Can Facial Surgery to Fix Smile and Teeth Issue?

When my mouth is opened (calm, without laughing) I can see the half height of teeths. That is normal. But in a couple of months I will have a surgery to reposition the upper jaw (maxilla). The doctor will move it up.

The teeths will not be visible after the surgery. The doctor has no solution to suggest for that. Facial muscles isn't something that the orthognathic surgery can deal with. Is there any operation to help me elavate and reshape the smile to fix such problem?

Doctor Answers 4

Get a second opinion before undergoing maxillary shortening

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We need more information.

From your description, you are about to have a Le Fort I maxillary shortening / impaction. In this procedure, a horizontal sliver of the mid facial bone (maxilla) is removed and the lower segment (containing the roof of the mouth and teeth) is moved up / down / backward / forward, as needed (usually to correct the way teeth touch (IE occlusion).

In many cosmetic cases, this USED to be done when people had a Gummy Smile and showed more than just tooth white when they smiled - you saw their gums. It was treated by maxillary shortening - the operation you are having.

These days, this is largely fixable with well placed Botox. (Since the facial soft tissues stay the same, shortening the bone height results in the upper lip hanging lower and covering the teeth).

I cannot understand WHY in your case the maxillary height cannot be maintained to allow for visualization of the teeth.

I would advise you to get at least another opinion from an experienced orthognathic surgeon.

Memphis Plastic Surgeon

Upper Jaw Reconstruction

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It is unclear why your surgeon is moving your maxilla up (or performing a maxillary impaction) if not to correct long face syndrome (or excessive tooth show). Do you know the actual indication for this surgery? If you are striving to just correct several millimeters of excessive tooth show, that can be easily done with this procedure. Inadequate tooth show creates the appearance of being old.

LeFort I (Maxillary) Impaction Will Decrease Upper Tooth Show

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A LeFort I impaction, or maxillary shortening, will change the amount of upper tooth show that you have. You are likely having this surgery to fix a bite or occlusal relationship problem. Whether you will lose significant upper tooth show depends on how much maxillary impaction you are having. If it is just a millimeter or two, then this will not be significant. But if it is more than two millimeters, there will be some change in tooth show. There is no muscle or soft tissue repositioning surgery afterwards that can increase your tooth show. (with the exception of upper lip shortening through a subnasal lip lift or internal mucosal reduction)  I would make sure that the benefits of the orthognathic surgery that you are about to undergo are worth this one aesthetic trade-off.

Ups and Downs of orthognathic surgery

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Dear Dinko,

It sounds like you are going to have a maxillary impaction (moving the jaw upwards). One of goals of the surgery is not only to position the jaw to balance your face but to make sure that you have the right tooth and lip relationship. For a patient that shows half of the tooth at rest (which is usually excessive) the planned surgery should move the front portion of the upper jaw just enough to show less tooth at rest and all the tooth when smiling. The back part of the upper jaw may be need to moved upwards more. This is called a differential impaction. The should be no reason in my mind that after orthognathic surgery that your tooth to lip relationship should be worse.

I hope this was helpful.

Dr. ES

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.