Bimaxillary retrusive face: when the face needs more support
The teeth may fit well. In the details, the face tells another story.
What a bimaxillary retrusive face is like
In a bimaxillary retrusive face, the upper and lower jaw both lacked development. Because they grew in proportion to each other, the teeth often fit, and that's why it goes unnoticed (we cover it in What if my bite is fine?). What shows is the support: the bones are the base that the lips, cheeks, nose and chin rest on, and when that base is smaller, the face doesn't look its age.
In some people it looks more childlike: a small face, a discreet chin and lips that project little. In others it looks older: folds appear earlier, the angle between the chin and the neck is less defined and the nose seems more prominent than it is, as if the face had aged ahead of time.
What you notice and what you feel
Aesthetic: a profile with little projection, thin lips with little support, a discreet chin and teeth that barely show, hidden behind the lip when you talk or smile. The folds beside the nose and mouth appear earlier, and the chin and neck blend together.
Functional: the tongue, the muscles attached to the jaws and the airway have less room. During sleep, when the muscles relax, that space can close, bringing snoring, sleep that isn't restful or tiredness when you wake up. These signs aren't a diagnosis: sleep apnea is confirmed with a sleep study (polysomnography) and other tests. But they are a reason to look at your case carefully.
Oral: the teeth fit, but in the details it's another story: they're often crowded or tipped to make up for the lack of room, and wear appears. The joints can be affected too (TMD).
Postural: to open up breathing room, the head tends to move forward and the neck to stretch. The tongue rests low and breathing often ends up through the mouth.
How it's treated
There's no single formula. Each case is decided individually, based on what your diagnosis shows, what you prefer and what the team sees for your situation. Most often, the foundation is orthodontics and surgery working together: your teeth, and how they fit, are the key that makes everything come together and stay in place, and surgery brings the structure into an optimal, harmonious position. In a bimaxillary retrusive face, when the plan calls for it, the upper and lower jaw are brought forward together: the tongue and the airway gain room, and the lips, nose and chin regain their support. In many cases there's a rejuvenating effect, a kind of reverse facelift: the tissues are supported from within again. Depending on the case, other specialties or facial procedures are added. Everything is planned beforehand on a digital twin of your face; the full path is in The process.
If your bite fits but your profile, your smile or your sleep leave you with questions, it's worth looking at the whole picture.
Frequently asked questions
What is bimaxillary retrusion?
It's when the upper and lower jaws both lacked development at the same time. It usually shows as a profile with little projection, lips with little support, teeth that barely show when you smile and, often, a face that looks older than it is. It's diagnosed comprehensively, looking at the whole face and not just the bite.
Can I have bimaxillary retrusion if my bite is fine?
Yes. Because both jaws lacked development at the same time, the teeth can fit together well, and that's why it often goes unnoticed. The evaluation looks beyond the bite: the support of the face, the smile, the airway and the harmony of the profile. We explain this in "What if my bite is fine?".
Why do my teeth show so little?
Because the base that holds them developed less, so the teeth stay hidden behind the lip when you speak or smile. It isn't an issue with the teeth themselves. By bringing the upper and lower jaws into a harmonious position, the plan aims for your smile to blend naturally with your face.
Is bimaxillary retrusion related to sleep apnea?
It can be, because the tongue and the airway have less room, and snoring is a sign worth looking into. Not every case of bimaxillary retrusion leads to sleep apnea: it's confirmed with a sleep study (polysomnography) and other tests, and we work as a team when the case calls for it. When properly indicated, moving the jaws forward is the surgery with the greatest impact on obstructive sleep apnea.
Can it be corrected with a genioplasty?
A genioplasty works on the chin and, in some cases, it's enough for what the person is looking for. But in bimaxillary retrusion, what was missing was development of the upper and lower jaws, so the chin is only one part: the room and support for the rest of the face depend on that base. We look at it case by case, with the advantages and limits of each option.
Will I look very different?
You'll look like you, with more support. In many cases the face looks more rested and youthful, because the lips, nose and chin rest on their base again; every face responds in its own way. During virtual planning, we review together where we're headed, before surgery, so there are no surprises.
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