Impact of Surgical Orthodontics on Facial Attractiveness and Perceived Age

Orthodontic treatment involving orthognathic surgery has become a widely used combined treatment approach in correcting severe dentofacial discrepancies. Motivation to undergo treatment is often influenced by expectations that surgery will lead to improved function and facial esthetics. While the functional and occlusal benefits of surgical orthodontics are readily quantifiable, esthetic improvements after surgery are difficult to evaluate numerically. This study was designed to investigate the relationship between surgical orthodontics and the perceived facial attractiveness and estimated age of surgically-treated patients. Evaluations were completed by a panel of orthodontists and laypersons using a series of pre-surgical and post-surgical facial photographs. The patients studied consisted of individuals treated surgically at the University of Illinois at Chicago (UIC) College of Dentistry and affiliated hospitals. The orthodontic component for all patients was completed either by UIC orthodontic residents, or by non-UIC orthodontists in private practice. Patients with concave soft tissue profiles who had undergone either single-jaw or double-jaw orthognathic surgery were included in this study. Patients with craniofacial anomalies or syndromes were excluded from the sample. Pre-treatment and post-treatment facial photographs in three views (frontal at repose, frontal when smiling, profile) were gathered for all eligible individuals. 17 total subjects, both male and female, were included in the study. Patient ages at the pre-surgical timepoint ranged from 15 to 25. Pre-surgical and post-surgical photographs were de-identified, randomized, and evaluated by a panel of 10 orthodontist and 10 laypersons who were not involved in the treatment of any patients in the sample. Evaluations for two criteria, facial attractiveness and perceived age, were judged by each evaluator on a visual analog scale. Each evaluator completed the assessment twice in order to evaluate for consistency in ratings. Results showed that scores for both facial attractiveness and perceived age were highly consistent among each evaluator for both sittings. Patients were rated significantly higher in facial attractiveness in the post-surgical timepoint as compared to the pre-surgical timepoint for both evaluator groups. Ratings from orthodontists and laypersons showed average post-surgical attractiveness improvements of 52.7% and 27.3%, respectively. No significant changes in the perception of age were found to occur as a result of surgical treatment. On average, the perceived age change for both orthodontists and laypersons was less than the actual time elapsed between pre-surgical and post-surgical photographs. Our results suggest that perception of age is a very complex variable, showing significantly greater variability between evaluators and within the same evaluator as compared to facial attractiveness assessments. Isolating the effects of surgical treatment on perceived age from the natural aging process is a challenging endeavor.