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Records for more than 2,000 individuals seen in the Dentofacial Clinic of the University of North Carolina were examined to evaluate trends in referral patterns for orthognathic surgery and acceptance of surgical treatment The vast majority of patients have been white and female from the beginning, and the female-male ratio remained constant at 2:1 throughout the 1990s. The proportion of nonwhite patients increased significantly after 1995, with the change resulting almost totally from more Hispanic and Asian patients. The proportion of African Americans, who represent 22% of the general population, remained almost constant at 10%. Class III and long-face individuals were more likely to seek evaluation than those with Class II problems, but of those who were offered orthognathic surgery, relatively more of the Class II group accepted it. This may reflect greater severity of a Class II problem before a patient seeks treatment. More than 1 of the Clinic population had some sort of facial asymmetry, but the presence of asymmetry did not seem to influence the decision to have surgical treatment. The dental and skeletal characteristics of those who had surgery were similar to those of patients who did not have surgery, suggesting that the decision to elect a surgical treatment plan was influenced by factors other than clinical characteristics.