthodontic treatment:

• 1) The orthodontist should attempt to match the arch width with the face width.  My first orthodontist also made the mistake of widening my arch with a palatal expander.  My face was too narrow, and suddenly I had a mismatched wide arch that didn't go with my face or lips.  My Mom literally told me after I got the braces off that I had a bad smile, that it looked like I had to force my lips around my teeth.  Some orthodontists think that they should make all four front teeth, or even the front six (including the canines) straight across.  This often creates a very visually unpleasing result. This has been improved with my second orthodontic treatment.  My arch is now narrower, and fits my face and lips better.
  

• 2) The braces will result in thickening of the inner lips and cheek.  This is only a temporary reaction to the stress of the bracket abrasion on your mouth tissues, and will gradually fade after the braces are removed. However, during treatment, this, in conjunction with the size of the brackets themselves, can create an unsightly bulging effect around the mouth.  Don't stress over it, it's temporary (however, if the orthodontist makes the arch too wide as described above, a similar bulging effect can occur due to just the teeth).
  
  

- David

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