A new public survey finds that people generally prefer facial profiles with a slightly protruding upper jaw over a perfectly straight profile. The study, published in the Journal of Maxillofacial and Oral Surgery, suggests that jaw surgeons and orthodontists should consider everyday aesthetic tastes alongside clinical measurements when planning procedures.
The human face plays a central role in social communication and biological signalling. Evolutionary pressures appear to have shaped neural processes that recognise facial patterns, with facial attractiveness often acting as a marker of reproductive fitness. Structural features, it argues, heavily influence how individuals are perceived by others.
Attractiveness also functions as a social construct that shapes daily interactions. Concepts such as the beauty stereotype imply that more attractive people are deemed desirable and likeable. Given the weight carried by facial features, reconstructive and cosmetic procedures aim to achieve a balanced, visually pleasing appearance.
Orthognathic surgery, a specialised operation repositioning facial bones, alters the skeletal support beneath the skin. Surgeons move the upper jaw, or maxilla, and the lower jaw, or mandible, to address functional issues and improve aesthetic harmony. The soft tissues of the face are tightly linked to the underlying bones, so changes to the skeleton directly modify the outer profile.
Traditionally, clinicians plan these operations using cephalometric analysis, which measures landmarks on head X‑rays to determine the position of the facial bones. Reference lines such as the Frankfurt plane help establish a horizontal baseline, while the True Vertical Line assesses whether the jaws project forward or backward relative to the rest of the face.
Clinical tools provide standard geometric angles and distances for a harmonious profile, but the ideals held by medical professionals do not always align with public tastes. Previous research on facial profile attractiveness mainly reflected orthodontists’ and dentists’ opinions.
Guido Gabriele, Niccolò Pini and colleagues at the University Hospital of Siena in Italy designed the study to capture the perspectives of everyday people. By surveying a random population, they aimed to identify which jaw alignments laypeople find most and least attractive.
The researchers created an online survey featuring eighteen profile images: nine male and nine female silhouettes rendered in solid black and white to remove variables such as skin colour, facial hair or eye shape from influencing judgments.
The profiles depicted different jaw relationships, including a normal baseline and various misalignments commonly seen in surgical patients. The misalignments encompassed retrognathic maxilla, prognathic maxilla, receding lower jaw, protruding lower jaw and bimaxillary conditions where both jaws protrude or recede.
A total of 135 subjects completed the survey, comprising 95 men and 35 women aged between eighteen and fifty. Participants rated each profile on a scale from one (unattractive) to five (extremely attractive).
To minimise recall effects, the survey inserted a five‑second black screen between each silhouette before the next image appeared. The researchers then compared scores for the altered profiles with those given to the normal profiles.
Normal facial profiles were rated as moderately attractive, typically scoring three out of five. Profiles with a forwardly protruding upper jaw also attracted high marks, with more than a third of participants giving them four out of five for both male and female silhouettes.
By contrast, several misalignments were regarded unfavourably. Protruding lower jaws, or underbites, mostly received scores of one or two. And mismatched jaws—one jaw receding while the other protrudes—also drew the lowest ratings from lay observers.
The attractiveness of a receding upper jaw appeared to depend on gender. The female silhouette with a receding upper jaw was largely deemed unattractive, with sixty-six per cent assigning it the lowest score, while the same jaw relationship in a male silhouette was judged as having an average, neutral appeal.
Some altered profiles did not differ statistically from the normal baseline. For example, a receding lower jaw was viewed as relatively neutral, and silhouettes featuring both jaws protruding or both receding tended to receive middle-of-the-road scores.
The findings have direct implications for surgical planning. Procedures such as the Le Fort I osteotomy, which moves the upper jaw, and sagittal osteotomies that reposition the lower jaw, influence the final resting position of the lips and chin. The study implies that leaving the upper jaw slightly protruding could yield a more socially desirable outcome than achieving a perfectly flat profile.
However, the researchers caution about the sample. The participant pool of 135 represented a relatively narrow cross‑section of the general population, with nearly three times as many men as women. This skew could influence overall aesthetic scores toward male preferences.
Additionally, the study notes that the age range was limited, with fewer participants in the older bracket. Since age can affect how faces are evaluated, the researchers call for broader, balanced samples across wider age ranges in future work to guide evolving standards of appearance.
The study, titled The Attractiveness of Facial Profile: A Random Population Survey on the Relationship of Jaws, was authored by Guido Gabriele, Niccolò Pini, Simone Cicorella, Flavia Cascino, Valerio Ramieri and Paolo Gennaro.
