The answer to the question ,"who is the candidate for surgery in addition to orthodontics ?" is that the surgery will be needed if there is a severe skeletal problem or very severe malposition of tooth and tooth bearing bone which cannot be treated completely by orthodontics alone. If the jaw relationship is correct crowded and malaligned teeth can be corrected by orthodontic tooth movement. But there are definite limitations to how far a tooth can be moved .

Facial deformities

There are various deformities in the face which are present individually or in combination with soft tissue problems.

Long face syndrome - individuals with this type will have elongated upper jaw, elongated cheek bones, lower jaw and also proclined teeth. They will have excess show of the upper front teeth while smiling speaking and also at rest. They will have difficulty in closing the lips together. They get conscious about excess tooth visibility and use their hands to hide while smiling. This can be corrected by aligning the tooth by orthodontics and reducing the length of the mid face and upper jaw by orthognathic surgery

Short face syndrome- individuals with this type will have reduced length of upper jaw and retroclined teeth ,they will not have any upper front tooth exposure while smiling or speaking ,which gives them a old look even for younger individuals.They might have broad cheek bones and wide nose. The face will look squarish in shape. This can be corrected by orthodontics and lengthening the face by surgery.

Combination of deformities- Individuals can have deformities in combinations. They can have protruded upper jaw and tooth and backwardly placed lower jaw. They will have bird shaped face without the chin prominence. In this the tooth can be aligned with orthodontics and upper jaw length can be reduced and lower jaw can be elongated along with chin to get a harmonious face.

Chin surgery- A protruded chin in women can produce a older and witch appearance.In chin surgery chin can be elongated,reduced,widened and narrowed.

In the past these individuals have to live with the deformity with low self esteem and has to face the society with lot of compromises in job, marriage, position in society etc. In the contemporary situation with the advent of orthognathic surgery, any facial deformity can be corrected to a harmonious, balanced and a good looking face with a aesthetic smile.

Any change for the better is never late and always good.A happy person with aesthetic smile will stimulate more smiles around him and make the world a better place.