Double jaw surgery or just bottom? Orthognathic surgery (photo)

I believe you should take the premolars out so your upper lip looks better. I would most likely do two jaws since it sounds like there is asymmetry present as well. 

I would definitely recommend double jaw surgery. Based on the x-ray, the upper jaw is set back in relation to the nose and the cranial base. In addition, any horizontal discrepancies greater than 7-8 mm should be performed in 2 jaws as a general rule of thumb. This is due to long-term statistics that show a much greater increase in post operative relapse in moves greater than 7 mm in one jaw only. Having two jaw surgery would satisfy the upper jaw as well as the lower jaw and put them both in proper proportions to the cranial base. As is stated below, I would also consider having upper bicuspid teeth removed to allow for proper angulation of the upper front teeth prior to double jaw surgery. .Best of luck to you.Dr. David Mueller

It hard to give a accurate answer without seeing photos and a clinical exam. However with just that xray alone, I would recommend a double jaw surgery. Hope this helps with you decision.