It is impossible to treatment plan your case with a single photo but I can still give you a few ideas and suggestions. You have severe dental crowding, to properly align the teeth you will have to create space. There are two ways to create space: 1. extract teeth or 2. enlarge the dental arches. There are permanent consequences for each option. Extracting teeth will more than likely create excess space which will result in over retraction of anterior teeth. This causes a myriad of negative consequences; including narrow smile, small lips, nose looks longer, potential sleep breathing problems and TMJ Dysfunction. Increasing the size of the dental arches is a much better option. This can be accomplished using simple, comfortable dental appliances. My favorite for adults is the DNA appliance. Enlarging dental arches will result in a broader smile, full lips, more teeth, and a healthier airway and TMJ. Before extracting teeth, ask the treating doctor what the consequences are. Ask specifically about the potential consequences there are to your facial aesthetics and TMJ and airway health. If the doctor can not talk intelligently and confidently on the subject or says there are no consequences then you need to find a new doctor. Make sure multiple competent doctors agree on extracting teeth before proceeding. Good luck!