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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.)

Objective: The purpose of this study is to determine children's perception of secondary cleft lip deformity (SCLD) using objective eye tracking technology and subjective responses on a survey to understand pediatric perceptions of facial scarring., Design: Cross-sectional study of participants aged 5-17 years old., Methods: Participants viewed images of children's faces with an eye tracking device. Sixteen images were displayed, 12 with unilateral SCLD and four with no facial scarring. Eye tracking data were obtained. Gaze samples were analyzed for areas of interest (AOIs). Immediately after viewing each image, participants answered two survey questions relating to facial asymmetry attitude toward the child pictured. For analysis, participants were divided into age groups., Results: A total of 259 participants were enrolled (42.5% female). Mean age was 10.5 years and 78% identified as White. In all age groups, total fixation time was greater for SCLD compared to control images. Early elementary age children spent significantly less time assessing the nose AOI compared to other groups, and also spent the least total fixation time and had the lowest visit count on all AOIs. Subjective survey questions showed similar trends with elementary age not noticing facial asymmetry compared to older age groups., Conclusion: This study demonstrates the successful use of eye tracking technology in children as young as 5 years old. This study suggests that SCLD is perceived as less noticeable in elementary age children and becomes more noticeable to older groups. Understanding peer perception on SCLD from this study may impact decision on revision surgery for SCLD., Level of Evidence: IV Laryngoscope, 134:2726-2733, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, 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.

Humans have structures dedicated to the processing of faces, which include cortical components (e.g., areas in occipital and temporal lobes) and subcortical components (e.g., superior colliculus and amygdala). Although faces are processed more quickly than stimuli from other categories, there is a lack of consensus regarding whether subcortical structures are responsible for rapid face processing. In order to probe this, we exploited the asymmetry in the strength of projections to subcortical structures between the nasal and temporal hemiretina. Participants detected faces from unrecognizable control stimuli and performed the same task for houses. In Experiments 1 and 3, at the fastest reaction times, participants detected faces more accurately than houses. However, there was no benefit of presenting to the subcortical pathway. In Experiment 2, we probed the coarseness of the rapid pathway, making the foil stimuli more similar to faces and houses. This eliminated the rapid detection advantage, suggesting that rapid face processing is limited to coarse representations. In Experiment 4, we sought to determine whether the natural difference between spatial frequencies of faces and houses were driving the effects seen in Experiments 1 and 3. We spatially filtered the faces and houses so that they were matched. Better rapid detection was again found for faces relative to houses, but we found no benefit of preferentially presenting to the subcortical pathway. Taken together, the results of our experiments suggest a coarse rapid detection mechanism, which was not dependent on spatial frequency, with no advantage for presenting preferentially to subcortical structures.

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: The aim of this systematic review was to identify patient-reported outcome (PRO) instruments used in research with children/youth with conditions associated with facial differences to identify the health concepts measured., Design: MEDLINE, EMBASE, CINAHL, and PsycINFO were searched from 2004 to 2016 to identify PRO instruments used in acne vulgaris, birthmarks, burns, ear anomalies, facial asymmetries, and facial paralysis patients. We performed a content analysis whereby the items were coded to identify concepts and categorized as positive or negative content or phrasing., Results: A total of 7,835 articles were screened; 6 generic and 11 condition-specific PRO instruments were used in 96 publications. Condition-specific instruments were for acne (four), oral health (two), dermatology (one), facial asymmetries (two), microtia (one), and burns (one). The PRO instruments provided 554 items (295 generic; 259 condition specific) that were sorted into 4 domains, 11 subdomains, and 91 health concepts. The most common domain was psychological (n = 224 items). Of the identified items, 76% had negative content or phrasing (e.g., "Because of the way my face looks I wish I had never been born"). Given the small number of items measuring facial appearance (n = 19) and function (n = 22), the PRO instruments reviewed lacked content validity for patients whose condition impacted facial function and/or appearance., Conclusions: Treatments can change facial appearance and function. This review draws attention to a problem with content validity in existing PRO instruments. Our team is now developing a new PRO instrument called FACE-Q Kids to address this problem.

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.)

Aim: The aim of the study was to identify the presence of post-traumatic stress disorder (PTSD) in patients who had sustained facial injuries, additionally, we aimed to identify other variables that may modify the psychological response to trauma that include gender, age and presence of disfigurement post-treatment and visible scars/orthopedic injuries., Materials and Methods: Participants comprised of 460 patients from several multinodal trauma centers in Bengaluru City, Karnataka, who had sustained facial injuries that had healed either with or without significant disfigurement or scarring and with visible/orthopedic injuries. One hundred and eleven patients of the chosen 460 had sustained nondisfiguring facial injuries while 153 patients sustained disfiguring facial injuries, 64 patients who sustained facial injury (i.e. 19.5%) were lost to follow-up and were not included in the study. One hundred and thirty-two had sustained orthopedic/visible injuries; however, in this group, 18 (i.e. 13.6%) patients were lost to follow-up and were excluded from the study. The impact of events scale (IES) was used to check the presence of PTSD., Results: Statistically significant higher means of IES were present in patients with disfiguring facial injuries compared to nondisfiguring facial injuries, female patients compared to male patients, patients with disfiguring facial injuries compared to orthopedic/visible injuries and patients who were younger than 50 years of age compared to patients who were older than 50 years of age and the results observed were similar at all three study intervals (date of discharge (DOD), 1 month and 6 months postoperatively)., Conclusion: Patients with disfiguring facial injuries had significantly higher PTSD levels compared to patients with nondisfiguring facial injuries, patients with orthopedic/visible injuries had statistically significant lower IES scores which could not be strictly termed PTSD when compared to patients with disfiguring facial injuries who had high scores of IES corresponding to high levels of PTSD and these results were observed at all three study intervals (DOD, 1 and 6 months postoperatively). Female patients with disfiguring facial injuries had significantly higher PTSD levels compared to male patients (at all the study intervals) and patients younger than 50 years of age had significantly higher PTSD levels compared to older patients.

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.

Aim: To examine factors associated with patients' decision to decline surgery., Material/methods: Of 470 consecutive patients referred to the University of Oslo from 2007 to 2009, a sample of 160 subjects who had not undergone surgery was identified and contacted. 236 operated patients from the same period served as a comparison group. Morphology was assessed from cephalograms and photographs, and the individuals' opinions were recorded using questionnaires., Results: Dentofacial morphology represented normative treatment need and was generally similar except for a higher rate of severe negative overjet in the operated group (p < 0.001). The most prevalent reasons for declining surgery were risks of side effects, the burden of care, and a general reluctance to undergo surgery. Many un-operated subjects were dissatisfied with their masticatory function and dentofacial appearance., Conclusion: Informed consent to orthognathic surgery represents a challenge both to the patient and the professional. The findings imply that patients' motives and fears should be explored during consultation and that the information provided should be adapted to the potential risks and benefits related to the actual treatment., (Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

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.)

Background: There is little evidence-based information on secondary rhinoplasty patient motivations for surgery, satisfaction, or revision rates., Methods: The charts of 150 consecutive patients (121 women and 29 men) who underwent secondary rhinoplasty between July of 2007 and October of 2008 were reviewed; preoperative deformity severity was graded from 1 to 5. The patients' primary reasons for surgery, patient and surgeon satisfaction, and postoperative depression or body dysmorphic disorder were tallied., Results: The average number of prior operations was 3.6. The most commonly expressed reason (41 percent) for undergoing revision was the development of a new deformity after the primary rhinoplasty. Those patients also had the most severe preoperative deformities (p < 0.02). Other motivations were failure to correct the original deformity (33 percent), an intolerable perceived loss of personal, familial, or ethnic characteristics (15 percent), the desire for further improvement in an already acceptable result (10 percent), and a new or unrelieved airway obstruction (1 percent). Ninety-seven percent of patients were happy with their outcomes. Forty patients (27 percent) were depressed before surgery and three (2 percent) displayed evidence of body dysmorphic disorder postoperatively. The depressed and dysmorphic patients did not have worse deformities than those who were not depressed postoperatively (p < 0.8695)., Conclusions: Most secondary rhinoplasty patients have motivations similar to those of our other reconstructive patients and will be pleased with their surgical outcomes. The most severe preoperative deformities were iatrogenic. The unhappy postoperative patients, including those with body dysmorphic disorder, did not have more severe preoperative deformities than the others (i.e., their deformities alone did not justify their unhappiness).

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.

We explored the experiences of a group of participants with craniofacial conditions before, during, and after orthognathic surgery. Semi-structured interviews were conducted, recorded, transcribed, and analysed using interpretative phenomenological analysis, and purposive sampling focused on a homogenous group was selected. Participants described unpleasant experiences related to their appearance, the difficulties they had in adjusting to facial changes as a result of surgery, and the differences these changes had made to their body image. The superordinate themes identified after interpretive phenomenological analysis were: self-awareness of facial appearance; attitudes of others and facial appearance; treatment issues; impact of surgery; and support and coping. The accounts provide information about living with an unusual appearance, medical aspects of facial operations over time, changes in body image before, during, and after operation, and the effects of support and coping styles on resilience., (Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Although there is principal agreement that increased facial asymmetry is associated with decreased facial attractiveness, there are no studies analysing face perception in patients with a unilateral cleft lip and palate (CLP) (uCLP) compared to orthognathic Class III patients. To this end, three-dimensional (3D) data on the faces of 30 adults with a complete uCLP, 20 orthognathic patients with a severe skeletal Class III, and 20 adults with a skeletal Class I as a control group were generated. The 3D asymmetry of the facial soft-tissue was analysed. These data were compared with subjective ratings for attractiveness carried out by 100 laypersons. Compared to the controls, uCLP patients and orthognathic patients had a significantly higher facial asymmetry. No difference was found between uCLP patients and orthognathic patients. The attractiveness ratings showed that uCLP patients and orthognathic patients were rated less attractive compared to the controls. However, although there were no differences in the facial asymmetry between uCLP patients and orthognathic patients, the uCLP patients were rated significantly less attractive. This leads to the conclusion that not only the extent of asymmetry has an influence on attractiveness but also the location of asymmetry. For clinical use, these findings underline the importance of accurate as possible surgical reconstruction of the nasal morphology in uCLP patients., (Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

We present a pilot study to evaluate the benefit of static facial suspension with Silhouette sutures. We operated on a female patient with complete facial palsy secondary to otic tuberculosis. The patient has currently achieved satisfactory facial symmetry, mastication and speech production. As a result, self-esteem and social interaction have also been recovered. Static facial suspension with Silhouette sutures is an alternative to dynamic techniques in patients who do not wish to or cannot undergo those more complex surgeries., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

Objective: To assess how faces with a cleft lip and palate are perceived and to study how faces with and without a unilateral cleft lip and palate are viewed by individuals with a unilateral cleft lip and/or palate in comparison to nonaffected controls., Design: Prospective clinical study., Setting: Department of Orthodontics and Department of Psychology, University of Wuerzburg., Participants: Thirty-three participants (20 men and 13 women; mean age, 25.4 ± 6.6 years) with a unilateral cleft lip and/or palate and a control group of 30 participants (15 men and 15 women; mean age, 26.8 ± 3.4 years) were enrolled in this study., Main Outcome Measures: Eye movements were analyzed via an eye-tracking camera while all participants looked at pictures of faces with and without a unilateral cleft lip and palate., Results: The nose and the mouth area of pictures of faces with a unilateral cleft lip and palate were looked at significantly longer by both groups. Additionally, the participants with a unilateral cleft lip and/or palate looked at faces with and without a unilateral cleft lip and palate differently, taking more time to view the nose and less time to view the eyes compared with the participants without a cleft lip and palate., Conclusion: When perceiving a face with a unilateral cleft lip and palate, the observer's gaze is distracted to the nose and mouth area. Moreover, participants with a unilateral cleft lip and/or palate themselves focused greater attention on those features that are anomalous on their own faces in comparison to participants without a cleft lip and palate. Specifically, this different scanpath is reflected in the cumulative duration of the eye movements as well as in the initial facial scan pattern.

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.)

Aim: To test the hypothesis that the faces of patients with a severe Class III are contemplated differently from and assessed more negatively than skeletal Class I patients in direct face-to-face interaction., Method: The eye movements of 24 randomly recruited evaluators were analyzed with a noninvasive, infrared high-speed camera while looking at 18 standardized frontal photographs of adult orthognathic Class III patients and 18 photographs of adults with skeletal Class I relationships as controls. Additionally, all images were assessed for appearance, symmetry, and facial expression., Results: The Class III patients were rated significantly more negatively in terms of appearance, symmetry, and facial expression than the Class I individuals. The eye movement data revealed that orthognathic patients were appraised differently from the Class I individuals, with fewer fixations in the face center, especially around the mouth., Conclusion: Skeletal Class III patients were characterized as less attractive than Class I individuals. Faces of Class III patients were visually perceived with different eye movements. These differences in visual perception are described for the first time in the present study. Although they were small, they are an indication of an objectively different perception of faces that are rated subjectively as less attractive and more asymmetric and exhibiting a more negative expression., (© 2010 Quintessence Publishing Co, Inc.)

Objective: To obtain descriptive information about diagnosis-specific patterns of psychosocial adjustment for children and adolescents with craniofacial anomalies., Design: Chart review of medical records was used to obtain psychosocial checklists. Scores were compared with published norms to evaluate elevated risk of problems, separately for six diagnostic groups., Setting: Plastic surgery department in urban university medical center., Participants: As part of routine ongoing care, 408 caregivers completed checklists assessing psychosocial adjustment of children aged 2 to 18 years with diagnosis of cleft lip and palate, cleft lip only, cleft palate only, craniosynostosis, hemifacial microsomia, and hemangioma., Main Outcome Measure: Child Behavior Checklist ( Achenbach, 1991 , 1992 )., Results: The craniosynostosis group showed elevated rates (beyond norms) of social, academic, and attention problems. The cleft lip and palate group showed elevations in social problems and deficits in social, academic, and activities competencies. The other diagnostic groups had few areas of elevated problems and had reduced risk in some areas., Conclusion: Specific patterns of strengths and weaknesses in psychosocial adjustment may vary by craniofacial anomaly diagnosis. Replication of these findings, with extension to other craniofacial anomaly diagnoses, is warranted.

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."

Discussing aesthetic issues and their management with patients is a growing area of dermatologic practice. Sometimes treatment options within one's own discipline are rapidly discussed, without a clear idea of the various aspects of the face which all combine to produce beauty and attractiveness. We review various features leading to the impression of beauty and attractiveness. Familiarity with these concepts should facilitate a broader discussion with the patient on the aspects of beauty and attractiveness beyond the borders of one's own discipline and also lead to multidisciplinary treatment options. We also examine the question how much the personality of the beholder himself is involved in the perception of attractiveness and beauty (of the person sitting opposite to him). The "ideal" face has an average profile with slightly protrusive and full lips. Attractiveness increases with average features and symmetry. Moreover, particular features such as the scheme of childlike characteristics combined with aspects of maturity and expression make a female face appear especially beautiful. Which attributes contribute to attractiveness of a man's face are controversial. Clear male signals such as a strong chin are likely not to increase attractiveness.

There is evidence that persons with cleft lip and palate (CLP) suffer psychosocial consequences as a result of their facial appearance. However, no data exist on how they are perceived by others. Our hypothesis was that CLP faces were looked at differently compared with faces lacking an anomaly. Eye movements of 30 healthy participants were recorded (via an eye-tracking camera) while they viewed photographs of faces with/without a CLP. Subsequently, the faces were rated for appearance, symmetry, and facial expression. When the CLP faces were viewed, there were significantly more initial fixations in the mouth and longer fixations in the mouth and nose regions, compared with reactions when control faces were viewed. Moreover, CLP faces were rated more negatively overall. When faces with CLP were viewed, attention was directed to the mouth and nose region. Together with the negative ratings, this may explain at least some of the social deprivations in persons with CLP, probably due to residual asymmetry.

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.

Objective: To determine changes in quality of life (QoL) after orthodontic-surgical treatment in patients with dentofacial deformities, using generic health, generic oral health, and condition-specific QoL approaches., Study Design: Patients were evaluated at baseline (T(0)), postoperative 6 weeks (T(1)), postoperative 6 months (T(2)), and after orthodontic treatment (T(3)). Generic health-related QoL, generic oral health-related QoL, and condition-specific QoL were assessed using the 36-item Short Form Health Survey (SF-36), the 14-item Short Form Oral Health Impact Profile (OHIP-14), and the 22-item Orthognathic Quality of Life Questionnaire (OQLQ), respectively., Results: There were significant changes in Physical-Health Component Scores (PCS) (P < .001) and Mental-Health Component Scores (MCS) (P < .01) of SF-36, in OHIP-14 scores (P < .001), and in OQLQ scores (P < .001) during the trajectory of treatment. A transient decrease in PCS was found at T(1) (P < .001) and an increase in MCS was found only at T(3) (P < .05). There was a significant decrease in OHIP-14 scores at T(2) and T(3) (P < .001) and in OQLQ scores at all time points compared with T(0) (P < .05)., Conclusion: Significant changes in QoL occurred after orthodontic-surgical treatment. A comprehensive assessment of QoL using generic health, generic oral health, and condition-specific approaches proved to be useful in determining the trajectory of changes., (Copyright 2010 Mosby, Inc. All rights reserved.)

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.