In this instructional video, the speaker outlines the diagnostic criteria for ideal facial height proportion—pupil‑to‑subnasale (2/5 of total face height), subnasale‑to‑stomion (1/5), and stomion‑to‑soft‑tissue menton (2/5). He explains that severe malocclusions are frequently associated with a long facial profile, which traditional orthodontics cannot shorten and may even exacerbate. The conventional view that only surgery can reduce lower facial height is challenged by presenting orthotropic therapy, a growth‑modifying approach that, when applied before age 10, can prevent or reverse unwanted facial lengthening without surgery. The talk uses multiple clinical photographs—including a longitudinal series of Michael Phelps, a chronic mouth‑breather, a habitual clencher, and a surgical case—to illustrate how oral posture, mouth‑breathing, and molar over‑eruption affect facial height. Surgical correction (double‑jaw surgery with counter‑clockwise occlusal plane rotation) is described as a last‑resort option for adolescents and adults. The speaker emphasizes the importance of early orthotropic intervention to improve airway health, reduce facial height, and avoid future surgical procedures.
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Welcome back. This segment is entitled Diagnostic Criteria: Facial Height Proportion. Here is the facial height proportion. You measure the distance between the pupil and subnasale, and that vertical height should be 2/5 of the entire face height. The upper lip from subnasale to stomion should be 1/5, and from stomion to soft tissue menton should be 2/5. That is considered ideal facial height proportion. What we know is the most severe malocclusions are usually accompanied by long faces. And unfortunately, traditional orthodontic treatment does nothing to shorten a long face and usually slightly increases the length of the face. And we've been taught that significant reduction in face height in adolescents or adults can only be corrected surgically. In reality, orthotropic treatment prior to age 10 can prevent unwanted lengthening of the face and eliminate the need for surgery later. We can also decrease the lower face height, as we're going to show you in a moment. Let's first of all apply this to an individual. And here's a child with a very long face. And let's look at him. He's had surgery to get from the above pictures to the pictures below. And you can see what his teeth looked like in the beginning, and here they are after the treatment. He had very poor restoral posture, hung his mouth open all the time, which allowed the maxilla to narrow like you see, and for his entire face to fall down and back. So, he had a surgical correction to reduce the lower face height. You can see what was done for him. Here we see somebody else that everybody is familiar with. This is actually Michael Phelps. Here he is with his mother being bottle-fed, which is the exact wrong thing to do. Here he is when he's a little bit older. And here he is when he's a young child on the edge of a swimming pool with his mouth hanging open. And a few years later, his face height has increased to this dimension. And by the time he Wins his first gold medal in the Olympics in Beijing, his face height is very long. Here he is by the time he goes to win his Olympic medals in London, and you can see his incredibly long face. Here he is from the side. Here he is in Rio de Janeiro getting his medals. That's the best profile picture I could get, but you can see how dramatically long his face is. And you can see most pictures of him, his mouth is hanging open all the time. Contrast that to somebody who clenches their teeth together for much of the day, and you can actually see that the face height can be reduced. And here's such a woman, and her chin has come forward over the years because of the clenching, and her face height is reduced because of that. She is the exact opposite of Michael Phelps, who hung his mouth open. Here you see her. She also has a headache pattern, but you can see how her upper incisors are basically— have disappeared up underneath her upper lip because of her clenching and moving them maxilla upward. The exact opposite of Michael Phelps. Here's another person in my practice that I saw many years ago. The picture on the left was taken approximately 7 years before the one on the right. And she was an intense clencher, and her face height changed that much with a rotation forward of her, of her entire lower face. She was not growing in the left. This was entirely something that occurred while she was an adult. But the face change is dramatic. Her face height is getting shorter and shorter, and her chin is tending to come forward. Out of a popular movie from many years ago, you see Paris Hilton here and someone else in the movie called The Hottie and the Nottie. You see a short face, shorter face individual with Paris Hilton, and the longer face individual with this other person. You can see the contrast between the two. So it's been said that you, in our profession, that the lower face height cannot be reduced except by surgery. So, let's show you a surgical case, how that's done. And here's a girl who's had traditional orthodontics with 4 bicuspids removed, and not surprisingly, a huge increase in the open bite and in her face height. It really was a very unsuccessful treatment, as usually it is. And typically, what's going to happen when this happens is that the orthodontist is going to say, we'll never get your teeth to fit if you don't keep your tongue out of there. In reality, It's not about the maxillary anterior teeth falling down too much. It's about the molars over-erupting and causing the mandible to rotate open and increase the lower face height. Those upper anterior teeth are way too far down. They don't need to come down further. They show this massive amount of gum tissue, which is not aesthetic. Surgically, you can change this, and that's what's been done here. And this is what she looks like 1 year post-surgery. But let's look at her face from the side. Double jaw surgery required, maxilla brought forward, the posterior aspect brought down, and a counterclockwise rotation of the occlusal plane, and you can get that kind of a nice correction in the facial balance. And from the front, you can see the gummy smile disappears as the maxilla is properly positioned upward. Upward, remember that, upward and forward in the face. in the long face individual. Now, let's look at a child, and can we reduce her face height? Look at her face height, how much dramatically increased the lower face height is. This is a very long lower face, and her flattened chin shows us that she's a chronic mouth breather with a lot of muscle strain necessary to get her lips together. She basically has her mouth hanging open all the time. With orthotropics, we're able to change that and develop the entire maxilla forward, and decrease the face height in the process through a very interesting technique which we teach in our orthotropic mini residency. If you want to look at it from the side, you can go from the left, pretreatment, to the right. You can see how a dramatically increased face height can be decreased without any type of surgery whatsoever, but we have to be treating the patient under age 10 to make this happen. So there you have it, diagnostic criteria, facial height proportion, and the long face patients present much more frequently for treatment for airway issues. The point is, we'd like to not have anybody develop the long face, and that's what orthotropics is all about trying to do.
