I'm just going to address the FIRST question here.
Since the relationships in maxfax are geometrical; a study that uses points, lines, angle, planes, rotations...etc...many of which are very basic and fundamental, it follows that basic geometrical concepts are applicable to basic observations one can make on a ceph.
For example the answer to your question: 'Should I be retracting my upper incisors pre-surgery?' is YES. You would have arrived at the same answer of 'yes', without any on line tools by using the same type of deductive process that people who have some geometry under belt use.
The answer of YES arises from following the LINE of the upper lip and looking to see if you can find a PARALLEL line drawn through the incisor inclination. Thing is to do that, one needs to be looking for RELATIONSHIPS one line has with another line. That involves looking at the ceph in terms of it being a GEOMETRIC CONSTRUCT.
2 diagonal lines can be found on your ceph that are parallel to each other. One drawn along the outer contour of the mouth/philtrum (which is a diagonal line) and the other drawn through the incisors (another diagonal line parallel). It doesn't matter where to draw the line through the incisors. What matters is whether a line parallel to the line that can be followed along the 'mouth area' can be found through the incisor area and the answer is YES. That right there tells you there is a RELATIONSHIP between the 'mouth area' and the incisor area the mouth area is inclined on/ resting on, ORIENTED on.
There is no requirement here to measure the angles. What's required is to OBSERVE the lip area is angled/inclined outward because it's resting on an incisor area that's angled/ INCLINED outward. Although there is no requirement to measure the angles, what's required to know is that when a line is INCLINED, the angle of inclination is relative to another line. So, here the inclination is relative to a vertical and a vertical is used to look at profile orientation.
'Retraction' as it applies to the incisors means to disincline or REDUCE the angle of inclination. So, if you wanted to RELATE any concerns you had about the mouth area being brought 'forward' and looking to 'protrusive' (with maxillary advancement) you would have to RELATE BACK to the INCLINATION it has relative to a vertical. Again, you don't have to ponder how many mm or wonder about 'illusions' or measure any angles you just need observe that reducing the angle of inclination the 'mouth area' has (with a vertical) is also RELATED to reducing the angle of inclination the incisor area has (with a vertical).
Hence, the ONLY way to mitigate the 'mouth area' looking too protrusive subsequent to the maxilla being brought forward is to reduce its angle of inclination by reducing the angle of inclination of the 'plane' it's inclined on (incisor area) which is what RETRACTION means. That's why the answer is 'Yes'.
ETA: As to the second part of your first question where it sounds like you could be hinging a decision for retraction on whether or not you have 'true protrusion':
Since the decision to retract is based on decreasing the angle of inclination the upper lip area has (because it's resting along the inclination of the incisor area ), it's irrelevant whether or not it's called 'true protrusion'. Even if it was, like in bimax protrusion, most US dentists retract the area. Hence pondering whether or not to hinge a decision on that is extraneous.
As to the other second part of your first question where you ponder if the 'mouth dominant' area could be an 'illusion cause by a recessed ANS/paranasal/midface area'. Since the angle of inclination the mouth area rests on is NO 'illusion' and the decision to retract is based on the need to disincline it (decrease its inclination) SO the maxilla can be advanced forward BUT NOT exaggerate the 'mouth dominant' area, pondering illusions..etc is also extraneous.
In closing, since the answer to 'should I be retracting my upper incisors' is YES, any more pondering that might hurl you into indecision as to 'yes' or 'no' based on what ever 'this or that' you might generate, would also be extraneous.
Hi Kavan,
First off, I want to say that I genuinely respect the depth of knowledge you bring to the forum. Your posts over the years have shaped how many of us understand facial geometry and orthognathic mechanics — myself included. You’ve consistently brought clarity to complex topics, and I really appreciate that.
Thanks for your detailed reply — I appreciate the effort and clarity you brought to breaking down the geometric relationships. You’re absolutely right that incisor inclination determines the lip’s orientation to vertical, and I’ve actually used the exact same reasoning — the parallel diagonals and lip-incisor alignment — when discussing my case with surgeons. (And yes, I know — no online tools required to see that.)
What’s been difficult, though, is that several of the most respected maxillofacial surgeons I consulted (including names regularly cited as among the best globally) didn’t agree that retraction was necessary in my case. One (Dr. Alfaro) repeatedly told me that my lip projection was a “racial trait” and should be preserved, while others warned that retraction might cause unwanted flattening in the upper lip region, as well as visual lengthening of the philtrum.
Even a number of the surgeons who were ultimately on board with retracting my upper teeth only agreed after I explained that I didn’t want my upper teeth to end up further forward than they are pre-surgically. Prior to that, they didn’t see a strong aesthetic reason to retract — they simply planned to advance the maxilla by a few millimetres with the dentition as-is. But I’ve since let go of that hard line. I’m no longer set on keeping the teeth in the same anteroposterior position — I’m open to either outcome, as long as it leads to the best aesthetic result in the context of my face.
Don’t get me wrong — I actually made the same observations you laid out in your reply several years ago, and I’ve been heavily leaning toward upper incisor retraction ever since. My confusion doesn’t come from a lack of conviction in that logic, but from trying to reconcile it with the strong — and often contradictory — opinions I’ve received from respected surgeons. I’m simply trying to make the most precise, balanced decision I can in light of all the variables.
In fact, a number of those surgeons expressed genuine surprise at how analytically I approached my case — particularly my ability to apply geometric reasoning to assess incisor inclination, lip orientation, and facial plane relationships. That’s part of why their pushback was so confusing: they acknowledged the logic, but still advised against retraction, often citing ethnic soft tissue norms or risks of flattening and loss of incisor show. It left me wondering whether certain anatomical or aesthetic variables override what would otherwise be a straightforward geometric prescription in this case.
Even if it’s true that “most US dentists retract that area,” I’m less concerned with what’s typical and more interested in what will create the most harmonious, structurally coherent result. I do recognize that beauty is subjective and culturally mediated — but I also believe that in the context of orthognathic planning, general aesthetic principles do exist. And in cases like mine, where the midface is underdeveloped and the lip full, I’m trying to understand whether a degree of lip protrusion might actually be the lesser trade-off compared to flattening or tension loss.
I’ll admit I was a little surprised by how strongly you framed everything else as “extraneous” or over-thought — especially since these weren’t speculative musings but grounded questions I raised after serious consults with global experts and years of research. I say that with respect — just hoping to keep the dialogue as thoughtful and two-sided as your geometric breakdowns always are.
I also remember that back in a 2021 thread, you cautioned me that retroclining teeth too much could lead to aesthetic compromises. That stuck with me — and it’s also why I’ve started wondering about the inclination of my lower teeth now that they’ve been retracted en-masse. I’m not sure if they’re overly upright now — that's why I asked about that as well.
I hope it’s clear I’m not trying to be difficult or chase perfection for its own sake. I’m just a patient who’s done what so many others on this forum are advised to do — see the best surgeons I can, educate myself thoroughly, and ask critical questions. But I’ve found it genuinely difficult to figure out the right path given the conflicting opinions I’ve received. That’s why perspectives like yours are so valuable — they help cut through some of the noise.
So while I agree with your geometric framing in theory, I’d still really value your insight — especially on how to reconcile the need to reduce inclination (to avoid excessive mouth dominance post-advancement) with the counter-risk of soft tissue flatness and reduced incisor show. Do you think there’s a threshold of safe retraction that still allows for lip support, or that some minor protrusion should be accepted when midface support is limited? Perhaps asking Dr. Gunson whether it might make sense to retract the upper teeth by a couple of millimetres while trying to preserve their current inclination — or, if that’s mechanically unavoidable, to re-establish a more favorable inclination after retraction — could be a useful way to approach it?
Would love to hear your take.
Recent Posts
