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It is a common misconception that braces/ standard orthodontic treatment causes facial recession in most scenarios. however, in the vast majority of cases, braces or clear aligners do not negatively alter your facial profile.
However, the debate often comes down to two differing philosophies in modern orthodontics: Airway (or Orthotropic) Orthodontics and Camouflage Orthodontics.
"Camouflage" orthodontics aims to mask an underlying skeletal issue by simply moving the teeth to fit together, rather than correcting the actual position of the jaw bones. In specific scenarios, this approach CAN lead to unwanted changes in the facial profile.
When these premolars are removed and the lateral incisors are pulled back, the dental arch is both narrowed and shortened, which flattens the lips, diminishes facial support, and visually "recesses" the profile.
Furthermore, retracting these anterior teeth drastically reduces the overall volume of the oral cavity; (bone and cartilage in the mouth) which actively regresses the maxilla and collapses subnasal support. this leaves less room for the tongue, forcing it backward into the pharynx and potentially compromising the airway which increases the risk of sleep apnea.
Traditional orthodontists often use this method to treat crowding because it is a fast, easy, and profitable shortcut to straight teeth, rather than doing the harder work of expanding the jaw. However, many advanced, airway focused orthodontists now treat extraction and retraction as a last resort, opting instead for jaw expansion to safely create space without collapsing the facial structure.
Elastics:
Another misconception is that wearing orthodontic elastics inherently causes recession. Elastics themselves are just tools; the damage comes entirely from HOW they are used to camouflage different malocclusions. The reality is, elastics themselves cannot generate enough force to inherently alter the facial structure of your face. This can only happen if you genuinely wear them for 20 years straight
Class 1 Malocclusion
This is the ideal skeletal alignment where the upper jaw (maxilla) and lower jaw (mandible) are properly positioned relative to each other.
The patient may have crowding or gaps, but the jaw structure is correct. Treating this with simple alignment poses zero risk of facial recession.
(top represents class 2 bite
bottom is the ideal for reference)
A class 2 malocclusion is when the upper maxillary and teeth sit significantly farther relative to the lower.
Lazier or old school orthodontists will extract the upper premolars and use Class 2 elastics to pull the upper jaw and teeth BACKWARd to meet the recessed lower jaw. This does not fix the weak chin; it simply ruins the upper face to match the broken lower face, resulting in a completely recessed profile.
The Correct Approach: You must advance the mandible forward. In growing patients, this requires functional appliances like the Herbst appliance to force jaw growth forward, not pulling the top jaw back.
Class 3 Malocclusion:
This is unfortunately the most brutal of the 3, the case in which the mandible sits significantly ahead of the upper jaw.
This could be caused by a multitude of things:
A condition called prognathism, commonly found in African Americans which is a structural facial abnormality where the lower/upper and or both protrude outward.
The upper maxilla being retruded, often caused by genetics (found in mainly people of east asian and hispanic descent)
or due to environmental factors such as cronic mouth breathing, bruxism, etc.
Orthodontics usually cant fix this skeletal issue unless they extract lower teeth and recess your mandible. This results in a collapsed lower lip and severe chin recession, leaving the patient with both jaws recessed.
This malocclusion often requires Orthognathic Surgery such as: Bimaxillary Osteotomy /double jaw surgery.
When Extractions ARE Needed:
In majority of cases extractions are inherently not needed. However, my own experience proves that a targeted extraction can be legitimately required when dealing with genetic asymmetry rather than simple crowding. To treat my narrow jaw structure, my orthodontist first utilized a palatal expander to build skeletal width, but because genetics left me with a severely shifted, off center dental midline, expansion alone could not balance my bite. In a scenario like mine, getting a single premolar extraction on one side is a necessary tool; removing just that one tooth allowed the orthodontist to shift the teeth over and correct my severe midline discrepancy without constricting the entire arch or causing the total facial recession seen in lazy, traditional protocols.
The ultimate takeaway is that orthodontics should never be a linear process. While traditional camouflage protocols often take the lazy route of collapsing a jaw to fit a bad bite, modern, airway focused treatment proves you can achieve a straight smile without sacrificing your facial structure or your health. Do not fall into the trap of believing all extractions are inherently evil, but do not let a traditional orthodontist ruin your profile for a quick fix either. The goal of modern orthodontics should be to expand and balance the face based on your unique genetics, protecting your airway, your profile, and your health from start to finish.
Sources:
my own research on orthotropics and experience
However, the debate often comes down to two differing philosophies in modern orthodontics: Airway (or Orthotropic) Orthodontics and Camouflage Orthodontics.
"Camouflage" orthodontics aims to mask an underlying skeletal issue by simply moving the teeth to fit together, rather than correcting the actual position of the jaw bones. In specific scenarios, this approach CAN lead to unwanted changes in the facial profile.
The Problem with Extractions and Retraction:
The primary scenario where orthodontic treatment can cause facial recession is when healthy premolars are extracted followed by heavy retraction to fix crowding or a protrusion.When these premolars are removed and the lateral incisors are pulled back, the dental arch is both narrowed and shortened, which flattens the lips, diminishes facial support, and visually "recesses" the profile.
Furthermore, retracting these anterior teeth drastically reduces the overall volume of the oral cavity; (bone and cartilage in the mouth) which actively regresses the maxilla and collapses subnasal support. this leaves less room for the tongue, forcing it backward into the pharynx and potentially compromising the airway which increases the risk of sleep apnea.
Traditional orthodontists often use this method to treat crowding because it is a fast, easy, and profitable shortcut to straight teeth, rather than doing the harder work of expanding the jaw. However, many advanced, airway focused orthodontists now treat extraction and retraction as a last resort, opting instead for jaw expansion to safely create space without collapsing the facial structure.
Elastics:
Another misconception is that wearing orthodontic elastics inherently causes recession. Elastics themselves are just tools; the damage comes entirely from HOW they are used to camouflage different malocclusions. The reality is, elastics themselves cannot generate enough force to inherently alter the facial structure of your face. This can only happen if you genuinely wear them for 20 years straight
Class 1 Malocclusion
This is the ideal skeletal alignment where the upper jaw (maxilla) and lower jaw (mandible) are properly positioned relative to each other.
The patient may have crowding or gaps, but the jaw structure is correct. Treating this with simple alignment poses zero risk of facial recession.
Class 2 Malocclusion: (Overbite / Retrognathism)(top represents class 2 bite
bottom is the ideal for reference)
A class 2 malocclusion is when the upper maxillary and teeth sit significantly farther relative to the lower.
Lazier or old school orthodontists will extract the upper premolars and use Class 2 elastics to pull the upper jaw and teeth BACKWARd to meet the recessed lower jaw. This does not fix the weak chin; it simply ruins the upper face to match the broken lower face, resulting in a completely recessed profile.
The Correct Approach: You must advance the mandible forward. In growing patients, this requires functional appliances like the Herbst appliance to force jaw growth forward, not pulling the top jaw back.
Class 3 Malocclusion:
This is unfortunately the most brutal of the 3, the case in which the mandible sits significantly ahead of the upper jaw.
This could be caused by a multitude of things:
A condition called prognathism, commonly found in African Americans which is a structural facial abnormality where the lower/upper and or both protrude outward.
The upper maxilla being retruded, often caused by genetics (found in mainly people of east asian and hispanic descent)
or due to environmental factors such as cronic mouth breathing, bruxism, etc.
Orthodontics usually cant fix this skeletal issue unless they extract lower teeth and recess your mandible. This results in a collapsed lower lip and severe chin recession, leaving the patient with both jaws recessed.
This malocclusion often requires Orthognathic Surgery such as: Bimaxillary Osteotomy /double jaw surgery.
When Extractions ARE Needed:
In majority of cases extractions are inherently not needed. However, my own experience proves that a targeted extraction can be legitimately required when dealing with genetic asymmetry rather than simple crowding. To treat my narrow jaw structure, my orthodontist first utilized a palatal expander to build skeletal width, but because genetics left me with a severely shifted, off center dental midline, expansion alone could not balance my bite. In a scenario like mine, getting a single premolar extraction on one side is a necessary tool; removing just that one tooth allowed the orthodontist to shift the teeth over and correct my severe midline discrepancy without constricting the entire arch or causing the total facial recession seen in lazy, traditional protocols.
The ultimate takeaway is that orthodontics should never be a linear process. While traditional camouflage protocols often take the lazy route of collapsing a jaw to fit a bad bite, modern, airway focused treatment proves you can achieve a straight smile without sacrificing your facial structure or your health. Do not fall into the trap of believing all extractions are inherently evil, but do not let a traditional orthodontist ruin your profile for a quick fix either. The goal of modern orthodontics should be to expand and balance the face based on your unique genetics, protecting your airway, your profile, and your health from start to finish.
Sources:
my own research on orthotropics and experience
