Orthodontics and profile change: when to wait for HOF

Many facial harmonization patients are in orthodontic treatment or have just finished. They arrive excited because "now my teeth are aligned" and want to finish the job with lips and chin. The question is: has the face finished changing? Orthodontics moves teeth, and teeth support lips. When the teeth move, the profile changes, and a volume placed earlier may end up out of balance later.

This page guides when to bring HOF in, the reassessment of the profile and integration with the orthodontist. For profile reasoning, see also orthodontics and facial profile in HOF and HOF plan after orthodontics.

How does orthodontics change the profile?

The lips rest on the teeth and the alveolar bone. Orthodontic movements that retract the incisors, as in treatments with extractions, tend to reduce lip support and alter the nasolabial angle. Movements that project the teeth can project the lip. Expansion, space closure and bite correction also affect the relationship with the nose and chin.

The effects vary greatly from case to case, and there is no general rule that spares you from examining the profile after the change.

When to wait and when to integrate

The safest approach is usually to wait for the profile to stabilize. Placing lip or chin filler during a movement that will change support can lead to two problems: disproportionate volume after the teeth are retracted, or the need to dissolve the product earlier than planned. There are exceptions, and the decision is made case by case, preferably agreed with the orthodontist.

Some situations in which integration helps:

• Event with a set date: a patient who wants discreet volume before graduation. Plan with caution and inform the orthodontist.
• Concern independent of the movement: for example, nasolabial fold or under-eye hollow, which do not depend on the teeth.
• Stable retention phase: the profile has already changed and the measurements can be used.

See thin lip and visible gum as an example of a concern in which dentistry enters the decision.

What to reassess after orthodontics

When the braces come off and the profile stabilizes, it is worth repeating the assessment as if it were the first. The face may have changed in a way that old concerns disappeared and new ones appeared.

• Lips: thickness, projection and relationship to the esthetic line, after the new dental support.
• Chin: projection relative to the lower lip and the nose, especially after jaw movements.
• Lower third: height and proportion, which can change with bite corrections. See disproportionate lower third and open bite and appearance.
• Smile: incisor and gum display, buccal corridor. See smile analysis in HOF.
• Skin and laxity: weight loss associated with the treatment may have changed the face.

Also reassess the patient's concern in her own words. Aligning the teeth changes self-image, and what bothered her before may no longer matter.

The role of the team

Integration between HOF and dentistry is part of the care. Exchange information with the orthodontist: what was planned for the profile, which movements remain, when the treatment ends and whether orthognathic surgery is planned. If there is surgery, wait for recovery and for the swelling to settle. See HOF integrated with dentistry and referring patients in HOF.

Safety

If you use hyaluronic acid in lips or chin, keep hyaluronidase available and know the local vascular anatomy, such as the labial and submental arteries. Possible complications include swelling, bruising, asymmetry, nodules and, rarely, vascular occlusion. In patients with fixed braces, watch for gum bleeding and hygiene care after the procedure. See dental treatment and filler.

Simulation and expectations

Harmy starts from the frontal photo and simulates volume in Lips and Chin. It does not simulate tooth movement, does not show the profile and does not predict how the face will look after orthodontics. Use it only to discuss the effect of volume in areas that can be marked, making clear that the profile change from orthodontics is another variable. The image is illustrative, in 2D.

Summary for the decision

Orthodontics moves lip support and the profile, and HOF should wait for that change to settle, always talking to the orthodontist. After stabilization, reassess everything as if it were the first consultation, with profile photos and measurements. Plan conservative volumes and record the integration with dentistry. Everything at the discretion of the qualified professional, in line with the rules of their professional council in Brazil, without promising results.