jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: aristidine on April 23, 2015, 10:27:21 PM
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Hey there, I'm a 28 year old female and there are a few things which have been bothering me for quite some time.
I recently had a consultation with a plastic surgeon about these things, and he was the one to suggest consulting with an orthognathic surgeon, so I've been reading all I can in the past week.
I have normal occlusion, and I wasn't a mouth-breather as a kid. That said, my upper and lower jaws seem to be too small for my face, making it look "short" somehow. My face seems to have changed after I had braces as a kid. Before, I had a great facial contour and good incisor show upon parting my lips slightly. When I smiled, the entire top row of the teeth showed. Now, when I part my lips, my upper lip just hangs and there is absolutely no incisor show, not even a milimeter, giving me that toothless look :-\ When I smile, my upper lip covers half of my upper teeth.
I spoke to the plastic surgeon dr. about this thinking maybe a lip lift could solve the problem but he was saying it was a maxilla that hadn't grown long enough. Then I started to think about the rest of the things that concern me about my face and realized, what if it really is a jaw problem? Here's what I'm talking about: I have these 3 lines - 1. under both my eyes 2. deep nasolabial folds, and 3. corners of my mouth. This makes my mid-face feel sunken in or something. There's the incisor show thing I mentioned, and my chin is very quite obviously not in proportion to the rest of my face. I don't have an over or underbite, which is the weird part. Could it be that my jaws just didn't grow big enough, even though they occlude well?
I can't post a photo at this time because my cell camera is non-functional from water damage. Without posting one, I am curious if anyone here with much more than my week's worth of knowledge could offer me some thoughts as to what this could be and what procedures the are to remedy this. I just read about the lefort 2 procedure which brings the mid-face forward. I wasn't really able to find any photos illustrating the difference before and after the procedure.
This is driving me crazy. Any help appreciated!
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Thanks for the replies so far, guys.
I was thinking the same about using plastic surgery when it could be a case of a structural problem, but my upper lip is pretty droopy and as I figure out how the hell I'm going to pay $20,000+ out of pocket (insurance won't cover since it isn't an occlusion issue) for jaw surgery, I thought it could be something I can do to remedy it in the meantime, as well as using fillers to get rid of those nasty nasolabial folds. What's hilarious is I am constantly told by others, much to my chagrin (makes it difficult in the professional world), that I "don't look a day over 20", and yet all these lines and sunken look makes me feel like I look like the people in their 50s who are looking to get a facelift for their sagging face. Aagghhh, so f**king frustrating.
Come to think of it, I think people perceive me as being 8 years younger because my facial skeleton is underdeveloped. So I have this, shall I say, shapeless face. No really good angles of projection, and the features are soft, like my chin, which is waaayy underdeveloped.
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hopefully you can get some picture up, but it sounds fairly similar to me.
I have a fairly shapless face, and it feels chubby, even when I am at a very low bodyfat percentage. (that's when I first finally realised that it wasn't a 'fat' issue, but likely a skeletal one!)
I look a million times better when I give myself a 'facelift' but pulling up my skin, but I realy want to treat the cause rather than the symptom!
I think it's because my jaws are too small and too far back. It doesn't provide enough support for the underlying tissue which I think gives me a 'heavy' appearance.
I have an overbite and a crossbite.
I sometimes think about just getting braces to 'fix' the overbite, but I really CANT ' imagine how that will help/affect my face/appearance at all!
(some say it can, some say it definitely won't)
I'm in the UK.
I'd like to speak to both a functional orthodontist, and also a maxfac surgeon to finally get things clear in my head as to what exactly the problems are
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my bmi for a female my height and weight is perfect. i calculated it the other day. so yea, can't be that.
i do the "mid-facelift" thing too! :P
i'm in this weird place right now where i can't seem to be able to schedule a consultation with an orthognathic/maxillofacial surgeon because of the "must be referred" runaround with my insurance. i'm going to see what happens today when i go see the dentist. even though it wouldn't be any kind of solution, i'd be relieved to know what the damn problem is so i can at least start planning to rectify it.
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i have to see one to get referred to any specialists.
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all right, here's a photo. it's blurred, but you can see the deep nasolabial folds, the droopy upper lip and short/recessed chin.
so i have absolutely NO incisor show upon parting my lips.
i really think there's something i can do to improve these things.. but i have no idea what!
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OK.
Stop. Wait a second. Hold the presses.
You're pretty. Hands down. No debate.
I don't know how you look smiling and I know that is one of your complaints but I'm looking at an attractive woman.
Keep in mind - if you're talking LF2 or moving your maxilla down - those are at the low end of the stability scale for these types of surgeries so you should consider the risk very carefully.
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having the maxilla advanced was what the plastic surgeon recommended instead of giving me a lip lift and a chin augmentation. he was trained in oral surgery at columbia, so was able to evaluate my concerns about the maxilla/lack of incisor show.
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yeah your attractive but i can see how a maxillary advancement might help make you hotter
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Ok...I get that the OP may have room for improvement but damn near everyone in the world does.
Now - and I can only speak for myself but - if I were as handsome a man as the OP is a woman - there is no way in hell I would put myself through surgery on my skull to be a bit more attractive.
I think you are beautiful just the way you are. We are often our own worst critics.
I highly suggest you consider what you are proposing to put yourself through, the risks - vs rewards and make your best decision.
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don't touch your face.
+1
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all right, here's a photo. it's blurred, but you can see the deep nasolabial folds, the droopy upper lip and short/recessed chin.
so i have absolutely NO incisor show upon parting my lips.
i really think there's something i can do to improve these things.. but i have no idea what!
Your upper lip looks long. But there are no absolutes with faces. (OK, you could get some statistics of philtrum lengths and see where you fit in, but the ratios matter more.) So you could lengthen the chin to get the ideal 2/3 - 1/3 ratios between your chin and upper lip, but it won't solve your weak smile.
The long upper lip will still look long after advancing the jaws. It won't lengthen or shorten, but may in fact look longer being closer to the observer (that's my case).
If your jaws are indeed recessed, I would only do linear advancement of both jaws without lowering the maxilla and then get a lip lift. Lowering the maxilla is really only done on scrunched up short mid faces. It's not a very stable operation anyway. A linear advancement alone will give you more tooth show (also my case, but my tooth show is 1-2 mm less than ideal because of my long upper lip. I will probably get a lip lift to fix this)
tldr; I would consult with aesthetically minded maxillofacial surgeons. More than one.
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what is the difference between the procedures of linear advancement and lowering the maxilla? where would the movement be if it was linearly advanced? the reason i'm trying to learn about all this to begin with is that is what the plastic surgeon concluded needed to be done to get the look i'm after. he didn't want to perform cosmetic surgery because he didn't think it would help at all, which i really appreciate. he could have just as well done them and taken my money. he *did* have very good training at columbia dental college (columbia university), so he was able to evaluate me from that perspective.
i don't have better photos right now, the one i posted was something i dug up. i don't take a lot of photos because of the complaints i've presented here.
@ Mark505, i'm new to this, so i'm still learning. after further reading i understood more what a lefort 2 operation was. you probably didn't start out knowing all about it either ;)
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all right, here's a photo. it's blurred, but you can see the deep nasolabial folds, the droopy upper lip and short/recessed chin.
so i have absolutely NO incisor show upon parting my lips.
i really think there's something i can do to improve these things.. but i have no idea what!
well internet insanity strikes again. you look FINE. Pretty, yes. I have a feeling the internet combined with the fact every photo is airbrushed is making people have serious BDD. There are many celebrities who are not as attractive as you are. You have no drooping lip. And the lighting is causing us to even notice your nasolabial folds.
Now, if you can see your teeth when you smile you're fine. Maybe you just need a bit of ortho work to move them a bit out. If having nasolabial folds bothers you just get some filler.
Women aren't supposed to have HUGE chins. Yours is perfectly balanced for your face.
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Also if you compare yourself to celebrities, remember that they're hotter because they are celebrities, society told us that they are hot/perfect/or whatever.
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Also if you compare yourself to celebrities, remember that they're hotter because they are celebrities, society told us that they are hot/perfect/or whatever.
that's absolutely true. Brooklyn Beckham is NOT a particularly attractive dude if you see him in regular photos. But he's in f**king burberry modelling campaigns and is getting like crazy tang from the hottest chicks. Why? Cause his name is Brooklyn Beckham. It's called the "boyband effect." Put any dude in a music video with teenage girls crying and chasing them and then real girls are gonna act the same way. Truth. Tons of these people are average and less so.
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thanks to all the replies so far, truly.
i'm surprised that you guys have said i look fine, i was really afraid to put that photo up. maybe the photo isn't really illustrative of what i'm describing. i wish my cell camera would work so i could take a more edifying photo.
i'm still really unhappy with the things i'm talking about. at 28, i don't want to look toothless when i speak. i just don't. it doesn't look good and lowers my confidence level. i don't see others have this, everyone's teeth show when they speak and i've had boyfriends tell me that it is definitely noticeable. the thing is i feel fine about my other features, and this toothless look significantly detracts from my appearance, as far as the "point system" goes. wherever i am on that scale, i lose like 2 points when i open my mouth, lol.
as someone suggested here, i'm going to start out with an orthodontist. since braces seem to have created this problem, maybe they can improve it. i have an appointment scheduled in a week, and this ortho seems really promising. free 1 hr. consultation and they'll take xrays, and they work with a good maxillofacial surgeon so if it's outside the scope of the ortho, he will refer me. it's a good start i think.
@Lazlo, my upper teeth are about 50% obscured when i smile, actually. don't know what the point of getting my teeth straightened when i was a kid was, if it had the effect of hiding the visibility of my teeth. so they're straight now, but are completely hidden from view. great.
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you know, it was just about 15 years ago and i honestly don't remember. i always had a class I bite, but my teeth were pretty crooked. all that i do remember is that i had a "vampire tooth". i know that i got it done at kaiser so i suppose i could contact them to retrieve those records. maybe it would be enlightening. *edit* just called kaiser, all records have been destroyed.
i remember when i got them taken off, though, as if it was yesterday, because of how upset i was. i remember going to school not excited but so downtrodden. they gave me a "before and after" foldout booklet thing - on one side was my before and the other my after. half my upper teeth were hidden, my nose looked bulbous because it slightly tipped down when smiling, and i got the toothless mouth. in the before, while my teeth were crooked, i had a far superior smile and my nose was straight when smiling. i have no idea what happened and i remember trying to make sense of what the benefit to me was to get my teeth straightened only to not be able to show them off. i was genuinely confused about that.
the plastic surgeon seemed to think that the growth of both upper and lower jaws was retarded at some point.
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I had a big toothy smile before braces and extractions too.
I f**king hate orthodontists
Jesus you too? f**k I share your pain bro. Motherf**kers. Why the f**k do they do this?
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yeah man, i would take my former crooked teeth over my "improved" look any f**king day.
:-X
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i wish i never had brace. f**ked me up big time, luckly i had no extractions but it lengthened my face. I only had it for 1.5 years.
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i wish i never had brace. f**ked me up big time, luckly i had no extractions but it lengthened my face. I only had it for 1.5 years.
yeah but that can be corrected in surgery, you'll be fine trust me. You probably just need regular bi-max --I'd go with Camanetti if I were you. It'll be basically free too.
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Well to be fair, i had braces when i was still growing, perhaps my genetic pattern would lead me to having 0 incisor show anyway.. cant really blame ortho when i dont really understand the process.
No, in your case, it was the bicuspid extractions for sure. Sinn explained to me that the molars can't move cause they have three or four roots, so what happens is the dips**t orthos (which are basically most of them) retract all the teeth, this leads to major loss of support for the nose making it look bigger and less tooth show. All these problems can be addressd through CCW and bi-max but the results would have been better if you still had your bicuspids which prop up your midface. It's really a f**king "catastrophe" as this surgeon told me. Dude if you'r in England I would so go for having your ortho work overseen by Mike Mew in prep for sugery. that is the way to go.
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@lazlo- I'd love to go to Camanetti but he doesn't go CCW rotation, which I need. My occlusion angle is slightly steep and if he just moved everything on the same angle it'd make my face look longer. He wasn't even open to doing a CCW rotation, sucks. He also wants to do a multi segment Lefort. f**k that.
I still haven't visited the other top guys here so we'll see what they say.
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What is the solution? Lots of talk of orthos doing more harm than good, pulling teeth out etc etc.
If someone wants their bite improved, what should they do?
Is it about finding a special sort of ortho? Maybe a functional orthodontist?
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^ see if they specialized in dentofacial orthopedics/ orthotropics
orthotropics is only for children, though?
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I had two premolars extracted from my lower jaw in preparaton for a BSSO (the front teeth were slanted way forward, now they are straight again after being pulled back). Should I be worried about my face collapsing as described above, or does that only apply to extractions from the upper jaw?
Sorry if this is a very stupid question, I'm still very new to all this :)
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Right, and if you have an ortho that will work with you- they'll expand as much as they can/your body will allow and then go from there.
Again, adult expansion is new stuff but, it can work to an extent (or more) and all the adults I know have had successful expansion without the need for pulling teeth; myself included.
Interesting.
Thanks.
I'm still not sure what I want to do. When I look at myself, I feel as though my jaws are a little recesed, and maybe a little narrow, too.
I've seen 2 orthos (just for quick consultations to discuss braces) and they both said that my case wasn't really bad enouogh to warrant surgery.
But I don't just want straight teeth. I want my face/cheeks to get proper support, and i'm not sure that just fixing my bite with braces will be enough to help with that (the apparent 'brace lift' effect for example).
My head is constantly spinning with it all, lol.
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Your upper preomolars are still intact?
Yup, the rest of my teeth are all there, including the wisdom teeth. Only lacking the two foremost premolars in the lower jaw. The front arch has been pushed back a fair bit, and the molars are being pulled forward to close the gap.
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^ still have all your permanent teeth?
If so, braces with an ortho that plans your treatment out that isn't cookie cutter can also do wonders. Braces are only bad when they're pulled back with no consideration to the entire face. Widening your smile or tipping the teeth helps with tooth show and filling out the mouth which will then give you more support.
If you've extracted one or more teeth, going the braces route and trying to expand will be very tough... but, if you have the time and money- give it a try. You can technically reopen the gaps but, again- this will take you up to 2 years or maybe even more.
Embarrassingly, I just had to count my teeth in the mirror as I really can't remember how many teeth I had pulled, and whether they were my adult teeth or not! I appear to have 30 teeth.
I kind of remember getting one of the vampire teeth pulled out (one that was 2 to the left of my left upper 'middle' tooth) because it was growing in a weird place due to crowding.
I also must have had maybe a molar or a canine pulled out at some point, but I can't remember when or why!
If you've extracted one or more teeth, going the braces route and trying to expand will be very tough... but, if you have the time and money- give it a try. You can technically reopen the gaps but, again- this will take you up to 2 years or maybe even more.
So based on that, are you saying that jaw surgery would be the only solution?(I understand that you're not an expert, but I want your opinion, so don't worry about giving medical advice! :))
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So we're supposed to have 32 teeth, but apparently that includes the 4 wisdom teeth?! If so, i'm confused.
I can count 30, I don't have any wisdom teeth (never came through). I've had at least one adult tooth removed.
How does that add up?! lol
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I had 4 premolars out, that is what made my midface sag downwards? Where is the evidence for this?
So if I was to get my planned surgery - bimax with cw- would that prop it up? Or is it only CCW that would help? I can't get CCW cos my face is short as f**k already
any advancement would prop up your face properly you don't necessarily need ccw. Buddy, you want evidence? Just type "bicuspid extractions and face" and you welcome to the litany of horror stories of how it destroys faces. I'm actually lucky I didn't have mine done as a kid like you, but my whole face has drooped down since the spaces were closed. I don't mind your challenging attitude it's healthy, but there's also a time to shut up and listen tumerican.
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@lazlo- I'd love to go to Camanetti but he doesn't go CCW rotation, which I need. My occlusion angle is slightly steep and if he just moved everything on the same angle it'd make my face look longer. He wasn't even open to doing a CCW rotation, sucks. He also wants to do a multi segment Lefort. f**k that.
I still haven't visited the other top guys here so we'll see what they say.
oh f**k him then. i don't think tocchio does it. Cameron Clokie is not great. Dr. Stephen Ho does it as well as other procedures --definitely get a consult with him.
What I'm thinking in fact is that you get CCW here in canada, then you can go to the states for the orbital rim advancement --it can't be done at the same time as bimax anyway and you'll need 10 months wait between operations.
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i think i've read in a couple of places that jaw surgery is significantly cheaper in canada. is there truth to this? if so, why is that the case?
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i think i've read in a couple of places that jaw surgery is significantly cheaper in canada. is there truth to this? if so, why is that the case?
it is probably cheaper if you paid for it out of pocket but it is free for us canadians. They only charge for the genioplasty which plus some administrative fee comes to 2-4 grand total. That;s all you pay (oh and your ortho work). For a foreigner i don't know probably same price as an average doc in america like 20-40 thousand i'd estimate.
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it's probably closer to $40k for bimax huh.
this thread is awesome. i've learned a lot so far.
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it's probably closer to $40k for bimax huh.
this thread is awesome. i've learned a lot so far.
yeah i'm pretty awesome ; )
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Oh ok, and they made the top and bottom fit together with the missing premolars on bottom?
Not yet, the BSSO has to take place first, then the occlusion will be fixed via orthodontics.
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Thanks for the advice lazlo I'll check them out. It'd be such a blessing if I find someone here in Toronto who's on the same page. Saving $60k on jaw surgery out of country would be amazing since I'd be paying for this out of pocket.
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Thanks for the advice lazlo I'll check them out. It'd be such a blessing if I find someone here in Toronto who's on the same page. Saving $60k on jaw surgery out of country would be amazing since I'd be paying for this out of pocket.
Dr. Stephen Ho is very advanced and also is a big advocate of CCW. One of the program writers on 3-D imaging. Make sure you mention the fact you want an alar cinch to keep the nose slim.
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Do you think it's be good to get surgical planning/advice from other top surgeons like a&g or the dude in Spain thay langpam went to and share it with a surgeon I find here?
Because Ive so far been to 10 orthodontist appointment and every single one of them has a different plan of action. It's kind of f**king scary. Like how do you know who's right. One recommends extractions. One recommends no JS. One recommends tads with JS etc etc.
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Do you think it's be good to get surgical planning/advice from other top surgeons like a&g or the dude in Spain thay langpam went to and share it with a surgeon I find here?
Because Ive so far been to 10 orthodontist appointment and every single one of them has a different plan of action. It's kind of f**king scary. Like how do you know who's right. One recommends extractions. One recommends no JS. One recommends tads with JS etc etc.
yes. and get Arnett and Gunson to instruct the ortho with what to do. Actually I'll tell you who to go to if you'r in ontario. Wish I went to this guy.
Here you go, he's smart, has studied with aren't, won't do extractions, damon braces actually do widen the arch slightly. f**k i wish i had found him instead.
http://www.drgordieorgan.com/damon-system.php
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dude you can thank me now for the rest of your life.
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Thanks man!!!Lmao I know I cant.
Im actaully located west end Toronto/mississauga area. So it should be no problem.
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figured out what my problem is.
i have a short face growth pattern. this is why my teeth don't show and my face looks "squashed". all these years i've been holding my lower jaw out with effort, to look more balanced. this is why you guys thought my chin looked fine in that photo. if i relax my face i look comical. like someone took my face and squashed it together. that "square" look that i've read people with maxillomandibular deficiency have.
i think i found my surgeon. he's based in san francisco. thankfully i have friends in the bay area and will be able to stay with them for a few days after the srugery. the awesome thing is i won't have to pay insane hospital fees because the hospital has different rates for patients undergoing cosmetic procedures. i thought i was looking at thousands for hospital fees alone, turns out it'll be $900. here's to a year of saving for this thing.
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yes, jawbone.
and possibly genioplasty, but that isn't certain. i don't have the surgical plans yet. i'll know more in the following weeks.
i am getting a really good vibe from this surgeon, though.
i'll post more about him when i figure more out.
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thanks! *waves* :D :o
(that smiley has more tooth show than me)
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Aris. I know what it's like to push jaw out to make up for things....No more of that for me thankfully. I also know what its like to loose self confidence over such things.
Just remember - to the right people you are more than just what is in the mirror.
I hope all goes well for you. You seem like a good person.
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i have pics of my malady
now you can see what i mean
ugh. super super bummed about this look. i never smile :-X and i think that makes me come off as unfriendly.
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it makes me look like an idiot, no? :-[
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no, T, i'm in the states. i'll post more about the surgery i'll be getting after i get a few more things figured out. i'm not ready to talk about it yet.
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i wish i never had brace. f**ked me up big time, luckly i had no extractions but it lengthened my face. I only had it for 1.5 years.
I know that extractions can lengthen a face, but now do braces lengthen a face? I've never heard that before.
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braces can lengthen the face only if you have an open mouth posture. This isnt scientifically proven, but to me it makes sense.