She was diagnosed as having a constricted maxilla (upper jaw), retrusive mandible (lower jaw) in part to a high jaw angle, proclined and protrusive upper incisors (front teeth), and an excessive overjet (front to back distance between the upper and lower incisors). Her facial balance needed improvement due to the lower jaw being so retrusive, which also causes the lip balance to appear strained when trying to keep the lips closed.
The initial cephalometric radiograph below illustrates the jaw and bite discrepancies from a lateral view (patients facial photos are not shown for privacy purposes):
Orthodontic treatment was initiated with the expected 12 months of pre-surgical tooth movements needed. Essentially it is the orthodontist's job to align and level each arch individually so that when the jaws themselves are moved, the dental arches and bite will fit together nicely. Once we were ready and all preparations were made, the jaw surgery was completed and about 9 months of post-surgery orthodontic finishing was done. Jaw surgery usually requires 2 weeks of rest (usually no school or work) post-surgery and patients start feeling 100% about a month after the surgery. A month of rest and healing is worth the dramatic quality of life improvement in my opinion.
The following before and after photos impressively illustrate the powerful changes that jaw surgery combined with orthodontics can make for those who can benefit from it:
Believe it or not that is the same patient in the before and after photos and needless to say she is thrilled and can't wait to start college.