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Understanding Aging Makes Beauty Timeless

How orthodontics, cosmetic and oral surgery enhance beauty

By Dr. David M. Sarver


Before treatment.
Before treatment (side view) showing poor facial profile with lack of upper lip support and prominent chin.
After treatment.
After treatment (side view) showing excellent facial profile with normal lip and chin relationships.
Photos provided by Dr. David Sarver

Other Challenges And Improvements

Another way to change the position of the teeth relative to the face is not only through orthodontic treatment, but also with the addition of orthognathic (“ortho” – straight or erect; “gnathos” – jaw) surgery. When the discrepancies in jaw size and position are minor, an acceptable aesthetic and functional result can be achieved by just moving the teeth by orthodontics — with braces or clear aligners. However, when the jaws are too far off from each other and the horseshoe shaped dental arches do not line up, jaw surgery may be required.

This surgery has itself undergone a revolution in the last 30 years, with better treatment outcomes and fewer side effects such as relapse and discomfort. Other benefits have included the incorporation of aesthetic procedures such as rhinoplasty (“rhino” – nose; “plasty” – reshaping), which can greatly enhance the aesthetic results. In addition, the dental profession has made it a goal to make orthognathic surgery as acceptable as a facelift.

Meet “Lance,” who at age 19 not only had a severe malocclusion (“mal” – bad; “occlusion” – bite), but also the associated facial changes that resulted in a compromised appearance that in time would only accelerate his aging process. Generally speaking, he would always look much older than he would actually be because the lower third of his face was disproportionately smaller than normal. Perhaps more importantly, he could never have achieved the kind of physical and psychological self-image without the corrective procedures of orthodontics, orthognathic surgery and rhinoplasty. The lower third of his face being shorter than normal made him look as though he had lost his teeth and his lip posture made him look much older. By looking beyond his teeth, his “team” (orthodontist, general dentist, oral surgeon and plastic surgeon) recognized there were more global issues to be dealt with. As a result of his growth pattern and poor tooth positioning, he did not show teeth when he smiled, his lips reversed into a frown, and his lower jaw was too far forward — all causing him to look much older. Because of inadequate skeletal (bone) support for his lips and mid-face, the tip of his nose was depressed, and its base too wide. To make matters worse, based on knowledge of growth, maturation and aging it could be predicted that Jason's facial appearance would inevitably and unfortunately only get worse with time.

Lance's treatment plan consisted of preliminary orthodontics, followed by orthognathic surgery with rhinoplasty followed by finishing orthodontics. The preliminary orthodontic treatment plan was to position the teeth into the proper relationship prior to orthognathic surgery. Through a team approach, the orthognathic surgery and rhinoplasty were performed at the same time. An important component was the diagnostic evaluation that establishes new goals for orthognathic surgery. The upper jaw was moved downward and forward to help support the lips and to show more tooth at rest and when smiling. The lower jaw was rotated in a downward and backward fashion resulting in a dramatic improvement in the length of the lower third of the face. The dramatic improvement in facial profile was further enhanced by rhinoplasty, elevating the tip of the nose. In essence, the lengthening of the face and nasal changes resulted in a more youthful and aesthetic appearance, all countering the effects of aging. Lance's facial balance was dramatically improved so that when smiling, his teeth were now visible, creating his very handsome appearance. The final results were remarkable.

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