(a–f) The use of an external elastic force to reduce premaxillary protrusion. (a, b) The protruding premaxilla extends forward in the facial profile. (c) Head bonnet with attached elastic placed against the protruding premaxilla causes it to ventroflex with the fulcrum at the premaxillary vomerine suture. (d, e) Facial photographs at 3 years of age. The lateral lip elements are united with the medial positioned prolabium over the protruding premaxilla in one stage. Because the premaxilla is already ventroflexed at the time of surgery, there is reduced ­muscle tension at the suture sites. (f) Intraoral photograph shows excellent anterior and buccal occlusion even with bilateral deciduous cuspids in crossbite. Comment: A severe overbite or overjet with a buccal crossbite at this age does not create a functional dental problem or inhibit palatal growth. Midfacial protrusion is expected and even desirable at this age. A straight profile in the mixed dentition usually indicates a concave profile will develop in adolescence after the pubertal growth spurt