Protrusion: Can This Be Fixed with Braces or is This a Surgical Issue?

You have a significant bimaxillary protrusion which simply means that your upper and lower teeth are too far forward. I too would recommend full braces along with the extraction of 4 bicuspid teeth. You do not have to worry about getting a "dished-in" facial profile with treatment.  However, you do have to worry about not getting enough retraction of the teeth to correct the protrusion.

Your protrusion is so severe that the extraction of 4 teeth may not be enough to correct the problem to your satisfaction. You are what is referred to as a "maximum anchorage" case.  This means that all of the space created by the extractions needs to be used for retraction of the front teeth. However, with traditional orthodontics, typical closure of spaces occurs reciprocally. This means that teeth in front of the space move back and the teeth behind the space move forward until the space is closed. In other words, not all of the space available from the extractions is used to reduce the protrusion.

I personally would incorporate the use of TADS (Temporary Achorage Devices) with the braces to maximize the reduction of the protrusion. The TADS would allow the front teeth to move back and prevent the back teeth from moving forward.

No way could orthodontics with extractions cause you to have a dished in face! You are so protrusive that even the extraction of 4 teeth would still leave you on the "full" side of the profile spectrum.  IPR could only provide room to resolve your crowding...not enough space to have any effect on the protrusion.....

If you want to see any positive facial effects I think you need full braces and extractions!