Would surgery-first be an aesthetic compromise in my case?

[brooks27]

I've been told I can have surgery-first or orthodontics first. It's up to me really. But I'm unsure if surgery-first would lead to less than ideal movements because of my incisor proclination not allowing the mandible to advance more.
I'd hate to end up with smaller lips, so I guess that's a pro of surgery first as I wouldn't get my incisor proclination fixed or either arch distalized.

Any opinions are welcome. Happy to answer any questions.

Cephalometric angles

SNA: 82.61°

SNB: 80.46°

ANB: 2.15°


Maxillo-mandibular relationship

B–A linear difference: 5.7 mm

Pog–PSM difference: 0.19 mm


Incisor measurements

Lower incisors

IMPA: Right 98.54°, Left 96.70°


Upper incisors

Upper incisor PHF angle: Right 122.79°, Left 126.55°


Interincisal angle

Right 118.58°

Left 117.95°


Denture reference

Right 20.09°

Left 18.80°


Overjet / overbite

Overjet:

11–41: 2.70 mm

21–31: 2.52 mm


Overbite:

11–41: 1.35 mm

21–31: 1.91 mm



Barcelona line / forehead reference

Upper incisor to BL: 6.9 mm behind

Soft-tissue pogonion to BL: 2.5 mm behind


Occlusal plane

Horizontal: 11°

Midsagittal: 9°

Maxillary occlusal plane: Right −17.05°, Left −16.08°


Vertical facial dimensions

Ricketts Facial Axis: 96°

Lower facial height: 60.34 mm

Total face height: 121.97 mm


Transverse

Skeletal transverse discrepancy: −4.2 mm

[GJ]

I wouldn't recommend surgery first unless there's a good reason, such as you need an immediate fix for sleep apnea.

Maybe in a case where the teeth are already lined up well but the jaw isn't.

That's about it.

If someone is telling you you can do surgery first, you should get at least two more opinions. If you post some records it would be easier to see what's going on than reading numbers.

[brooks27]

I wouldn't recommend surgery first unless there's a good reason, such as you need an immediate fix for sleep apnea.

Maybe in a case where the teeth are already lined up well but the jaw isn't.

That's about it.

If someone is telling you you can do surgery first, you should get at least two more opinions. If you post some records it would be easier to see what's going on than reading numbers.

My teeth are lined up and been like that for 15 years, I had braces as a teenager. I think that's why surgery first is an option. I've seen 2 surgeons and they both said surgery first is an option. I'm worried there's an optimal aesthetic option between surgery first and orthodontics first.

I don't want to post photos online. Would scans work?

[GJ]

My teeth are lined up and been like that for 15 years, I had braces as a teenager. I think that's why surgery first is an option. I've seen 2 surgeons and they both said surgery first is an option. I'm worried there's an optimal aesthetic option between surgery first and orthodontics first.

I don't want to post photos online. Would scans work?

If you're all lined up and two surgeons gave the okay, then you're probably good to go. Usually braces compensate the teeth and you need the de-compensation. So that is odd they said that. I'd consult with a third to be sure.

The issue with braces first is it introduces more room for error given they have to plan for the movement of teeth after surgery. When the put the models on the articulator to simulate surgery, it's just another variable introduced, which is never ideal.

[brooks27]

If you're all lined up and two surgeons gave the okay, then you're probably good to go. Usually braces compensate the teeth and you need the de-compensation. So that is odd they said that. I'd consult with a third to be sure.

The issue with braces first is it introduces more room for error given they have to plan for the movement of teeth after surgery. When the put the models on the articulator to simulate surgery, it's just another variable introduced, which is never ideal.

Here's my teeth so you have an idea how compensated they are.