# Role of initial facial attractiveness in the perceived aesthetic outcome of convex profile treatment

## TL;DR

This study shows that patients with less attractive faces before treatment are perceived to have bigger improvements after orthodontic or surgical treatment.

## Contribution

The study reveals that pre-treatment facial attractiveness inversely affects perceived treatment outcomes in convex profile patients.

## Key findings

- Patients with lower initial attractiveness were perceived to have larger facial changes after treatment.
- Combined orthodontic and surgical treatment was perceived more favorably than orthodontic-only treatment after adjusting for attractiveness.
- Facial attractiveness had a significant inverse relationship with perceived facial change (0.3% decrease per 1% increase in attractiveness).

## Abstract

Facial attractiveness significantly influences various life outcomes, motivating individuals to seek interventions for improvement. However, the actual benefits of such interventions and patient satisfaction largely depend on the perceived changes in facial appearance. This perception may be influenced by certain mediating factors. This study aimed to investigate how pre-treatment facial attractiveness affects the perceived facial appearance changes in convex profile patients undergoing orthodontic-surgical vs. orthodontic-only treatments.

The sample comprised 36 non-growing Class II Division 1 patients, divided evenly between treatments, with similar demographics, overjet, and treatment durations. The treatments had distinct effects on the facial contour angle (orthodontics-only: −1.2 ± 2.1°, combined orthodontics/surgery: −6.2 ± 3.9°; p < 0.001). Pre-treatment attractiveness and perceived facial changes were evaluated using frontal and profile photographs, assessed on a 100 mm visual analog scale (VAS). Each photographic set was rated by 10 surgeons, 10 orthodontists, 10 patients, and 20 laypeople, resulting in 3,600 completed questionnaires for perceived treatment effects and an additional 3,600 for attractiveness ratings.

The overall facial attractiveness was lower than average (mean: 36.1), with orthodontics-only patients being significantly more attractive than patients that received surgery (mean difference: 8.2%, p < 0.001) and no significant influence of patient sex or rater type. For every 1% increase in overall facial attractiveness, there was a 0.3% decrease in the perceived facial change (p = 0.002). After accounting for pre-treatment facial attractiveness, the combined orthodontic/surgical treatment led to a substantial improvement (16%) of facial appearance, as compared to the orthodontics-only group.

The study highlights the critical role of facial attractiveness in shaping perceived treatment outcomes. Pre-treatment facial and profile attractiveness were inversely associated with perceived changes, suggesting that patients with initially lower attractiveness experienced more noticeable improvements. After accounting for facial attractiveness, combined orthodontic and surgical treatment was perceived significantly more favorably than orthodontic treatment alone in patients with convex facial profiles. These findings underscore the importance of incorporating facial attractiveness considerations into patient counseling and treatment planning.