Underbite: Moving Upper Jaw Forward or Lower Jaw Back?

From your pictures, you would benefit from a Lefort 1 (maxillary advancement) with a rhinoplasty and genioplasty at the same time.  Not only would this drastically improve the aesthetics of your face, but would prevent you from developing obstructive sleep apnea (and may even help you sleep better now...you didn't mention snoring, etc...).

I would not recommend a mandible setback - your problem is that your mid face and maxilla didn't grow, not that your mandible grew too much.  Not to mention, a setback in your case would not likely look good from a purely cosmetic standpoint, and would almost guarantee you would develop sleep apnea in the future.

Hope this helps,

Dr. Hall

Dear nodoubt:

From the review of your photos, I believe you would have the best result with advancement of the maxilla.  Your midface is deficient and the maxillary osteotomy with advancement would give the best facial profile and the correct the bite.  You could set the mandible back and correct the malocclusion but your facial cosmetics would suffer.  I would probably recommend the Lefort I surgery and a secondary rhinoplasty vs the Lefort II.  This would allow more detail in the nasal correction and one could also correct any widening of the nasal base as a result of the maxillary advancement at the same time.  I also believe a small genioplasty would be of benefit with review of the photos since a stonger chin is a pleasing feature in males.  I hope this answers most of your questions.

Sincerely

Donald R. Nunn MD, DDS