In growing children, where the upper jaw is underdeveloped or held back relative to the lower, facemask therapy offers a non-surgical way to advance the upper jaw forward using the child’s own growth potential.
This is a treatment that is only effective in growing children. The window for facemask therapy is limited; it is most effective before the mid-facial growth plates begin to close, typically before the age of 10, though selected cases can be treated successfully up to the early teenage years. Once growth is complete, the same correction requires surgical intervention. Acting within this window can make a profound difference to the outcome and potentially avoid surgery altogether.
In most children, facemask therapy is used in combination with palatal expansion. There are two reasons for this.
First, many children with a class III bite also have a narrow upper arch; widening the palate simultaneously with protraction addresses both the transverse and the anteroposterior dimensions of the jaw relationship.
Second, separating the midpalatal suture through expansion loosens the bony sutures of the mid-face, making the upper jaw more responsive to the forward protraction forces of the facemask. The combination of expansion and protraction produces more consistent and significant forward movement of the upper jaw than protraction alone.
In selected cases, MARPE combined with a facemask can be used in older children where the suture is less responsive, delivering the expansion needed to mobilise the suture before forward protraction is applied.
If your child has an underbite, a class III bite, or a flat mid-face, an early specialist assessment is important. Book an appointment at Lusk Orthodontics to find out whether facemask therapy is appropriate and whether your child is still in the optimal treatment window.
In a growing child with a skeletal class III pattern driven by an underdeveloped upper jaw, facemask therapy can:
Following the active facemask phase, the child typically wears a retaining appliance to maintain the correction achieved while growth continues. In most cases, comprehensive orthodontic treatment with fixed braces or aligners is carried out in the teenage years to align the teeth and finalise the bite once the permanent dentition has fully erupted.
5.0
We highly recommend Dr Erfan Sallom. He transformed our daughter’s teeth, and she’s extremely happy with her beautiful smile! We were looking for an Orthodontist who had a reputable history, gave excellent results, held high standards, was kind and gentle, and that is what we got. She didn’t have to get any teeth removed, which was a bonus. Really appreciated the individual time, updates, never felt rushed, and a personable approach. Thank you, Erfan. – Georgina
5.0
I was very anxious about orthodontic treatment and, as such, delayed it for years. I did not need to be nervous with the expertise and professionalism of Erfan. He was very motivational and ensured I achieved an excellent result. I am now extremely happy with my smile. I would not hesitate to recommend him to anyone. – Ciara K
5.0
I would really recommend anyone to Dr Erfan Salloum. My experience with Erfan was amazing. I had no issue; he was very knowledgeable about his work and was always happy to explain the next steps with my treatment and concerns, or answer any questions about my treatment plan, etc!
I would recommend Erfan to anyone, there’s no safer hands to be in than Erfan for sure! – Martin R
5.0
I have just finished my two-year orthodontic treatment with Dr Erfan, and I would highly recommend him. He explained everything perfectly about the treatment plan, and I was always treated with great care. You are in good hands! Many thanks. – Julie P
5.0
I would highly recommend Dr Erfan from start to finish. He took the time to make the entire process for our daughter as easy as possible. We are delighted with the results & she has received many compliments on her beautiful smile. – Caroline C
5.0
I’m very happy with my treatment and results. I was delighted with Dr Erfan Salloum’s attention to detail, and so happy he took the time to make sure everything was perfect. Thank you. – Orlaith D
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My daughter has been under the care of Dr Erfan Salloum for the past three years, as she had a lot of work to be done. She has had braces removed, and the result is stunning. We are thrilled about how well everything went. – Elizabeth G
5.0
Absolutely delighted with my results. Thank you to Dr Erfan and his team for taking care of me so well! Treatment lasted 24 months, and it was so worth it. Would recommend it to everyone! – Ang
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Everyone was very nice and professional, and Dr Erfan Salloum did a great job with my braces. – Matthew C
5.0
I am very grateful to Dr Efran Salloum for taking the time to do a free video consultation with me to discuss my issue. He listened attentively to my concerns, offered insight and advised me of a range of clear options to explore for my particular issue (which concerns narrow airways). I very much appreciated his expertise, which he conveyed with kindness and without expectation. I would highly recommend Dr Efran for his expert knowledge and professionalism. – Shelagh S
5.0
My daughter had a great experience, thrilled with the results. She was treated very well at every appointment and now has a gorgeous smile thanks to Erfan and the team. – Auds C
5.0
Incredibly happy with my experience with Dr Erfan. He was a pleasure to deal with throughout the process, explained everything clearly, offered all support needed, and the results have been absolutely perfect. Ultimately, I can’t recommend Dr Erfan highly enough. He and his team are incredibly professional and highly skilled, so you’ll be in safe hands throughout your treatment. – Laurence W
5.0
We highly recommend Dr Erfan Sallom. He transformed our daughter’s teeth, and she’s extremely happy with her beautiful smile! We were looking for an Orthodontist who had a reputable history, gave excellent results, held high standards, was kind and gentle, and that is what we got. She didn’t have to get any teeth removed, which was a bonus. Really appreciated the individual time, updates, never felt rushed, and a personable approach. Thank you, Erfan. – Georgina
5.0
I was very anxious about orthodontic treatment and, as such, delayed it for years. I did not need to be nervous with the expertise and professionalism of Erfan. He was very motivational and ensured I achieved an excellent result. I am now extremely happy with my smile. I would not hesitate to recommend him to anyone. – Ciara K
5.0
I would really recommend anyone to Dr Erfan Salloum. My experience with Erfan was amazing. I had no issue; he was very knowledgeable about his work and was always happy to explain the next steps with my treatment and concerns, or answer any questions about my treatment plan, etc!
I would recommend Erfan to anyone, there’s no safer hands to be in than Erfan for sure! – Martin R
5.0
I have just finished my two-year orthodontic treatment with Dr Erfan, and I would highly recommend him. He explained everything perfectly about the treatment plan, and I was always treated with great care. You are in good hands! Many thanks. – Julie P
5.0
I would highly recommend Dr Erfan from start to finish. He took the time to make the entire process for our daughter as easy as possible. We are delighted with the results & she has received many compliments on her beautiful smile. – Caroline C
5.0
I’m very happy with my treatment and results. I was delighted with Dr Erfan Salloum’s attention to detail, and so happy he took the time to make sure everything was perfect. Thank you. – Orlaith D
5.0
My daughter has been under the care of Dr Erfan Salloum for the past three years, as she had a lot of work to be done. She has had braces removed, and the result is stunning. We are thrilled about how well everything went. – Elizabeth G
5.0
Absolutely delighted with my results. Thank you to Dr Erfan and his team for taking care of me so well! Treatment lasted 24 months, and it was so worth it. Would recommend it to everyone! – Ang
5.0
Everyone was very nice and professional, and Dr Erfan Salloum did a great job with my braces. – Matthew C
5.0
I am very grateful to Dr Efran Salloum for taking the time to do a free video consultation with me to discuss my issue. He listened attentively to my concerns, offered insight and advised me of a range of clear options to explore for my particular issue (which concerns narrow airways). I very much appreciated his expertise, which he conveyed with kindness and without expectation. I would highly recommend Dr Efran for his expert knowledge and professionalism. – Shelagh S
5.0
My daughter had a great experience, thrilled with the results. She was treated very well at every appointment and now has a gorgeous smile thanks to Erfan and the team. – Auds C
5.0
Incredibly happy with my experience with Dr Erfan. He was a pleasure to deal with throughout the process, explained everything clearly, offered all support needed, and the results have been absolutely perfect. Ultimately, I can’t recommend Dr Erfan highly enough. He and his team are incredibly professional and highly skilled, so you’ll be in safe hands throughout your treatment. – Laurence W
The founder and the specialist orthodontist at Lusk Orthodontics. He is a winner of the British Orthodontic Society's Maurice Berman Prize for clinical excellence, with a particular interest in complex orthodontic treatment,…
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“We highly recommend Dr Erfan Sallom. He transformed our daughter’s teeth, and she’s extremely happy with her beautiful smile! We were looking for an Orthodontist...”
“I was very anxious about orthodontic treatment and, as such, delayed it for years. I did not need to be nervous with the expertise and...”
“I would really recommend anyone to Dr Erfan Salloum. My experience with Erfan was amazing. I had no issue; he was very knowledgeable about his...”
“I have just finished my two-year orthodontic treatment with Dr Erfan, and I would highly recommend him. He explained everything perfectly about the treatment plan,...”
A facemask (also called a reverse pull headgear or protraction facemask) is an orthodontic device worn externally, resting against the forehead and chin, with elastic bands that attach to hooks inside the mouth, typically to a palatal expander or fixed appliance inside the upper arch. The elastics apply a gentle forward force to the upper jaw, stimulating its forward growth and bone remodelling at the mid-facial sutures.
The device is worn at home, typically for 12 to 16 hours per day, including during sleep and is removed for school, sport, and social occasions. Because it is worn mainly at home, most children find it more acceptable than it might initially appear.
Facemask therapy is most effective between the ages of 7 and 10, when the mid-facial sutures are most responsive to protraction forces. Selected cases can still benefit up to approximately 12–13 years. An assessment will determine whether your child is still in the effective window.
No — the facemask is worn at home and during sleep. Most children wear it in the evening and overnight, which achieves the necessary hours of wear without any impact on school or social life.
Facemask therapy significantly reduces the severity of the skeletal discrepancy and, in milder cases, can correct it sufficiently that surgery is not needed. In more significant cases, surgery in adulthood may still be the best long-term option — but the extent of correction required will be less, and the outcome better, than if no early treatment had been undertaken.
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