Facial rejuvenation

Orthodontics changes the face. Always.

It is not an option we tick in the treatment plan. It is a mechanical consequence: the teeth support the lips, the arches support the cheeks, the vertical dimension decides the proportions of the lower third. Whatever we move on the inside shows on the outside.

The only real question is whether that change was intended or simply happened.

The lesson the profession taught us

Orthodontics learnt this at its patients' expense, over the course of a century.

For a good part of the twentieth century, the standard protocol for crowding was the extraction of four premolars and the retraction of the front teeth. The teeth came out straight. The models looked good. The measurements fell within the limits.

The faces, in some patients, flattened. The upper lip lost its support. The profile receded. The angle between the nose and the lip opened up. And this effect was not visible at eighteen — it showed at thirty-five, when the face matures and loses the youthful volume that had covered the difference.

Nobody did this with bad intent. Everyone followed the protocol of the era. But the lesson remained, and it is the most important lesson my profession has taught me: the dental result is not the result. The result is the face the person lives in.

What "rejuvenation" means here

I want to be very clear, because the expression can be misunderstood.

I do not perform aesthetic procedures. I inject nothing, I cut nothing, I propose no cosmetic interventions.

What I do is restore support — and the face responds to that.

Concretely, this is what changes visibly when the arches are well supported:

• Lip support. The lips rest on the teeth. Arches with the correct dimension at the sides and at the front support the upper lip instead of letting it collapse inwards.
• Fullness of the lateral zone. Narrow arches leave dark spaces in the corners of the smile. Wider arches fill the smile out to the corners of the mouth.
• The lower third of the face. When the vertical dimension is reduced — through wear, through bruxism, through tooth loss — the chin moves closer to the nose, the grooves at the corners of the mouth deepen, the expression becomes "pinched". Restoring the vertical dimension opens up the lower third.
• The muscular tone of the face. A balanced muscular environment, with the tongue up and the lips closed without effort, looks different from one in which the muscles work permanently to compensate.
• Masseter volume. In patients who clench, the masseter muscle hypertrophies and widens the contour of the face, sometimes asymmetrically. When the parafunction is resolved, the volume decreases over time and the contour returns towards its natural shape.

The last point is the one that surprises patients the most — and, in my experience, it is often the most motivating, especially for women for whom a square face is not aesthetically desired.

Why it matters, in the mirror at home

These changes are not spectacular from one week to the next. They are cumulative.

What patients usually notice is not a change they can name. It is that they are told they look rested. That their photographs look different. That the face seems more open, without anyone being able to explain exactly why.

It is exactly the kind of change that restored support produces, as opposed to a one-off intervention: it does not add anything foreign, it lets the structure return towards the shape genetics had given it anyway.

What it cannot do

Here I must be just as precise, because a page about the face attracts high expectations.

Orthodontics does not lift the skin and does not change what belongs to the skin. Expression lines, collagen loss, elasticity — these are not my territory and I do not claim to influence them.

It does not change the underlying skeletal structure in an adult. A severe skeletal pattern remains a severe skeletal pattern; for that there is orthognathic surgery, and whoever tells you otherwise is not telling you the truth.

It does not produce identical results in two different patients. What can be achieved depends on the starting point, on age, on bone, on what has been done before.

And it is not quick. What I describe here happens over the course of a complete orthodontic treatment, not in a few appointments.

Why I refuse to treat the face as a side effect

Because it is the only result the patient sees every day, for the rest of their life.

The study models stay in a drawer. The radiographs stay in a folder. The face walks out of the door every morning.

That is why, when I plan a case, the face is the first variable, not the last. I look at the profile, at the lip support, at the lower third, at what happens when the patient smiles — and only then do I decide what to do with the teeth, so that what I do with the teeth takes the face where it needs to go.

It is exactly the reverse of the order I was originally taught. And it is the only order that makes sense if the result we measure is the person, not the model.