title: Association between ratings of facial attractivess and patients' motivation for orthognathic surgery.
abstract: OBJECTIVE
  To compare the judgments of facial esthetics, defects and treatment needs between laypersons and professionals (orthodontists and oral surgeons) as predictors of patient's motivation for orthognathic surgery.
  
  
  METHODS
  Two panels of expert and naïve raters were asked to evaluate photographs of orthognathic surgery patients for facial esthetics, defects and treatment needs. Results were correlated with patients' motivation for surgery.
  
  
  METHODS
  Fifty-seven patients (37 females and 20 males) with a mean age of 26.0 +/- 6.7 years were interviewed prior to orthognathic surgery treatment. Three color photographs of each patient were evaluated by a panel of 14 experts and panel of 18 laypersons.
  
  
  METHODS
  Each panel of raters were asked to evaluate the facial morphology, facial attractiveness and recommend surgical treatment (independent variables). The dependent variable was the patient's motivation for orthognathic surgery. Outcome measure--Reliability of raters were analyzed using an unweighted Kappa coefficient and a Cronbach alpha coefficient. Correlations and regression analyses were used to quantify the relationship between variables.
  
  
  RESULTS
  Expert raters provided reliable ratings of certain morphological features such as excessive gingival display and classification of mandibular facial form and position. Based on the facial photographs both expert and naïve raters agreed on facial attractiveness of patients. The best predictors of patients' motivation for surgery were the naïve profile attractiveness rating and the patients' expected change in self-consciousness.
  
  
  CONCLUSIONS
  Expert raters provide more reliable ratings on certain morphologic features. However, the layperson's profile attractiveness rating and the patients' expected change in self-consciousness were the best predictors for patients' motivation for surgery. These data suggest that patients' motives for treatment are not necessarily related to objectively determined need. Patients' decision to seek treatment was more correlated to laypersons' rating of attractiveness because they see what other laypersons see, and are directly or indirectly affected by others reactions to their appearance. These findings may provide useful information for clinicians in counseling patients who seek orthognathic surgery.
authors.affiliation: Division of Dental Hygiene, School of Dentistry, West Virginia University, Morgantown, WV, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Vargo
authors.forename: M
authors.initials: M
authors.lastname: Gladwin
authors.forename: P
authors.initials: P
authors.lastname: Ngan
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D004954:Esthetics; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D005881:Gingiva / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008310:Malocclusion / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D008334:Mandible / Q000473:pathology; D008875:Middle Aged; D009042:Motivation; D020380:Needs Assessment; D009970:Orthodontics; D010781:Photography; D015203:Reproducibility of Results; D012649:Self Concept; D013223:Statistics as Topic; D013334:Students; D013515:Surgery, Oral