Double jaw surgery for overbite (maxillary impaction, BSSO & sliding genio) in someone with a not so high smile (Photo)

Your doctor is correct to note that your maxilla is too far back after orthodontics. The reason it is too far back is because bicuspid teeth were extracted and incisors were retracted. This caused your upper lip to also be retracted and your nose to "grow" (the nose was not retracted so it looks like it is longer). What has not been addressed is your retruded lower jaw. Your mandible that has always been too far back was left where it was and your maxilla was pulled back to match the lower jaw that was in the wrong place. If all you are concerned about is straight teeth then this is the easiest way to get straight teeth (extract upper bicuspids and pull the upper front teeth back). Unfortunately, by straightening the teeth in this way you are now left with both your upper and your lower jaw in the wrong place. The ramifications of this are a potential for TMJ Dysfunction, an unhealthy airway, a long narrow face, inadequate upper lip support, a narrow smile, a long nose, poor facial profile, and two less teeth.Before any teeth are ever moved and especially any teeth are extracted a knowledge of what the effects will be on facial aesthetics and the health of the TMJ and airway should be well known and understood. If the doctor proposing orthodontic treatment can not speak confidently and intelligently about the orthodontic effects on joints, airway and facial aesthetics then it is time to consult with a different doctor.In your specific case I would undo the orthodontics that has been done and basically start over. I would open up the spaces that were closed when upper bicuspids were extracted and eventually "put the bicuspids back" with implants. This would be done with an appliance to develop the upper dental arch and maxilla. I would also further develop the lower arch to accommodate the newly developed upper arch. I would then bring the lower jaw forward using a simple orthopedic appliance. Braces would have to be worn again at the very end for 6-12 months. Good luck!