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Background and Objectives : Facial symmetry is a key component of facial beauty and attractiveness. However, perfect symmetry is rare, and slight asymmetries, also known as natural asymmetries, are common and contribute to the uniqueness of each face. The perception of facial asymmetry varies among individuals and can be influenced by several factors. This study aimed to investigate the self-perception of dento-facial asymmetry among a sample of Romanian individuals, focusing on their awareness, the extent to which it bothers them, and their desire for correction. Materials and Methods : A cross-sectional analytical study was conducted with 283 participants from Romania between January and February 2024. Participants completed a questionnaire designed to assess their self-perception of facial asymmetry and socio-demographic characteristics. The questionnaire included 10 questions on self-perception of facial asymmetry and 8 questions on socio-demographic data. Statistical analysis was performed using SPSS 26.0, and the Pearson Chi-square test was used for comparative analysis. Results : The sample was predominantly female (75.3%) with an average age of 32.24 years. Most participants were from urban areas (80.6%) and had university degrees (58.7%). About 28.7% of participants observed facial asymmetry, with dental asymmetry being the most frequently reported, followed by asymmetries in the eyebrows and eyelids. The right side of the face was more commonly perceived as asymmetric. Although 24.4% of participants were bothered by their asymmetry, 39.2% expressed a desire to correct it. Conclusions : One-third of participants identified dento-facial asymmetry, with the dental level being the most reported. A significant portion of participants expressed a desire to correct their asymmetries, highlighting the importance of understanding self-perception in the context of facial aesthetics. This study underscores the subjective nature of facial asymmetry perception and the varying thresholds for what is considered bothersome or in need of correction.

Objectives: To investigate the influence of vertical facial type on esthetic perception of lower facial asymmetry as evaluated by orthodontists, dentists, and laypeople., Materials and Methods: Three adult females were selected with normal growth patterns (NGP), vertical growth patterns (VGP), and horizontal growth patterns (HGP). Frontal photographs were made symmetric and digitally altered, rotating the lower facial third clockwise, ranging from 0° to 6° in 1° increments. A web-based survey was designed with 24 images (eight images for each model) in random order. Each image was rated using a scale ranging from 0 (unattractive) to 10 (the most attractive) by 75 orthodontists, 73 dentists, and 78 laypeople. Kruskal-Wallis test was used to determine whether differences among groups were significant. Pairwise comparisons were made with Mann-Whitney U test. The significance level was set at P = .05., Results: In NGP, orthodontists and dentists could recognize slighter deviations (2°), while deviations in VGP and HGP under 3° were not recognized by all groups. Severe deviations (≥4°) were distinguished better in HGP by orthodontists and laypeople. In VGP and NGP, there was no significant difference over 4°., Conclusions: Growth pattern has a significant influence on perception of lower facial asymmetry. Less severe asymmetry can be detected better in NGP. In severe degrees, increments of asymmetry can be perceived more in HGP by orthodontists and laypeople., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

Atypical facial morphology, particularly increased facial asymmetry, has been identified in some individuals with Autism Spectrum Conditions (ASC). Many cognitive, behavioural and biological features associated with ASC also occur on a continuum in the general population. The aim of the present study was to examine subthreshold levels of autistic traits and facial morphology in non-autistic individuals. Facial asymmetry was measured using three-dimensional facial photogrammetry, and the Autism-spectrum Quotient was used to measure autistic-like traits in a community-ascertained sample of young adults (n = 289). After accounting for covariates, there were no significant associations observed between autistic-like traits and facial asymmetry, suggesting that any potential facial morphology differences linked to ASC may be limited to the clinical condition.

Background: Limited data are available regarding observers' visual attention to faces with congenital difference. We implemented eye tracking technology to examine this issue, as it pertains particularly to faces with cleft deformity., Method: Four hundred three observers assessed 273 clinical images, while their eye movements were unobtrusively tracked using an infrared sensor. Forty-one facial images of the repaired cleft lip, 137 images of other facial conditions, and 95 images of matched controls were assessed. Twenty facial regions of interest ("lookzones") were considered for all images observed. A separate cohort of 720 raters evaluated the images for attractiveness. Observer and image demographic information was collected. Visual fixation counts and durations were computed across all 20 lookzones for all images. The effect of a variety of variables on lookzone fixation was analyzed using factorial ANOVA testing., Results: Cleft-repaired faces were rated as less attractive and drew observers' attention preferentially to the affected upper lip lookzone (p<.001). Images rated as less attractive garnered greater visual attention in the cleft-affected lookzones (p<.001). The eye tracking methodology demonstrated exquisite sensitivity to laterality of cleft deformity (p<.001). Individuals reporting a personal or a family history of facial deformity fixated more on the perioral region of cleft-repaired faces than did naïve observers (p<.001)., Conclusion: These findings highlight the utility of eye tracking measures for understanding critical variables that influence the visual processing of faces with cleft deformity. The data may provide analytical tools for assessing surgical outcome and direct priority setting during surgeons' conversations with patients., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: This study aims to understand the degree to which ptosis is recognizable to a layperson., Methods: Fifteen color drawings of a gender-neutral human face were created. Six faces exhibited right-sided ptosis (decreased margin reflex distance 1 and lengthened tarsal platform show) of 0.5 mm, 1 mm, 1.5 mm, 2 mm, 2.5 mm, and 3 mm, respectively. Six more faces exhibited left-sided ptosis of the same amounts. The 12 ptotic faces and 3 symmetrical faces were randomly placed on three 11-inch by 14-inch sheets of paper with 5 faces on each page. Lay observers were provided 6 seconds per face to indicate whether it appeared to be asymmetrical. Statistical tests examined the observers' ability to detect asymmetry better than chance. Sex differences in correctly recognizing asymmetry in ptosis at each 0.5 mm increment were analyzed., Results: One hundred thirty-one lay observers were enrolled in the study. Fifty-seven were women and 74 were men. Lay people were able to correctly recognize ptosis better than chance when the asymmetry was 1.5 mm or greater. Moreover, females were more accurate in recognizing ptosis at 1.5 mm, 2.0 mm, and 2.5 mm of asymmetry., Conclusions: Lay observers tend to recognize between 1.0 mm and 1.5 mm of ptosis on one side as being abnormal. This may have implications in the selection of candidates for ptosis surgery and the analysis of subsequent surgical outcomes.

Objective: Lip asymmetry after a unilateral cleft lip repair can be perceived as an unsatisfactory result. The objective of this study is to determine the degree of upper lip asymmetry and/or nasal alar hooding required for recognition of asymmetry in a simulated model of unilateral cleft lip., Design: A model of unilateral cleft lip was created using digital morphing software to simulate asymmetries in vermilion height and nasal hooding in photographs of children. Volunteers were shown photographs for different time intervals and with varying degrees of asymmetry. Ability to detect facial asymmetry was recorded and analyzed., Setting: This study was conducted by surveying layperson volunteers in public community settings., Participants: 108 layperson volunteers were randomly surveyed., Main Outcome Measures: The primary outcome measure was a reported lip or nose asymmetry by the volunteers. Proportions and corresponding 95% confidence intervals were obtained to estimate the probability of reporting an asymmetry at 3- and 10-second intervals., Results: After 3- and 10-second exposure, labial asymmetry was perceived by ≥50% of subjects at 2 mm (62%, P = .001) and 1 mm (89%, P < .0001), respectively. Nasal asymmetry was detected by <50% of subjects at 3 seconds, but ≥50% perceived a 3-mm alteration at 10 seconds (64%, P < .0001). Photographs with combined nasal and labial modification did not lower the threshold for asymmetry perception compared to either deformity alone., Conclusions: This study is the first to determine a predictable millimeter threshold for perceived asymmetry in cleft lip deformity using a digital model.

Aim and Objectives: To analyze the relationship between subjective and objective evaluations of pre-treatment posed smiles in patients with facial asymmetry and to assess the influence of dentofacial structures involved in asymmetry on the perception of smile attractiveness., Sample: Thirty-five patients (25 males and 10 females) between 18 and 25 years of age with facial asymmetry were selected., Materials and Methods: Pre-treatment clinical photographs of posed smiles were subjectively evaluated by a panel of 20 orthodontists, 20 oral surgeons, and 20 laypersons. A customized Smile Mesh program was used for objective evaluation of the same smiles. Direct comparison among three smile groups (unattractive, slightly attractive, and attractive) for different Smile Mesh measurements was carried out using two-way anova test. Additionally, linear regression was performed to evaluate whether these measurements could predict the attractiveness of captured smiles., Results: Patients with 'slightly attractive' smiles had a significantly greater distance between the incisal margin of the maxillary central incisor and the lower lip during smiling. The Smile Index was significantly greater in attractive smiles. However, based on the coefficients of linear regression, no objectively gathered measurement could predict smile attractiveness., Conclusions: Attractiveness or unattractiveness of smiles in patients with facial asymmetry could not be predicted by any measurement of Smile Mesh. The presence of facial asymmetry did not significantly influence the perception of smile esthetics., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Facial attractiveness is an important factor in our social interactions. It is still not entirely clear which factors influence the attractiveness of a face and facial asymmetry appears to play a certain role. The aim of the present study was to assess the association between facial attractiveness and regional facial asymmetries evaluated on three-dimensional (3D) images., Methods: 3D facial images of 59 (23 male, 36 female) young adult patients (age 16-25 years) before orthodontic treatment were evaluated for asymmetry. The same 3D images were presented to 12 lay judges who rated the attractiveness of each subject on a 100mm visual analogue scale. Reliability of the method was assessed with Bland-Altman plots and Cronbach's alpha coefficient., Results: All subjects showed a certain amount of asymmetry in all regions of the face; most asymmetry was found in the chin and cheek areas and less in the lip, nose and forehead areas. No statistically significant differences in regional facial asymmetries were found between male and female subjects (P > 0.05). Regression analyses demonstrated that the judgement of facial attractiveness was not influenced by absolute regional facial asymmetries when gender, facial width-to-height ratio and type of malocclusion were controlled (P > 0.05)., Limitations: A potential limitation of the study could be that other biologic and cultural factors influencing the perception of facial attractiveness were not controlled for., Conclusions: A small amount of asymmetry was present in all subjects assessed in this study, and asymmetry of this magnitude may not influence the assessment of facial attractiveness., (© The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Fluctuating asymmetry is the stochastic, minor deviation from perfect symmetry in bilaterally symmetrical organisms. It reflects the limit of developmental precision. Such a precision can be influenced by various factors, both internal (genetic mutations, stochastic variation at every levels of development) and external (environmental influences). Fluctuating asymmetry has receive an extreme attention for the past few decades, that culminated in the 90s: it has been used as an estimator of heterozygosity, fitness, environmental stress, and widely applied to human biology, sociobiology and psychology before being more or less discredited in the early 2000s. The reasons for such an extreme popularity and then disgrace are discussed here. Far from suggesting to abandon the study of fluctuating asymmetry, we indicate some of the most promising research avenues. ‡., (© 2016 médecine/sciences – Inserm.)

Objective: The aim of this study was to assess the degree of perception of occlusal plane inclination and mandibular deviation in facial esthetics, assessed by laypeople, dentists and orthodontists., Methods: A woman with 5.88° of inclination and 5.54 mm of mandibular deviation was selected and, based on her original photograph, four new images were created correcting the deviations and creating more symmetric faces and smiles. Examiners assessed the images by means of a questionnaire. Their opinions were compared by qualitative and quantitative analyses., Results: A total of 45 laypeople, 27 dentists and 31 orthodontists filled out the questionnaires. All groups were able to perceive the asymmetry; however, orthodontists were more sensitive, identifying asymmetries as from 4.32° of occlusal plane inclination and 4.155 mm of mandibular deviation (p< 0.05). The other categories of evaluators identified asymmetries and assigned significantly lower grades, starting from 5.88° of occlusal plane inclination and 5.54 mm of mandibular deviation (p< 0.05)., Conclusion: Occlusal plane inclination and mandibular deviation were perceived by all groups, but orthodontists presented higher perception of deviations.

Objectives: It has been postulated that symmetric faces are considered more attractive than asymmetric ones because symmetry may signal high quality due to developmental stability. However, other studies showed that both symmetric and slightly asymmetric faces are considered attractive. Here we aim to explore this discrepancy, beginning with the analysis of the normal prevalence of facial symmetry in a population as a necessary first step prior to any attractiveness assessment., Methods: We collected facial landmarks from two-dimensional digital images of a sample of Mexican individuals (280 females and 285 males aged 18-68 years) that were analyzed using geometric morphometric methods. Then, we chose a subsample of 100 photographs (50 females and 50 males aged 18-27 years) selected to represent a broad range of asymmetrical variation, in order to evaluate attractiveness using a sex-opposite test. Finally, we analyzed the linear correlation between attractiveness and asymmetry., Results: We found that every evaluated subject presents some degree of facial asymmetry, and that both fluctuating asymmetry and directional asymmetry were significant (P < 0.0001) components of total facial asymmetry. Fluctuating asymmetry was slightly associated with age (r = 0.0858, P = 0.0414) and there were no differences between geographical regions (P = 0.413). Attractiveness was not correlated to levels of asymmetry in either sex (males: P = 0.0973; females P = 0.7415)., Conclusions: Asymmetry was a prevalent feature in the present sample, and preferences for symmetric faces were not operating in the studied population., (© 2014 Wiley Periodicals, Inc.)

Objective: To investigate the perception of facial asymmetry in young adults to identify the amounts of chin asymmetry that can be regarded as normal and may benefit from correction., Materials and Methods: Three-dimensional (3D) images of 56 individuals of mixed ethnicity were obtained and used to produce average 3D images of male and female faces. Distortion was then applied to these average faces using a 3D graphics package to simulate different amounts of chin point asymmetry. Five observer groups (lay individuals, dental students, dental care professionals, dental practitioners, and orthodontists) assessed timed presentations of 3D images, rating them as "normal," "acceptable," or "would benefit from correction." Time-to-event analysis was used to assess the level of chin asymmetry perceived as normal and beneficial for correction for each group., Results: The factors influencing the perception of facial asymmetry were the degree of asymmetry and the observer group. Direction of the asymmetry and gender of the assessed individual did not affect the perception of asymmetry, except in the 4- to 6-mm distortion range. The gender of the observer had no influence on perception. There were statistically significant differences in the amounts of asymmetry that the laypeople and orthodontists considered to be normal (5.6 ± 2.7 mm and 3.6 ± 1.5 mm, respectively; P < .001) and felt would benefit from surgical correction (11.8 ± 4.0 mm and 9.7 ± 3.0 mm, respectively; P  =  .001)., Conclusions: Perception of asymmetry is affected by the amount of asymmetry and the observer group, with orthodontists being more critical.

This article highlights the authors' experience in the management of facial asymmetries with the use of distraction osteogenesis. It is a narrative based on the clinical experience at the Meenakshi Cleft & Craniofacial Center at Chennai.

Self-perception has been an enduring human concern since ancient times and remains a significant component of the preoperative and postoperative consultation. Despite modern technological attempts to reproduce the first-hand experience, there is no perfect substitute for human, stereoscopic, three-dimensional vision in evaluating appearance. Nowadays, however, the primary tools available to a patient for examining his or her own appearance, particularly the face, are photographs and mirrors. Patients are often unaware of how cameras and photographs can distort and degrade image quality, leading to an inaccurate representation of true appearance. Everyone knows that mirrors reverse an image, left and right, and most people recognize their own natural facial asymmetry at some level. However, few realize that emotions are not only expressed unequally by the left and right sides of the face but also perceived unequally by others. The impact and effect of this "facedness" is completely reversed by mirrors, potentially creating a significant discrepancy between what a patient perceives of himself or herself and what the surgeon or other third party sees. This article ties together the diverse threads leading to this problem and suggests several ways of mitigating the issue through technology and patient counseling.

Objectives/hypothesis: To quantify the threshold for human perception of asymmetry for eyebrow elevation, eye closure, and smile, and to ascertain whether asymmetry detection thresholds and perceived severity of asymmetry differ in distinct facial zones., Study Design: Online survey., Methods: Photographs of a female volunteer performing eyebrow elevation, eye closure, and smile were digitally manipulated to introduce left-to-right asymmetry in 1-mm increments from 0 mm to 6 mm. One hundred and forty-five participants viewed these photographs using an online survey, measuring accuracy of asymmetry detection and perceived expression unnaturalness (on a scale of 1-5)., Results: Photographs of facial asymmetries were correctly judged as asymmetrical over 90% of the time for 2 mm or more of asymmetry in eyelid closure, and 3 mm or more of asymmetry during smiling. Identification of eyebrow elevation asymmetry gradually rose from 23% correct to 97% correct across the range of 1 mm to 6 mm of asymmetry. Greater degrees of asymmetry were ranked as significantly more unnatural across all expressions (3 tests; X(2) (6, N = 145) = 405.52 to 656.27, all P <0.001)., Conclusion: Thresholds for asymmetry detection vary across different zones of the face; once detected, asymmetry in eyelid position is perceived as more unnatural than asymmetries in either brow elevation or smile. These data will inform counseling of patients with segmental facial weakness and may provide more objective goals for facial reanimation procedures., Level of Evidence: 4., (© 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Importance: In this study, we examined whether specific facial movements have different time-delay detection thresholds, and to what extent such side-to-side facial movement asymmetry affects subjective ratings of movement naturalness. Ratings of dynamic asymmetry in experimentally manipulated video recordings demonstrate that there are different side-to-side time-delay thresholds for distinct regions of the face, with a strong inverse correlation between naturalness rating and the length-of-time delay. These findings will be helpful for counseling patients with unilateral facial paralysis and guide the design of neural interfaces for facial reanimation., Objective: To determine the detection threshold of side-to-side facial movement timing asymmetry and measure its effect on perceived movement naturalness., Design, Setting, and Participants: Videos of 5 symmetrical facial movements (eye blink, rapid eyebrow raising, slow eyebrow raising, smiling, and lip depression) were edited to introduce 6 levels of side-to-side timing asymmetry, ranging from 33 to 267 milliseconds. Participants (N = 58) viewed video clips through an online survey service, indicating whether they noticed side-to-side asymmetry and judging movement naturalness on a 5-point scale., Results: There was a significant difference among facial movements in asymmetry detection threshold. There was a strong correlation between naturalness ratings and amount of delay across movements (R = 0.823), with greater asymmetry being judged as progressively less natural. Blink was judged as less natural at 33, 67, 100, and 133 milliseconds of side-to-side delay compared with all other movements (P < .005)., Conclusions and Relevance: Side-to-side asymmetry in blink timing is detected sooner and viewed as less natural compared with asymmetry of the eyebrow and lips. At 100 milliseconds of delay, nearly all movements are detected as asymmetric, although blink is judged as the least natural. These findings will help set timing goals for facial pacing technologies treating unilateral paralysis., Level of Evidence: NA.

Fluctuating asymmetry and averageness is correlated with our perception of beauty in human faces. Yet, whether deviations of centrality in the positioning of the eyes, the nose, and the mouth have different effects on our perception of asymmetry in a holistic human face, is still uncertain. In this study we aimed to test the relative effect of decentralising the horizontal position of three sets of paired dots representing eyes, nostrils, or mouth from the vertical midline of ambiguous dot figures, vaguely resembling a face. The figures were ranked according to perceived asymmetry by human observers. When associating the figures with non-facial objects (eg a butterfly), none of the figures' rank distribution differed from each other. However, when observers imagined the figures to represent a human face, the figure with the decentralised pair of dots representing the nostrils was significantly ranked as more asymmetric than the other figures. This result provides indications that the brain may deal with information about facial asymmetry and averageness heavily depending on the centrality of the nasal region.

In experiment 1, we examined developmental changes in the influence of symmetry on judgments of attractiveness by showing adults and children pairs of individual faces in which one face was transformed 75% toward perfect symmetry, while the other face was transformed by exaggerating its asymmetries by 75%. Adults and 9-year-olds, but not 5-year-olds, rated the more symmetric faces as more attractive than the less symmetric faces, although the effect was stronger in adults than 9-year-olds. The preference for symmetry was stronger for male than female faces, and stronger for adults' than children's faces. In experiment 2, comparisons of the symmetry of the original male and female faces revealed no measured differences but lower ratings by adults of symmetry in the male faces. Overall, the results suggest that the influence of symmetry on attractiveness judgments emerges after the age of 5 years, and matures after the age of 9 years. The stronger effects for adult viewers may reflect an increase in sensitivity to symmetry as experience with faces increases and/or as the visual system matures. As well, attractiveness may become more salient after puberty, so that honest signals of mate quality, such as symmetry, have a stronger effect for adult viewers, especially when judging adult faces.

The objective of this study was to evaluate the association between nasolabial symmetry and aesthetics in children with complete unilateral cleft lip and palate (CUCLP). Frontal and basal photographs of 60 consecutively treated children with CUCLP (cleft group: 41 boys and 19 girls, mean (SD) age 11 (2) years) and 44 children without clefts (control group: 16 boys and 28 girls, mean (SD) age 11(2) years), were used for evaluation of nasolabial symmetry and aesthetics. Nasal and labial measurements were made to calculate the coefficient of asymmetry (CA). The 5-grade aesthetic index described by Asher-McDade et al. was used to evaluate nasolabial appearance. Correlation and regression analysis were used to identify an association between aesthetics and CA, sex, and the presence of CUCLP. Ten measurements in the cleft, and 2 in the control, group differed significantly between the cleft and non-cleft (or right and left) sides, respectively. The significantly higher values of 9 of 11 CA in the children with CUCLP indicated that they had more asymmetrical nasolabial areas than children without clefts. However, the regression analyses showed that only a few CA were associated with nasolabial aesthetics. In conclusion, nasolabial aesthetics and nasolabial symmetry seem to be only weakly associated in patients with CUCLP., (Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objectives/hypothesis: To evaluate the impact of a crooked nose on observer perceptions of facial asymmetry and attractiveness and the ability of rhinoplasty to minimize it. We hypothesized that the presence of a crooked nose would penalize symmetry and attractiveness ratings as compared to normal faces. We further hypothesized that straightening rhinoplasty would restore symmetry and improve attractiveness., Study Design: Randomized controlled experiment., Methods: A group of 39 naïve observers viewed pictures of patients with crooked noses before and after straightening rhinoplasty, and normal patients. Observers rated the overall asymmetry and attractiveness, and the asymmetry of facial subunits using a survey with a rating scale of 1 to 10 for each category., Results: For asymmetry, patient group (preoperative, postoperative, normal) was statistically significant by multivariate analysis of the variance. Post-analysis of variance showed significant differences in asymmetry scores for overall, nose subunit, and mouth subunit. Pairwise testing then showed significantly different overall asymmetry scores between normal and preoperative (P < .001), and preoperative and postoperative (P < .001), but not between normal and postoperative (P = .215) groups. Mixed linear regression analysis showed that decreasing nasal asymmetry by 1 point increases attractiveness by 0.18 points or 0.082 attractiveness standard deviations (P < .001)., Conclusions: Faces with crooked noses were rated less symmetrical overall and less symmetrical at the nose and mouth subunits as compared to normal and postoperative faces. Straightening rhinoplasty diminished overall facial asymmetry and subunit asymmetry scores. Decreasing nasal asymmetry led to significant improvements in facial attractiveness. These data provide objective evidence supporting the idea that a straightening rhinoplasty can improve attractiveness., (Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.)

This article describes the surgical and orthodontic treatment of a 12-year-old boy with a significant deformity and functional involvement caused by hemifacial microsomia. The left mandibular ramus and condyle were hypoplastic and abnormal in form and location. The lower third of the face was increased, with mandibular retrusion and significant facial asymmetry. He had difficulties in speaking and chewing and problems related to his facial appearance, which caused severe psychosocial disturbances. The patient received orthodontic treatment and temporomandibular joint reconstruction with a costochondral graft on the left side while he was still growing. Three-year follow-up records are presented., (Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Purpose: The purpose of this investigation was to undertake an objective and quantitative evaluation of how severity of asymmetries affecting the mandible and chin point influence perceived attractiveness., Materials and Methods: The mandible and chin point of idealized male and female frontal facial images were altered in 5-mm increments from 0 to 25 mm and to the left and right, to represent horizontal, vertical, and combined asymmetry affecting these regions. These images were rated on a 7-point Likert scale by a preselected group of orthognathic patients before treatment, clinicians, and laypeople., Results: In relation to a 5-mm asymmetry, observers progressively decreased attractiveness ratings and increased the desire for surgery for greater asymmetries. Clinicians and patients were found to be more critical than laypeople. The desire for surgery decreased by 3% for each year increase in age, was 53% less for men, and 45% greater for white observers., Conclusions: Asymmetry of 10 mm is perceived as being significant; at 5 mm and below, it is largely unnoticed. The greater the degree of asymmetry greater than 10 mm, the more noticeable and the greater the desire was for correction. Clinician and patient ratings were similar and more critical than ratings of laypeople. A desire for surgery was negligible for 5 mm of asymmetry but increased considerably at 10 mm and continued to increase with greater degrees of asymmetry. The highest-rated images showed perfect bilateral symmetry, whereas the lowest-rated images showed significant degrees of mandibular and chin asymmetry., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

The impact of facial asymmetry on nasal deviation is an accepted but poorly understood part of plastic surgery and rhinology training. Recently, an increased understanding of the specific structural issues underlying this deformity has led to improved surgical techniques and patient outcomes., (© Thieme Medical Publishers.)

Statement of Problem: Most faces are not symmetrical, and this complicates the task of aligning the anterior segment of the teeth for the restorative dentist, orthodontist, or oral and maxillofacial surgeon. The dental literature provides conflicting advice regarding guidelines for aligning the anterior teeth., Purpose: The purpose of this study was to determine the sensitivity of laypersons to variations in the alignment of the anterior segment within a symmetrical face, and to investigate which guidelines were preferred by laypersons and prosthodontists when aligning this segment., Material and Methods: Lay participants (21) were shown a series of 25 modified images of faces on a computer screen and asked to indicate 'noticeability' of tilt and, with another series of 19 images, preference for angulation of the anterior segment. Prosthodontists (14) were shown a further set of 7 images and asked to use a Clinometer to select an appropriate angle. Statistical comparisons were performed with multinomial goodness-of-fit tests and repeated measures ANOVA, followed by Sidak multiple comparisons tests (α=.05)., Results: The average angle at which the tilt of the anterior segment within a symmetrical face became noticeable to the laypersons was approximately 1 degree. No significant correlation (P=.15) was found between the laypersons' choice of angle for the anterior segment and the angle of the eyes, lips, or horizon, but an angle of 0 degrees was chosen significantly more often than the other angles offered (P<.001). The prosthodontists generally chose an angle close to zero., Conclusions: The results suggest that the threshold tilt within a symmetrical face, for noticeability by laypersons, is about 1 degree, and that for both laypersons and prosthodontists, the most important guideline is not any individual facial feature or the horizon but the face as a whole., (Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Objective: To determine whether children with hemifacial microsomia (HFM) have higher risk for psychosocial problems than children without HFM., Methods: One hundred and thirty-six children with HFM (64% male, mean age = 6.9 years) were compared to 568 matched controls (50% male, mean age = 7.0 years) on parent and teacher measures of behavior problems and social competence, and teacher rankings of peer acceptance., Results: Parents of cases and controls reported similar levels of behavior problems and social competence. Teachers reported higher frequencies of internalizing problems, lower social competence and less peer acceptance for cases. Relative to controls, teacher-rated outcomes were worse for female cases, those with younger mothers at the time of birth, those with eye anomalies, and those with one or more malformations in addition to the core features of HFM., Conclusions: This study provides the first evidence of relatively poor psychosocial outcomes among children with HFM.

Objective: To determine the degree of facial asymmetry required to trigger conscious perception in the observer in a simulated model of facial paralysis., Methods: A model of unilateral facial paralysis was created using the face of a participant without facial paralysis. Digital morphing software was used to create progressive asymmetry of the brow, oral commissure, and combined brow and oral commissure based on the typical sequelae seen in facial paralysis. Volunteers naive to the goals of the study repeatedly were shown a series of photographs of faces without facial paralysis, with the manipulated image interspersed within the series., Results: At least 3 mm of facial asymmetry of the oral commissure, brow, or both was required before participants detected the asymmetry. With longer display intervals, participants tended to detect a smaller degree of asymmetry., Conclusions: To our knowledge, this is the first study directed at determining the amount of facial asymmetry required to trigger conscious perception of patients' facial paralysis in the naive observer. The pilot data and the discussion herein provide insight into the processes of visual perception of facial asymmetry and may be useful to surgeons for patient counseling and in setting surgical goals.

Acute alcohol consumption increases ratings of attractiveness to faces. This may help to explain increased frequencies of sexual encounters during periods of alcohol intoxication. At least in part, such increased attraction may be the result of alcohol consumption decreasing ability to detect bilateral asymmetry, presumably because of the reductions in the levels of visual function. We tested the hypotheses that acute alcohol consumption decreases ability to detect asymmetry in faces and reduces preference for symmetrical faces over asymmetrical faces. Twenty images of a pair of faces and then 20 images of a single face were displayed on a computer, one at a time. Participants were instructed to state which face of each of the face pairs displayed was most attractive and then whether the single face being displayed was symmetrical or not. Data were collected near campus bars at Roehampton University. Sixty-four self-selecting students who undertook the study were classified as either sober (control) or intoxicated with alcohol. For each face pair or single face displayed, participant response was recorded and details of the alcohol consumption of participants that day were also obtained. Sober participants had a greater preference for symmetrical faces and were better at detecting whether a face was symmetrical or otherwise, supporting the hypotheses. A further, unexpected finding was that males made fewer mistakes than did females when determining whether individual faces were asymmetrical. The reduced ability of inebriated people to perceive asymmetry may be an important mechanism underlying the higher ratings of facial attractiveness they give for members of the opposite sex and hence their increased frequency of mate choice., (2010 Elsevier Inc. All rights reserved.)

Objective: To test the hypothesis that young people's esthetic perception of dentition midline deviation or the threshold below which they find the deviation "acceptable" depends on the gender and face type of the person with the deviation and the gender of the evaluator., Materials and Methods: Facial images of six young subjects with three different face types were captured, and their dentition midlines were altered digitally. The images were evaluated by young people with no dental training. Statistical analysis was carried out to determine the threshold for acceptable dentition midline deviation and factors influencing perception., Results: The mean value for the threshold below which a deviation was judged "acceptable" was 2.403 mm (95% confidence interval, 2.315-2.491). The preferences of evaluators did not significantly depend on the direction of the deviation. Both male and female evaluators were significantly less tolerant of deviation in female subjects than in male subjects. However, female evaluators were significantly more tolerant of midline deviations in male subjects than were male evaluators. In addition, the same degree of deviation was most noticeable in male subjects with a tapered face type and least noticeable in female subjects with a square face type., Conclusions: The gender and face type of an individual with dentition midline deviation and the gender of the evaluator do affect young people's esthetic perception of a dentition midline deviation and the threshold below which they find the deviation "acceptable."

Introduction: The aim of this controlled study was to analyze the degree and localization of 3-dimensional (3D) facial asymmetry in adult patients with cleft lip and palate (CLP) compared with a control group and its impact on the visual perception of faces., Methods: The degree of 3D asymmetry was analyzed with a novel method without landmarks in 18 adults with complete unilateral CLP and 18 adults without congenital anomalies. Furthermore, the CLP and control faces were rated for appearance, symmetry, and facial expression by 30 participants., Results: The results showed that adults with CLP had significantly greater asymmetry in their facial soft tissues compared with the control group. Moreover, the lower face, and particularly the midface, had greater asymmetry in the CLP patients. The perceptual ratings showed that adults with CLP were judged much more negatively than those in the control group., Conclusions: With sophisticated 3D analysis, the real morphology of a face can be calculated and asymmetric regions precisely identified. The greatest asymmetry in CLP patients is in the midface. These results underline the importance of symmetry in the perception of faces. In general, the greater the facial asymmetry near the midline of the face, the more negative the evaluation of the face in direct face-to-face interactions.

Studies of facial asymmetry have revealed that the left and the right sides of the face differ in emotional attributes. This paper reviews many of these distinctions to determine how these asymmetries influence portrait paintings. It does so by relating research involving emotional expression to aesthetic pleasantness in portraits. For example, facial expressions are often asymmetrical-the left side of the face is more emotionally expressive and more often connotes negative emotions than the right side. Interestingly, artists tend to expose more of their poser's left cheek than their right. This is significant, in that artists also portray more females than males with their left cheek exposed. Reasons for these psychological findings lead to explanations for the aesthetic leftward bias in portraiture.

Effects of averageness and symmetry on the judgment of facial attractiveness were investigated using a generalized Procrustes method and multiple regression analyses. Participants (n=114) rated attractiveness of 96 photographs of faces with neutral expressions. Through a generalized Procrustes method, the faces and their mirror-reversed versions were represented as points on a hyperplane. Both averageness and symmetry of each individual were defined as distances on the plane. A multiple regression analysis was performed to examine the effect of symmetry and averageness for each gender. For male faces, both symmetry and averageness affected attractiveness ratings positively , and there was no difference between the effects of averageness and symmetry. On the other hand, for female faces only averageness affected attractiveness, whereas symmetry did not. However, these effects were not large.

Humans and other animals are highly sensitive to deviations from bilateral symmetry and prefer symmetric mates. Fluctuating asymmetries (FAs) are random deviations from perfect symmetry that can result from developmental instability. Human perceptions of facial asymmetry are driven by FAs and insensitive to directional asymmetries (DAs), which have a consistent direction of bias (e.g., left side always larger) across the population and are unrelated to developmental stability. We hypothesized that perceptual adaptation may filter out DAs and provide a proximate mechanism for this perceptual focus on FAs. We created a small population of faces with DAs by applying a unilateral distortion to the same side of each face. After 5 min of adaptation, (new) faces with these DAs looked less asymmetric and the most symmetric-looking distortion shifted toward the adapting asymmetry level. Parallel changes occurred for attractiveness. We suggest that perceptual adaptation may provide the proximate mechanism for an evolutionarily adaptive focus on FAs.

Objectives: To determine the impact of rhinoplasty on the objective measurement and subjective appreciation of facial symmetry and to investigate whether perceptual shifts are correlated with objective changes in facial proportions., Design: Frontal view photographs were used to measure bilateral symmetry ratios of the medial and lateral canthi, tragus, ala, and oral commissure in 100 patients before and 6 months after rhinoplasty. Gestalt dichotomous impressions of facial symmetry were also obtained in all cases. Paired t tests and chi(2) tests were used to compare facial proportions and the proportion of faces perceived as symmetrical, respectively, before and after surgery. The receiver operating characteristic and analysis of variance were used to assess whether perceptual shifts in symmetry could be correlated with objectively measurable changes in facial proportion., Results: The number of faces perceived as symmetrical increased from 42 to 62 after rhinoplasty (P < .001, chi(2) test). Objectively, midline-to-ala symmetry increased from an average of 91.1% (5.5%) (mean [SD]) to 93.8% (4.5%) after rhinoplasty (P < .001, paired t test). Other facial proportions did not change significantly (P > .10). The degree of change in midline-to-ala symmetry was the only objective measure that was significantly associated with the subjective perception of the face as symmetrical or asymmetrical (P < .01, 1-way analysis of variance). Most positive perceptual shifts were associated with an objective improvement in nasal symmetry that was greater than 2%. Conversely, most negative perceptual shifts were associated with minimal postoperative improvement or loss of nasal symmetry., Conclusion: Rhinoplasty leads to objectively measurable changes in nasal symmetry that correspond with psychophysical modifications in the perception of a face as symmetrical or asymmetrical.

Objective: The aim of this study was to investigate the influence of facial asymmetry on how an adult population with unilateral cleft lip and palate (CLP) perceived themselves and were perceived by others., Patients and Methods: 3D facial data of 30 adult patients with cleft lip and palate (CLP) was scanned and standardized extra- and intraoral photographs were taken. The measured degree of 3D asymmetry was computed for the entire face, midface and lower face. Subjective estimates regarding facial symmetry, attractiveness as well as satisfaction and a desire or indication for further treatment were surveyed by means of a questionnaire filled out by patients and an assessment group (10 orthodontists, 10 oral and maxillofacial (OM) surgeons, 15 laypersons)., Results: The study's results show that the largest degree of asymmetry was found in the midface of CLP patients. The vast majority of the patients were dissatisfied with their facial appearance, and patients, experts and laypersons expressed great interest in and a need of correction. We observed tangible incongruence between how the patients perceived their own faces and how others perceived them., Conclusions: Asymmetry, especially in the midface, appears to detract from how facial appearance is self-perceived and perceived by others, which explains the primary desire for or need of nose correction. The self-perception of patients affected by CLP does not correlate with objective results or how others perceive them. Clinicians should be open to adult patients' requests for correction, but the patient's self-perception should also be critically explored.

Hemifacial microsomia (HFM) is a variable, complex malformation involving asymmetric hypoplasia of the face and ear. Little is known about the risk factors for or consequences of HFM. In this study, we describe 3 studies that have been or are currently being conducted to further our understanding of this malformation. The first completed study examined whether HFM risk is related to maternal exposures that may affect blood flow. In that case-control study, interview data from 230 mothers of children in the case group and 678 mothers of children in the control group suggested that maternal use of vasoactive medications in the first trimester, particularly in combination with cigarette smoking, was associated with increased risks of HFM. The second study is currently underway, in which we are evaluating whether HFM risk is related to genetic variation in pathways associated with vasculogenesis and hemostasis, using DNA collected in the first study. The third ongoing study observes children with HFM to identify psychosocial, cognitive, dental, and medical sequelae. When the children from the original case-control study are 6 or 7 years of age, mothers and teachers complete self-administered questionnaires that cover a wide range of psychosocial development domains. Preliminary analyses of 115 case and 314 control children suggest that children with HFM may have worse teacher-reported academic performance and possibly higher levels of internalizing behavior problems than control children. When data on the full study sample are available, further analyses will determine whether the preliminary findings remain and if they vary by HFM phenotype, parenting style, or indicators of social risk.

Objectives: Introduce a novel method for objectively evaluating attentional bias to peripheral facial deformities using an established metric of attention., Methods: The SMI eye-tracker system (SensoMotoric Inc., Boston, MA) was used to record the eye movement patterns, called scanpaths, of eight naïve observers gazing at pictures of faces with or without peripheral surgical deformities. The scanpaths of observers gazing on those novel faces were compared, and the fixation durations for different facial regions were compared between faces., Results: There were statistically significant differences in the mean fixation times between the faces considered normal and those considered abnormal (those with an obvious defect). When multivariate analysis of variance was performed with dependent variables total fixation time, fixation time in central triangle, and fixation time in the defect region and the independent variable face, all four tests were highly statistically significant. When univariate analysis of variance was performed to test the hypothesis that defect fixation times varied by face, the results were highly statistically significant (F = 8.79, P = .0003)., Conclusions: Observers gazing on faces typically focus their attention on discriminating features, such as eyes, nose, and mouth. The well-established method of eye movement recordings was applied in a novel way to provide quantitative data showing changes in observer gaze patterns to focus on deformities. These gaze patterns are a direct reflection of observer attention. This is the first objective method to quantify the amount of distraction caused by peripheral facial deformities and may provide insight into the perception of facial deformity.

The goal of this study was to investigate the possible relationship between established measures of body and brain asymmetries and individual differences in paranormal beliefs. In addition to behavioural measures of cerebral laterality, measures of facial features and finger length were taken to calculate body asymmetry scores and indicators of fluctuating asymmetry (average absolute differences between left and right body features). Both the direction and degree of laterality measures were used. In addition to that, quantitative measures of inconsistency of cerebral lateralization were obtained. Results indicated that a stronger belief in paranormal phenomena was associated with fluctuating asymmetry of finger length, and that this aspect of body asymmetry may be related to greater intraindividual variability in the degree of 'atypical' functional lateralization. This intraindividual variability index, in turn, significantly predicted strength of belief in the paranormal. Belief in the paranormal was also higher in women than men and it was negatively correlated with the education level. In sum, these findings suggest that a part of the variance of strength of belief in paranormal phenomena can be explained by patterns of functional hemispheric asymmetry that may be related to perturbations during fetal development.

Introduction: We report a rare case of Proteus syndrome which presented with dysphagia due to unilateral tonsillar hypertrophy., Case Report: Our case had involvement of multiple organs in addition to bony deformities, namely, enlarged right parotid gland and right testis, verrucous naevus, varicose veins and abdominal lipoma. The features unique to this case were a larger right optic disc and expansion of the inner table of the skull., Discussion: A literature review revealed less than 100 bona fide, published cases which fit the revised diagnostic criteria proposed by Turner., Summary: The ENT manifestations of Proteus syndrome are high arched palate, gingival hypertrophy, malocclusion and overcrowding of teeth, hyperostosis of the external auditory meatus, and low nasal bridge. Our patient had a unilateral enlargement of the tonsil causing dysphagia, which was relieved by tonsillectomy.

Ratings of physical attractiveness are related to degree of facial symmetry. Acute alcohol consumption affects ratings of physical attractiveness and also attenuates aspects of visual perception. We tested the hypothesis that increases in ratings of attractiveness associated with alcohol intoxication can be attributed at least in part to a reduced ability to discern facial asymmetry due to reductions in levels of visual perception. We examined whether alcohol intoxication reduces ability to detect asymmetry in approximately symmetrical images. Sober and intoxicated subjects were shown a series of simple geometric images to which they responded on whether they perceived each one to be symmetrical or asymmetrical. Intoxicated subjects were significantly less able to detect asymmetry than were sober subjects, providing support for the hypothesis.

This case report describes the orthodontic treatment of a 43-year-old man with Class III malocclusion and crossbite of the maxillary anterior teeth. Treatment options included orthognathic surgery, nonextraction treatment, premolar extractions, and mandibular incisor extraction. The patient opted for nonsurgical treatment that included the extraction of a mandibular central incisor.

Introduction: The purpose of this study was to determine the means and the ranges of the thresholds of cephalometric indexes by which orthodontists subjectively differentiate patients needing treatment for facial asymmetry from those who do not. The study was performed at the Departments of Orthodontics and Oral and Maxillofacial Radiology, Aichi-Gakuin University School of Dentistry in Nagoya, Japan, in 2004., Methods: Ten orthodontists subjectively evaluated the frontal photographs of 100 subjects and classified them into 2 groups. The subjects in group A showed good or clinically acceptable levels of asymmetry and did not require treatment. Those in group B showed marked asymmetry, and treatment was recommended. The frontal cephalographs were also analyzed with 5 indexes related to the mandible. For each orthodontist, the threshold was determined by means of the discriminant analysis., Results: As the number of subjects who were judged to require treatment increased, the threshold of cephalometric indexes became smaller, and the discriminant accuracy was reduced. Among the 5 indexes evaluated, the distance of menton (mean, 4.28 mm), maxillomandibular midline angle (mean, 4.31 degrees ), and the distance of L1 (mean, 2.78 mm) showed relatively high accuracy in all observers., Conclusions: The distance of menton, the maxillomandibular midline angle, and the distance of L1 appeared to be relevant indexes for the subjective evaluation of facial asymmetry. The thresholds determined in this study could contribute to the planning and evaluation of orthodontic treatments.

Tyler (1998 Nature 392 877) proposed that 'painters centre one eye in portraits', and that this is a hidden aesthetic principle used implicitly by artists and by viewers of portraits. We assess that hypothesis in three related studies: a Monte-Carlo analysis of eye placement in synthetic faces randomly placed within a frame; a survey of eye position in 786 painted portraits from Western art of the past six centuries; and an experimental study in which fifty subjects were asked which of two versions of 60 pairs of portraits they preferred, in only one of which the eye was precisely centred. Taken together, the three studies showed no evidence to support Tyler's hypothesis, and in particular there was no evidence for subjects having an aesthetic preference for a centred eye in portraits. We conclude that one eye tends to be relatively close to the vertical midline because of geometric constraints on the placing of a relatively large object, the head, within a pictorial frame.

The purpose of this study was to investigate the relationship between the subjective evaluation of facial asymmetry and seven cephalometric indices. Ten orthodontists subjectively evaluated the frontal photographs of 100 subjects and categorized them into three categories, ie, category I--symmetrical view; category II--a little asymmetry not requiring treatment; and category III--marked asymmetry requiring treatment. Seven indices that were used to evaluate facial asymmetry were determined using frontal cephalographs of these patients. Interobserver agreement was assessed using Cohen's kappa statistic. Agreement among the observers for category III was higher than for categories I and II. To define the characteristics of each category, the cephalometric indices, which at least eight observers agreed on, were compared between the categories. No differences were found in any of the indices between categories I and II. Five indices showed differences between category III and the other categories. Among them, the distance of Me from the vertical reference line was the most relevant index for the subjective evaluation of facial asymmetry. When a discrepancy is found between skeletal measurements and a subjective evaluation, the influence of soft tissue structures should be considered in facial asymmetry.

Objective: To develop and refine a technique for measuring the tolerance for deviations in facial appearance., Design: A psychophysical method was administered using photocopies of altered facial photographs to measure tolerances for deviations in eye position and mouth angulation and judges' reaction time., Methods: Stimulus photos were displayed as Kodachrome slides to 76 individuals grouped by their familiarity with craniofacial anomalies, i.e. dental professionals, orthodontic and craniofacial patients, also a group of normal patients., Results: (1) Tolerance for deviation of facial appearance varies inversely with the magnitude of the physical deviations from normal; (2) tolerance varies directly as a function of assumed familiarity with deviation; (3) response and reaction time varied inversely with the tolerance for facial deviation., Conclusion: Significant differences in tolerance and reaction time were found among the groups and depended on whether an isolated feature was judged or if the feature was judged in the context of the whole face.

One purpose of this study was to assess the perception of (a)symmetry of the face by professionals, lay persons, and sculptors using the ratio estimation scale technique. The other purpose was to compare the perceptions of the faces of patients with those of the controls. Three groups of examiners were involved in this study: lay persons (n = 37), professionals (5 orthodontists and 11 surgeons, n = 16), and sculptors (n = 22). The total number of examiners was 75. All groups agreed on the ordering of the patients according to the severity of the affliction. The stage of asymmetry by group identity interaction effect (lay persons, professionals, and sculptors) was significant (P = 0.004). The between-examiner consensus was high for the original asymmetrical photograph, but the groups diverged further and further over the next steps. The subject identity by stage of asymmetry interaction effect was significant (P = 0.001), whereas the examiner's main effect was not. For all patients, each step resulted in a smaller need for treatment. A need for treatment was not found for any of the control subjects, with 1.5 being the highest need for treatment score for controls. The subject identity effect (patient/control) was significant (P < 0.001). Even at step 5 (the reconstructed symmetrical photograph), all patients were perceived to have an inferior appearance to that of control subjects. It is possible to obtain reliable assessment using the ratio estimation scale technique. Professionals, lay persons, and sculptors have different perceptions of the degree of asymmetry but not of the need for treatment. All patients were scored as asymmetrical compared with controls. Asymmetry of the patients was obvious for all the examiners.

The relations for hand preference with craniofacial asymmetry and ear advantage, and between craniofacial asymmetry and ear advantage were investigated in young healthy subjects. Ear advantage was recorded as duration of hearing, craniofacial asymmetry by computerized tomography in 44 right-handed and 38 left-handed male and female high school students. Right-handers had a right ear advantage and a larger left craniofacial region, whereas left-handers had a left ear advantage and a larger right craniofacial region. These results are consistent with the speculation that hand preference may be related to craniofacial and consequently aural asymmetries.

Facial aesthetics have an important influence on social behaviour and perception in our society. The purpose of the present study was to evaluate the effect of facial symmetry and inter-ocular distance on the assessment of facial aesthetics, factors that are often suggested as major contributors to facial aesthetics. The material consisted of 36 standardized facial photographs of patients (10-17 years of age) attending the orthodontic department. All except one were Caucasian. Eleven of these photographs (all Caucasian) were either left in their original form or modified by: (1) enlargement of the inter-ocular distance by 20 per cent; or (2) mirroring the right part of the face over the left part to obtain symmetry. Three series of 36 slides were composed, each including 11 modified slides or their unmodified counterparts. These were evenly distributed over the three series using a Latin square design. The photographs were assessed for their facial aesthetics using a visual ratio scale by a panel of 50 undergraduate dental and law students. The 11 modified/unmodified photographs enabled calculation of the effect of the modifications undertaken on the assessment of facial aesthetics. The scores of the 25 remaining photographs in each series were used as baseline data in order to estimate the inter- and intra-observer reproducibility. MANOVA and post-hoc t-test revealed significant differences between the unmodified and modified photographs (P < 0.001). The results show that symmetry and inter-ocular distance enlargement have a negative effect on facial aesthetics.

Objective: Previous psychosocial studies of adults born with cleft lip and palate have provided circumstantial evidence that surgically repaired right-sided unilateral clefts may be more disfiguring than left-sided clefts. The present study asked if such asymmetries are physiognomic asymmetries or arise "in the eye of the beholder," representing perceptual processes in face recognition., Design: Color slides of 160 children (6 years of age) and young teenagers (16 years of age) were rated by subjects for perceived disfigurement. Sixty of the subjects had unilateral complete cleft lip and palate (30 had a right-sided cleft and 30 had a left-sided cleft), 60 had unilateral cleft lip/alveolus (30 right-sided and 30 left-sided clefts), 32 children had bilateral cleft lip and palate, and 8 children had cleft palate only. Faces were shown in normal and in mirror-reversed versions; the order in which faces were shown was randomized, as were other stimulus factors such as cleft type, age, and gender., Setting: The study was conducted as a classroom-type experiment at the Vision Laboratory, Department of Psychology, Oslo, Norway., Participants: Thirty-seven students of psychology at the University of Oslo, who were ignorant of the purpose of the study, acted as subjects., Main Outcome Measure: Subjects rated perceived disfigurement using a visual analog scale., Results: Modest but highly consistent hemifacial asymmetries in judged disfigurement were found, with left-sided unilateral clefts rated as less disfiguring than right-sided unilateral clefts. Unilateral clefts were judged as being less disfiguring than the bilateral clefts, and cleft lip/alveolus was judged as being less disfiguring than cleft lip and palate. The patterns of facial judgments were almost identical in the normal and reversed-slides conditions., Conclusions: Asymmetries between left- and right-sided clefts reside in physiognomic factors rather than in hemispheric asymmetries controlling the perceptual process of face judgment.