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Hi, everyone, as an introduction, I'm a 21-year guy whose desperate for some help. For much of my childhood, I was a chronic mouth breather due to allergies. Finally, at the age of 20, I learned about the importance of proper tongue posture and started mewing. Sadly, the damage is already done, and I have the characteristic "mouth breather" face. I have an elongated, narrow face, and my jaw is angled too downward, making my jaw appear small and boyish from the front. From a side view, my maxilla and mandible appear recessed and sunken downward, and there are visible dark circles under my eyes. Also, my palate is v-shaped, narrow, and vaulted, and, consequently, I have some tooth crowding.
I really want to feel confident about my smile, and, heck, also my entire face. Do I have any options to correct this, or do I just need to accept that I'll always have an ugly face? Some might accuse me of vanity, but I just want to feel comfortable in my own skin. 😥
From everything I've read, it seems like surgically-assisted MSE in conjuction with a face mask could possibly be a viable treatment option. I would prefer surgically-assisted MSE as opposed to regular MSE, because, from what I understand, it can prevent asymmetric breaking of the skull's sutures, thus avoiding asymmetric expansion. The face mask would be to help move my maxilla forward, which might be able to address my sunken, recessed side profile while also causing my mandible to swing up. Of course, then I would probably need to widen my mandible, and I'm not sure what procedure would be best to accomplish that, although MSDO sounds promising.
The bottom line is, I'm in really uncharted waters it seems, and I don't want to ruin my face or cause other issues. I don't want to throw off the harmony of my features even more. I'm having trouble finding anyone who has done anything similar. The only person I know of is Ronald Ead, but he has had so many other procedures done, such as AGGA, which is terrible, that it's really hard to discern what MSE alone did.
I would greatly appreciate anyone's input, especially if you've had experience with any of these procedures. If you want, you're welcome to private message me. Also, I live in Ohio, and I would love it if someone could refer me to an appropriate specialist near me. I'm willing to travel out of state or even out of the country if I have to.
Thanks in advance for your thoughts! 😉
Could you post some pics so we can see exactly whats going on?
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Sure, it's very painful to share, but here are three photos. I'm sorry about the poor image quality. If you want, I can get higher quality photos tomorrow.
To note, some of the bags under my eyes are just from stress from college and working full time. But I do have poor under eye support as well.
First of all, no need to be so hard on yourself. Majority of people in 'civilised' countries have underdeveloped faces and many of the people we see in the media have undergone some type of surgical enhancement. Judging from these pictures, you are really not unattractive at all for a "mouth breather".
Since identifying yourself as a mouth breather, what steps have you taken to remedy this? Have you worked on developing a more consistent/healthy tongue posture? Do you have any other symptoms such as TMJ issues? Any history of orthodontic work?
From these pictures it seems your mandible is pretty well developed and your maxilla likely needs a bit more lateral growth rather than saggital, so an AGGA may not be of much benefit anyway. MSE if you can afford it seems the best way to go as it is surgical and almost guaranteed to get results. Alternatively I would suggest having a consultation with a DNA Appliance practitioner who may also be able to diagnose any breathing/sleep apnea problems you may have.
Thanks for the kind words and your thoughtful response. I haven't been mouth breathing for probably over 5 years after I addressed some underlying allergies. However, I only learned about proper tongue posture a little over a year ago. Prior to that, my tongue was resting on the bottom of my mouth. My under-eye support definitely improved when I started mewing, but this is the only benefit I've seen, and my palate is still very narrow and crowded. I don't have other issues, such as sleep apnea or TMJ. I also don't have any prior orthodontic work; however, my dentist is recommending I consult with one to get my wisdom teeth removed and my teeth straightened. Obviously, after learning what I have, I wasn't interested in that.
I would agree that MSE seems like it might be my best bet. One concern I have though is that I don't know if it can expand the palate in the way I need. From what I know, my palate is narrow and vaulted when it should be wide and flatter. I know MSE can make my palate wider, but can it make it flatter, or will it still be unnaturally vaulted? If it's only able to achieve one of these, I'm worried it might lead to an odd, off-balance look. Also, it would likely produce a discrepancy between my maxilla and mandible, and I'm not sure how I could address that.
Also, just a tangent, I think that AGGA and DNA could actually be kind of dangerous. I looked into both appliances and almost got the DNA. However, neither device produces bone-borne expansion, but rather tooth-borne expansion. They are not remodeling your face like they claim to. Instead, they are just shifting your teeth. This can be problematic because it's not addressing the underlying structural issues that led to crowded/misaligned teeth and shifting the roots of your teeth around so much can lead to many problems. Ronald Ead, youtuber with a channel called "Jaw Hacks", warns about the AGGA in several videos after having tried it himself. Sorry, I know this was a little off topic, but I want people to be aware of the dangers of some of these products.
So, yeah, I'm very interested in surgically-assisted MSE and a face mask, but I just don't want to experiment with my face. If anyone has gone through these procedures or knows something important, please reach out. I wish there were a way to predict the changes to my face that would occur before I had the procedures done. Thanks!
Dude Agga and dna are very deffirent things
@s4dboy Yes your maxilla is downswung. The space between your nose and upper lip is very long (high Mew indicator line). do you have a very gummy smile? In your case, you need to impact your whole maxilla / upper arch. You can do this naturally and slowly by chewing a lot or orthodontically via TADs and elastics
Thanks for your honesty. Oddly enough, my smile isn't that gummy, just narrow and crooked. Is there a certain age when chewing stops being effective? I've been chewing a lot of mastic gum, but I haven't seen any improvement. What should I be chewing and how often? Also, by TADs and elastics, are you referring to the MSE procedure specifically?
I would love to get some sort of procedure done, but I'm having trouble finding people who have done the same and seen good results. I really don't want to go into this blind and possibly mess my face up even more.
I understand that they're both different, but, if I understand correctly, they both achieve expansion through shifting the teeth not actually laying down new bone. Shifting the roots of the teeth can be very problematic. Also, while both devices are said to remodel the bone in the face, these claims just aren't backed up by science, unlike MSE. Also, another red flag is that these devices are marketed primarily to general dentists rather than orthodontists, the latter being much better equipped to pick up on fraudulent claims and appliances.
@s4dboy OK, it might be that the impression that the distance between nose and upper lip is long is due to your face being very narrow. In this case, expanding your palate + lower jaw will help. If your upper dental arch needs to be higher, this can be achieved by means of orthodontic mechanics and is therefore possible for adults as well. The idea is to put consistent light pressure on your upper teeth which will result in your teeth moving up into the bone over time. This can be accelerated by using mini screws that are screwed into your gums and using these screws as anchorage to hook elastics that pull your whole upper arch up. Like here: https://www.youtube.com/watch?v=Y3kur-NqPYY
Wow, the results in that video are pretty incredible. Thanks for your response, it gives me a lot of hope.
Out of curiosity, by "raising the palate" do you mean flattening it? I think it would be best if I could flatten my palate and get a flatter, wider, u-shaped palate. I don't want to just change the position of my narrow, v-shaped, vaulted palate. Basically, I'm wondering if there's a way to get rid of my palate's vaulting. I hope this made sense.
@s4dboy By putting constant pressure on the whole upper arch, the following two things will happen: Your upper teeth will intrude, meaning absorbed into the bone, and the alveolar bone itself will give in to the pressure and resorb itself as well (to a lesser extent). This will lead to a flatter palate. Your palate will definitely also get flatter from expanding the arch. Do you have photos of your teeth?
@s4dboy Thanks a lot for providing the photos! That provides a much clearer picture now.
Both upper and lower arch are very narrow. I would say that the upper arch is narrower, although your lower arch is also narrow -- your lower left canine, for example, is completely out of alignment as part of the crowding.
Your upper arch needs to be significantly expanded in the posterior regions (comprising your two molars and two premolars on both sides). Once the posterior segment is expanded so that it is "flush with the anterior segment", you still have a very narrow V-shaped arch. Once you are at that stage, you need to expand the whole upper arch.
Your increased vertical dimension in your frontal profile is definitely due to the narrow arch situation. I suspect that your bite is off where you bite cusps on cusps on your back teeth or even a posterior crossbite where your lower teeth are wider than your upper teeth. If your back teeth are biting cusp on cusp, then you would also have an anterior open bite (your front teeth do not close when you bite). Is that true? A picture that comes to my mind is Michael Phelps; it seems to me that you have a similar situation as him:
Due to the mouthbreathing, his posterior segment is completely overerupted, i.e., it looks like his back teeth have sunken/melted straight down. he also has a bilateral posterior crossbite and an anterior openbite.
The good news is that your situation has a very clear prognosis with the expansion protocol I mentioned. You should definitely go for it. You can try this using removable appliances first -- that does it in most cases, even for adults. If you cannot get expansion with removable appliances, you can try the MSE appliance. Once the constricted situations in both arches is fixed, you should also see significant facial improvements! Besides esthetics, you will have more tongue space and a wider airway.
I should have included this before, but here I some pictures of how my teeth come together. Very poor quality again, I know.
I'm sorry, I'm not really well versed in the anatomy of the mouth, so I had a little trouble understanding some of the issues you said I might have. But, yes, there definitely seems to be some similarities with the issues Phelp's has.
Because it seems like I need skeletal expansion, not just alveolar shifting, I'm tempted to go straight to the MSE as I've heard so many negative things about removable appliances. I'm curious what you think of this.
Additionally, do you think a knowledgeable MSE provider would be able to also perform a procedure like the one described in the link you sent me? ( https://www.youtube.com/watch?v=Y3kur-NqPYY ) It seem like the best approach would be to have both treatments.
Also, do you have any ideas for how I could go about expanding my mandible so a disparity doesn't develop? Because of all the expansion my upper requires, it seems inevitable that my lower will need some major expansion as well.
Also, do you have any recommendations on finding a practitioner? I know Doctor Won Moon has a database of MSE providers throughout the world, so I guess that's somewhere to start.
Hope I'm not being a bother with all the questions 🙂
I know I said this before, but thank you so much for all your input! Hopefully, some people reading through this forum are as encouraged and enlightened by your thoughtful responses as I was.
@s4dboy I am glad that I can help!
Here is my take on your case. You can look up the terms that you are not familiar with.
- You have a posterior crossbite on your premolars. Your molars are not in a crossbite due to the severe outward tipping of your upper molars.
- It seems that you have a Class I molar relationship, which is good. Due to the severe crowding in the front, it is a bit harder to make sense out of the canine relationship, but it seems like Class I as well.
- Looking at the first pic in the latest set of photos, it seems that you do have a bit of a gummy smile, aka increased vertical dimension. Like in Michael Phelps case, your posterior segment hangs lower than your anterior (front) segment. This means that not only do you need to intrude your whole anterior segment, you need to intrude the posterior segment even more (normally the back teeth are higher than the front teeth). You can look up the term "curve of Spee". This correlates with a nice smile line. Right now, you have a bit of a reverse smile line with a slight open bite in the front.
As for possible treatments:
Regarding the expansion, in my own experience, proper expansion is also possible with removable appliances even in adults, especially when you are still in your 20s or 30s. However, in your case, your upper molars are already tipped outward, which might be a problem. In any case, yes, an expansion with MSE will most likely work for you, but it is a little bit more involved compared to a removable appliance.
To fix the issues with the vertical dimension, yes, a treatment similar to the video I sent you earlier will work. You probably will need TADs in the back and in the front. As for the braces, both traditional braces (like in the video) or Invisalign should work for this.
I would not worry about the lower arch. Actually, it is much closer to a nice arch than the upper. You have crowding in the lower arch, which means that once you resolve the crowding, you will have a wider lower arch. Moreover, due to the crossbite in the posterior segment (excluding the molars -- but only due to their severe outward tipping), I would guess that you have about 7-10 mm expansion potential in the upper without even having to expand the lower.