Vertical Problems: The Long Face

Vertical evaluation of the face relies on perception rather than on measurements, since the “impression of short or long” is what matters. There are four components causing vertical problems: maxillary height, chin height, bite, and the transverse dimension of the face. Short faces need lengthening by means of clockwise maxillomandibular rotation and maxillary downgrafting, which are the typical movements associated with correction. Long faces, indeed, often do not need shortening but instead a redistribution of components. In the case of shortening of a long face, compensation should be achieved by anterior projection. Specifically, in relation to gummy smile, careful analysis is required to determine which of the three causes (vertical maxillary excess, lip hypermobility, and altered passive eruption) are implicated. Besides, the labiomental fold is often absent in long faces because of a lack of incisor torque and/or a receded chin.