Metal Mouth Message Board

Hi Everyone,

I'm a 20 year old male, and I'm incredibly self conscious about my looks to the point of depression. I've spent countless nights frantically obsessing over my facial features and researching orthodontic information to pinpoint what it is exactly that I am unhappy with. I've learned that my condition is known as 'long face syndrome' AKA Adenoid Facies. My facial balance is very skewed (at least in my opinion) by my excess vertical growth, and I am sure that this is caused by my years of mouth breathing as a child and adolescent.

The symptoms of my long face syndrome are:
- minor overbite (which is actually becoming worse as I continue to wear braces),
- retrognathic jaw,
- steep mandibular plane angle (high IMPA angle),
- recessed, underdeveloped chin,
- gummy smile,
- flat cheeks,
- convex facial profile
- TMJ pain

Furthermore, I think my smile looks incredibly strange. I look unnatural when I smile with my jaws together, and it looks very obvious that my lower jaw is too recessed. I really remind myself of Kenneth, from 30 Rock when I smile. Specifically, when I smile I notice:
- my lower jaw and chin are disproportionate/recessed,
- my other features look cartoonishly large, especially my nose (which is already large),
- I show a lot of upper gum and not a lot of lower teeth when I keep my lips open,
- I have to strain to keep my lips together when I don't show my teeth, and even still they don't quite meet

To make it look more normal, I purposely protrude my lower jaw to bring it in front of my upper jaw. It makes my face look a little squarer from the front. Otherwise, I try to smile by keeping my jaws apart and lips open, which is generally the least weird smile I can make. What this all means is that I just hate smiling because of how bad I look, which I know has had a pretty negative effect on my social interactions.

What bothers me the most about my appearance is probably my profile. My convex facial profile is hugely unattractive, and is only compounded by my steep mandibular plane angle and gross lack of chin. That, of course, and everything else. This kind of facial convexity does not run in the family either, so I am convinced it is a result of my long face syndrome.

As a kid I was a horrific mouth-breather; I had very large tonsils, occasional sleep apnea, and snored really loudly. I had my tonsils taken out when I was about 10, and my adenoids taken out when I was about 16. Last year I had SARPE to expand my narrow upper palate, and I got braces put in a few months ago. I am now capable of breathing through my nose, but the effects of heavy mouth breathing are still quite evident. Even still, I find my voice is still 'nasally'. I will be seeing a ear, nose and throat specialist to find out more.

I have to say that I am not thrilled with my orthodontist, and she has been rather dismissive about my concerns when I brought up the idea of long face syndrome. She tells me not to worry, and that I look 'fine'. She is not convinced that I have it, but I do not think that my problems are in my head, nor are they genetic. My brother had orthodontics at a young age (prior to puberty, unlike me), and now looks quite normal with straight teeth. My sister has the strongest jawline (somehow) out of all of us, with a relatively close to 90 degree IMPA angle and mostly straight facial profile (she only ever need braces). Because of my problems, I don't even resemble my own siblings anymore.

It kills me to think that I could've had a life where I didn't have these problems, and at the same time I absolutely hate myself for being so shallow and self obsessed. But I am unable to get past my insecurities about my looks. I get anxious and angry when someone tries to take my photograph, and I don't enjoy social outings anymore. I would love to have the self-confidence of knowing that I can look good. I work very hard in school and in my career, but I wish I could reflect that on the outside.

I would like to know what options I have available to address my problems through orthodontics and orthognathics.
I've heard of things like BSSO, LeFort osteotomies and so forth. What surgery, or, more likely, combination of surgeries, would achieve the fixes to my problems?
And must I wait for my braces to come off for these surgeries?

I would like to be able to bring this up to my orthodontist. However, I would also like to know if I should be looking into a new orthodontist because of how dismissive my current one is being about my concerns. Is that reasonable?

Thanks in advance for your time!

orthognathic surgery requires braces. i think you have a lot of grievances that people w/o proper education and training shouldn't diagnose or make recommendations. if you're an american, just schedule a consult with the closest respectable surgeon. if you're european, well i don't know.

I can relate to everything you said. You should see a surgeon ASAP. You're already 20-years-old, and your life is just passing you by with a face you detest. Jaw surgery is a long process, so you better start now in order to enjoy your new face while you're still young.

I have many of the same issues. I have seen some local surgeons who are supposed to be good, but they have brushed me off because my bite is fairly good. I had braces expander, and rubberbands as a teenager. The problem is the straight teeth don't fit right in my face! Relaxed I look slack-jawed, smiling I look like gummy chipmunk. Lose-lose.

The first orthodontist I went to said there was nothing wrong. The second said he could see some jaw abnormalities, and told me to go see a surgeon if it bothered me.

I would skip the orthos and just find a surgeon who concentrates on aesthetics. I've been researching this for a while, and you really will need surgery to fix these problems, so the orthos won't be much help until you find a surgeon.

What I've been doing is emailing places with a list of my issues and photos of myself. I ask them if they would be comfortable treating me, or if I am too "minor" for them to consider. This weeds out doctors who are going to charge me hundreds of dollars just to tell me "you look fine, we won't treat you."

By the way, I would focus on the retrognathic and cosmetic issues. Forget the TMJ. Most surgeons will tell you that 40% of people have TMJ issues and won't take that seriously unless your condyles are completely gone. If you come in with TMJ pain as your strongest complain, you will be leading in the wrong direction.

If you upload a pic I could tell my oppinion... Maybe you need an upper jaw impactation only, because when you cut off the upper jaw the lower jaw rotates counter clockwise and you will have a stronger jaw line and profile...But it deppends on the case. And I really can't say nothing without seeing photos. In my oppinion, if you really feel concerned about your looks and there exists patologies, you could take in consideration to undergo surgery to improve your life quality. But think it about very well, It's not an easy decision.