Serious Treatment Plan Doubts (2 Viewers)

[unauthorized]

Hey everyone, looking for some advice or a sanity check before I commit to a treatment plan.

I have a preliminary agreement with an orthodontist to place Damon braces only on my lower arch. However, I have concerns that this approach ignores the root cause of my issues. I suspect I have a narrow palate and lack maxillary projection.

My goal is to improve midface aesthetics. I am considering going back to ask about a two-phase approach: first, a skeletal expander like MSE (Maxillary Skeletal Expander) or FME (Facegenics Midface Expander) to widen the palate and advance the maxilla, followed by braces to finalize everything.

I want to run a few specific questions by you guys regarding how these movements affect common measurements:

1. FWHR (Facial Width-to-Height Ratio): My FWHR is currently on the higher side. If I expand the palate/midface, this will widen the bigonial width or bizygomatic width, which should technically lower the FWHR (making the face wider relative to its height). That seems aesthetically positive to me. Am I correct in assuming skeletal expansion is a valid way to reduce a high FWHR?
2. ESR (Eye Separation Ratio): This is my biggest worry. My eyes are already slightly close-set (0.45). If the midface expands, will this negatively impact my ESR? I know MSE/FME can widen the nasal bone and the inter-zygomatic distance . Since the eyes sit on the maxilla, will they actually move further apart, or does the expansion happen too low to affect inter-pupillary distance? Will it just make my nose look wider, making the eyes appear even closer?
3. FFR (Midface Ratio): I want to make the midface look more aggressive/masculine. How does skeletal expansion affect the ratio between the length of the midface and its height? Does the vertical dimension change much, or is it mostly transverse (width) and sagittal (projection)?

I know there is a risk of a "bluepilled" ortho just telling me what I want to hear (for example that my maxilla is well projected, etc.) to stick to the simple lower-braces plan. I want to go in armed with the right questions. For those who have done MSE or FME, did you notice any negative changes in eye spacing, or did the width gains (zygos, lower face) outweigh the potential risks?

TL;DR: Trying to decide if MSE/FME + braces is overkill vs. just lower braces. Worried about messing up my ESR but want to improve FWHR and projection.

 

[Eat My Dust]

Most of these problems will be fixed by the ortho or surgeon doing good scans and making ur MSE dependant on that for good results, tell him ur worries, he might even be able to help u with ESR

 

[CameronDarkTriadmax]

U unauthorized

Lower-arch Damon braces only affect tooth position in the mandible, they do not change the following:

• Maxillary width
• Zygomatic width
• Interpupillary distance
• Midface projection

so regarding skeletal midface structure, lower braces alone won't address this issue. You may see small improvements, but the widening will not be dramatic unless you're still growing, or combine expansion with SARPE, segmental osteotomy, etc. If your FWHR is high because your face is vertically long, expansion won’t fix that. If it’s high because your midface is narrow, you might see a mild improvement, but don’t expect a radical change.

Now regarding the ESR, interpupillary distance may not meaningfully increase, what typically happens is as follows:

• Nasal cavity widens
• Alar base widens
• Dental arch widens
• Lower orbital rim may shift subtly

in your case you may experience a slightly wider nasal base, slight infraorbital widening, and more midface fullness; what this means is that IF your nose widens but IPD stays the same your eyes could be interpreted as closer set relative to your nasal with. However, do bare in mind that clinical studies have shown that most adults do not notice dramatic negative ESR changes if at all, orbital widening is usually only fractions of a mm, and some people are of the opinion that their eyes look more balanced due to adequate cheek support. If your ESR is already 0.45 (which is borderline close set), your risk isn’t catastrophic but it’s smart to ask for CBCT based predictions before committing to it.

MSE produces little forward growth in developed patients, and may not actually be worth it if we're talking aesthetics primarily. If you're adamant on forward maxillary growth the only ways to truly achieve this is surgical advancement (LeFort for example). If you do not have skeletal transverse deficiency and are chasing FWHR tweaks, MSE may be overkill.

So when it comes to aesthetics, please consider the following in your case:

• MSE is not a reliable way to significantly alter FWHR.
• It will not meaningfully increase eye spacing.
• It may slightly widen the nose.
• Forward projection improvement in adults is limited.
• The aesthetic gain is often subtle relative to the invasiveness.

To help you a bit, I'll give you a few questions you can ask your orthodontist, because almost 99% of invasive & non invasive surgeons are bluepilled, it is extremely hard to find ones that are blackpilled, so refer to the following and feel free to ask them more, remember this is your skeletal structure we're talking about so you don't want to miss a single concern:

• Do I have true transverse maxillary deficiency on CBCT?
• What is my intermolar width compared to norms?
• Is there posterior crossbite or dental compensation?
• Would expansion meaningfully improve airway volume?
• How much skeletal vs dental expansion would I get at my age?
• What is the expected change in alar base width?
• Do you have before/after CBCT data for adults my age?

Lastly, to sum up and answer the main questions you have:

• Q: will MSE lower high FWHR significantly? A: Usually no, MAYBE a mild effect
• Q: will eye spacing increase? A: There's no meaningful IPD changes
• Q: Risk worsening ESR perception? A: Possibly slightly via nasal widening
• Q: Increase aggressive midface projection? A: Limited in adults

If your core goal is aesthetic midface masculinization, expansion alone may not deliver what you’re envisioning. However, If your goal is correcting real skeletal constriction, it makes sense.

 

[unauthorized]

U unauthorized

Lower-arch Damon braces only affect tooth position in the mandible, they do not change the following:

• Maxillary width
• Zygomatic width
• Interpupillary distance
• Midface projection

so regarding skeletal midface structure, lower braces alone won't address this issue. You may see small improvements, but the widening will not be dramatic unless you're still growing, or combine expansion with SARPE, segmental osteotomy, etc. If your FWHR is high because your face is vertically long, expansion won’t fix that. If it’s high because your midface is narrow, you might see a mild improvement, but don’t expect a radical change.

Now regarding the ESR, interpupillary distance may not meaningfully increase, what typically happens is as follows:

• Nasal cavity widens
• Alar base widens
• Dental arch widens
• Lower orbital rim may shift subtly

in your case you may experience a slightly wider nasal base, slight infraorbital widening, and more midface fullness; what this means is that IF your nose widens but IPD stays the same your eyes could be interpreted as closer set relative to your nasal with. However, do bare in mind that clinical studies have shown that most adults do not notice dramatic negative ESR changes if at all, orbital widening is usually only fractions of a mm, and some people are of the opinion that their eyes look more balanced due to adequate cheek support. If your ESR is already 0.45 (which is borderline close set), your risk isn’t catastrophic but it’s smart to ask for CBCT based predictions before committing to it.

MSE produces little forward growth in developed patients, and may not actually be worth it if we're talking aesthetics primarily. If you're adamant on forward maxillary growth the only ways to truly achieve this is surgical advancement (LeFort for example). If you do not have skeletal transverse deficiency and are chasing FWHR tweaks, MSE may be overkill.

So when it comes to aesthetics, please consider the following in your case:

• MSE is not a reliable way to significantly alter FWHR.
• It will not meaningfully increase eye spacing.
• It may slightly widen the nose.
• Forward projection improvement in adults is limited.
• The aesthetic gain is often subtle relative to the invasiveness.

To help you a bit, I'll give you a few questions you can ask your orthodontist, because almost 99% of invasive & non invasive surgeons are bluepilled, it is extremely hard to find ones that are blackpilled, so refer to the following and feel free to ask them more, remember this is your skeletal structure we're talking about so you don't want to miss a single concern:

• Do I have true transverse maxillary deficiency on CBCT?
• What is my intermolar width compared to norms?
• Is there posterior crossbite or dental compensation?
• Would expansion meaningfully improve airway volume?
• How much skeletal vs dental expansion would I get at my age?
• What is the expected change in alar base width?
• Do you have before/after CBCT data for adults my age?

Lastly, to sum up and answer the main questions you have:

• Q: will MSE lower high FWHR significantly? A: Usually no, MAYBE a mild effect
• Q: will eye spacing increase? A: There's no meaningful IPD changes
• Q: Risk worsening ESR perception? A: Possibly slightly via nasal widening
• Q: Increase aggressive midface projection? A: Limited in adults

If your core goal is aesthetic midface masculinization, expansion alone may not deliver what you’re envisioning. However, If your goal is correcting real skeletal constriction, it makes sense.

Im eternally grateful to you for your response