Many years ago, an orthodontic colleague referred a patient to me for extraction of four premolars. His orthodontic plan was to retract the front teeth back. However, when I asked the patient what made her sought orthodontic treatment in the first place, she said that she found her upper front teeth too protruding and that she was unable to close her lips. Looking at her face, even without smiling, most of her upper incisors could be seen. She had difficulty closing her lips, which were pushed outwards due to the protruding jaw bones. I called the orthodontist to share with him my view that this case was best treated with orthognathic surgery rather than braces alone. He agreed with me but thought that the patient would not accept surgery. That day, instead of extracting her four premolars, I explained the option of orthognathic surgery to correct her condition instead. Eventually, after due consideration, she decided to have surgery instead. I referred her back to her orthodontist for pre-surgical orthodontics and she came back after a year for the surgery.