Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

A Voice in the Arena: 'Short-Face' Patients by Dr. Chad Foster

View Comments (1) More by this author (47)
A Voice in the Arena: 'Short-Faced' Patients

by Chad Foster, DDS, MS, editorial director


Without a doubt, my clinical fascination over the past three years has been “short-faced” patients—those with a decreased lower-third (subnasale to menton) facial height. Why the obsession over such a niche category of our patients? Two reasons:

  • The unfavorable collateral effects that having a decreased lower facial height has on a variety of seemingly unrelated facial and smile aesthetic traits is mind-blowing, in my opinion.
  • I would strongly argue that no dentist, facial aesthetician, plastic surgeon or other health care provider has the potential to more significantly affect these patients at the core of the problem than an orthodontist. Our treatment can be truly life-changing for these patients.
Photographs of a 13-year-old patient I treated nonsurgically are shown as a reference for the traits discussed below.
Short-faced orthodontics
Short-faced orthodontics


Some common aesthetic effects
While short-faced patients can of course have a variety of other unique and unrelated facial traits, the common effects this decrease in vertical can have are often quite consistent. This negative impact on aesthetics has been thoroughly discussed by Dr. David Sarver in his book Dentofacial Esthetics. On profile view, patients with short lower-third facial height more often show unfavorable excess chin prominence. From the frontal view, with the lower jaw being overclosed, the more narrow anterior portion of the mandible is more level with the gonial angle, giving a “square” frontal facial form that’s not as aesthetically favorable as the “ovoid” form most often found in vertically well-balanced faces, where the narrow anterior portion of the mandible descends below the gonial angle.

Short-faced patients also display a short “smile window” as the over-closed jaw relationship causes the lips to be more compressed within that space, even when attempting a large smile.

This same soft-tissue compression or redundancy often reflects unfavorably in a number of other ways as well, including giving a more overall aged appearance. In children and adolescents with decreased facial height, I have coined the term “little old people” to describe the more aged look that is expressed. I like to say it’s as if God made the soft tissue perfect on Day 1, but then the hard tissue was made on another day when He was maybe a bit more distracted.

For many of our short-faced patients, this is where a dentofacial orthopedist can absolutely be of service. When the position of the hard tissue is normalized, it can be absolutely striking how the ideal expression of the now-decompensated soft tissue follows suit.

Finally, within the smile, these patients are often deficient in both smile arc (SA) and vertical incisor display (VID). Dr. Tom Pitts has championed a very popular bracket height positioning strategy (smile arc protection) as a tool to increase SA. In the right cases, I find it to be a simple and extremely effective technique. This alteration in bracket heights is specifically a tool that attempts to alter the occlusal plane via relative intrusion/extrusion to increase SA. I use some form of it in most of my cases and I’m grateful to have it in my toolbox.

That being said, I find that for many patients who are deficient in SA or VID, including short-faced ones, the root of the problem is not always as simple as a primary occlusal plane/SA problem. In my opinion, what grabs our attention as deficiencies in miniaesthetic issues (SA and VID) are quite often secondary to a more primary macroaesthetic issue (decreased lower-third facial height being one). If our strategy is aimed only at addressing the smile issue, we might be missing out on an opportunity for a greater and more profound impact on many of our patients’ aesthetic facial balance.

This column is the first of a four-part special feature I am doing on short-faced patients. The next three installments will dive deeper into my evolution in thinking and specific treatment planning and mechanics.

Orthotown makes it easy to share
an opinion with your peers!

We encourage verified members of the Orthotown community to share their thoughts, suggestions and opinions in the Comments section under this column—and every other article! If you’re not a verified member yet, click here to sign up and begin the process.

Orthotown Magazine
September 2025
Orthotown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie® Poll
Do you have a dedicated insurance coordinator in your office?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Orthotown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450