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Orthodontics/Retrusive lower lip question

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Dear Paul Supan,

I have a very mild class ii skeletal discrepancy with a fully functional bite that does not warrant any sort of intervention. My only concerns here as aesthetic and, to that end, I am looking to camouflage the discrepancy. Given that my jaw angle is aesthetically acceptable, the three elements that I am looking to modify are the slightly retrusive chin, mildly deep labiomental fold and the retrusive lower lip.

I am getting a genioplasty to cover the first, and I am aware of options to reduce a deep mentolabial fold. However, I am having trouble finding a solution to the slightly retrusive lower lip. I know that a full-blown BSSO will correct this, but I am unwilling to go through such an extensive procedure whilst my bite is satisfactory. Is there any conceivable solution that you can think of that might help a slightly retrusive lower lip?

My picture is attached, feel free to offer any comments on my profile aesthetics or otherwise.

Thanks,
Damien

Answer
Hello Damien,

Pardon the delay in responding. I have been away at a conference, and failed to set my account for “away”.

As always, what I write here are only my opinions based on limited information. Any comments should not be viewed as any form of diagnosis, definitive or otherwise, or any form of treatment recommendation.  As you know Damien, in the ultimate analysis all final decisions, particularly clinical ones, should only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Now, in your comments you very expertly noted several things.

1.   Mildly deep labiomental fold
2.   Slightly retrusive chin
3.   Retrusive lower lip

I have also talked to a Board Certified Dermatologist who is well versed in aesthetics about your question. Her comments reflect my perspectives as well.  

You asked specifically: Is there any conceivable solution that you can think of that might help a slightly retrusive lower lip? Let me parse the question into two parts.  

Dental Solutions.

I have looked at the profile, and whereas I do not have a lateral cephalometric radiograph, the problem does not seem too profound at all. The lower lip position and profile can be influenced by the lower incisors. However, the repositioning of incisors may only have a limited impact.

I do not think that there is a dental or orthodontic role in addressing your concerns.

Soft Tissue Solutions.

It would strike me Damien that the main influence here is the soft tissue drape and the skeletal architecture. You mentioned “  I am getting a genioplasty “. This may indeed have a significant effect. If you are indeed going ahead with this, then I would re-evaluate the aesthetics after this procedure has been done.

The second consideration is to have some collagen augmentation to the lips. This procedure is often done by a dermatologist or plastic surgeon.  If the augmentation is done, then both lips need to be evaluated for balance. Lip posture and balance are very important for Orthodontists. This is also the concern for you.

Therefore it appears that the next  steps for you Damien include:

Proceeding with the already scheduled genioplasty.
Permit post surgical recovery and healing.
Re-evaluate the resulting lip posture, profile, and repose.
Make an appointment for a soft tissue augmentation procedure to the lip or lips, with a dermatologist or other health care provider of your choice.

So Damien, it is 2016, and many new options are available for you.  Digital imaging is available to help you with your diagnosis and decision process.  

I hope my brief follow up comments have been helpful. You may wish to also post this in a different forum for plastic surgery or dermatology. I believe this is not so much an Orthodontic issue anymore, but more one of soft tissue augmentation.

As you know Damien, the website here encourages readers like you to always rate the answers and to resubmit with any follow up questions. Good luck with your treatment.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com

Please allow a full week for a reply; my replies are generally fairly extensive and researched. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. I sometimes consult with other doctors on complex interdisciplinary questions. This of course takes time.  Your understanding is appreciated.

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Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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