Vertical dimension and facial aesthetics

I’m presenting the case of a 37-year-old adult who is consulting us because her teeth are “moving” (becoming “crooked”) over time.
She doesn’t like the composite veneer on her upper left lateral incisor.
Clinical examination shows vertical maxillary excess with vertical maxillary excess causing gingival exposure when smiling. Prominence of the upper and lower dentition was also noted.
After explaining the list of problems, I proposed a treatment plan that included extraction of the four 2nd premolars, retraction of the upper and lower anterior teeth and bimaxillary orthognathic surgery (Le Fort 1 for upper repositioning, OSMB for accommodation and genioplasty for vertical reduction.
It’s important to explain the various problems observed during the examination, so that the patient can make an informed decision to undergo major treatment.
This lady is really happy with the changes she’s seen, and so am I.