How will the extraction of 4 premolars for braces affect my facial profile?

Doctor's Answers (2)

Extraction of premolars is often needed during braces treatment to create space to either :

1. relief crowding 

2. correct protrusion (teeth look like they slant forwards), lips are hard to close as a result of the protrusion

3. a combination of 1 and 2

If there is severe crowding and a lot of space is needed to correct the crowding, there will be little space remaining to push the teeth inwards and hence your facial profile may not change much after treatment. 

If the extraction is to correct teeth protrusion, the extraction spaces will be used to draw both the upper and lower teeth inwards and backwards. This will also allow the lips to close better around the teeth, thus improving the facial profile of the lips.The amount of soft tissue response is variable, for some individuals with thin lips the effect of correcting the teeth protrusion and lips falling backwards is quite obvious. While for others where their lips may be thicker, the change in the lips may not be quite as obvious as it is masked by the overlying thickness of the soft tissue.

It is best to consult your doctor on what you hope to achieve with braces treatment and discuss the effects that he/she may anticipate to your facial profile based on your current teeth position.

Hope this helps and all the very best,

Dr Priscilla Lu


Thanks for the question. I understand your concerns about your profile change after braces treatment because of 4 premolar extraction. 


In braces, 4 premolar extraction is normally required for crowding or protrusion (Upper or Lower or Upper & Lower) cases. 


1. If you already have nice profile + not much of crowding, then you may be able to expect some change of your profile, but it depends on lip thickness or facial profile like (rectangular or long profile) 

But if you have much of crowding, then there would not be much of change in profile as extracted spaces will be used for teeth alignment, which will not give much of shift of front teeth. 


2. If you have protruded profile + not much of crowding, profile will be changed at certain amount but profile will be nicer. This is because upper & lower front teeth will be retracted during braces treatment. you would be able to see improvement in profile. 


But, if you have much of crowding, then may not be able to see much of change in profile as extracted space will be used for teeth alignment correction not retract the front teeth. 


These are simple information about profile changes because of premolar extraction but it really depends on indivisual like soft tissue thickness, teeth size,  facial profile and skeletal relationship etc. 


Nowadays, TAD (Temporary Anchorage Devices) is useful method for braces treatment to give better outcome & shorten the treatment period. Please feel free to leave any questions if there are. 


Warm regards,

Thanks so much. 

Ryan (Dr) 

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