Assessing the influence of mandibular prominence on perceived attractiveness in the orthognathic patient, clinician, and layperson.

The purpose of this investigation was to undertake an objective and quantitative evaluation of how mandibular prominence influences perceived attractiveness. The mandibular prominence of an idealized profile image was altered in 2 mm increments from -16 to 12 mm, in order to represent retrusion and protrusion of the mandible, respectively. These images were rated on a 7-point Likert scale by a preselected group of pre-treatment orthognathic patients, clinicians, and laypeople. A duplicate image was used to assess intra-examiner reliability. From the results of this study, it is recommended that in treatment planning to alter the sagittal prominence of the mandible in an individual with an otherwise normal soft tissue facial profile, an 'ideal' sagittal position with soft tissue pogonion on or just behind a true vertical line through subnasale may be used. However, mandibular retrusion up to -4 mm or protrusion up to 2 mm was essentially unnoticeable. Surgery was desired from mandibular protrusions of greater than 3 mm (orthognathic patients and laypeople) and 5 mm (clinicians) and retrusions greater than -8 mm. The overall direction of aesthetic opinion appeared to be the same for all the observer groups; the greater the retrusion or prominence of the lower jaw, the less attractive the perceived attractiveness and the greater the desire for surgical correction. Orthognathic patients were found to be more critical than laypeople, suggesting that in future studies, greater emphasis might be put on evaluating the perceptions of patients as opposed to only a lay population.