Facial appearance plays a major role in human communication. It provides basic information such as age, sex and ethnicity, but it also creates biases that are related to social, academic, professional and other features constituting a person’s identity. The importance of facial appearance in multiple aspects of modern life has shifted the paradigm for patients seeking dental, orthodontic and surgical treatments. In orthodontics, since the beginning of the profession, the primary goals of treatment have been occlusal function and dentofacial esthetics. However, facial assessments are often based on concepts of facial harmony that do not necessarily represent normative population data and do not always reflect the esthetic standards of the society. Moreover, orthodontic treatment has traditionally been associated with younger patient groups and therefore, esthetic concepts and treatment goals are often developed according to the appearance of the facial structures at a younger age.

In recent years the number of adults seeking orthodontic treatment has increased, and, as the population of developed countries is aging due to advances in medicine and technology, it is expected to continue to increase in the coming years. In order to meet the esthetic requirements of an older patient population, orthodontists need to familiarize themselves with facial appearance at an older age and adjust their treatment strategies accordingly. This article discusses general evolutionary and societal aspects of facial attractiveness in relation to orthodontic treatment and provides insight into the dental and orthodontic community regarding factors that can influence facial appearance.