Skeletal types: key to unraveling the mystery of facial beauty and its biologic significance.

In random studies, some faces will deviate toward Type II skeletal and some toward Type III. Some will deviate toward a skeletally short vertical while some toward long. In their study, Langlois and Roggman digitized individual faces through a computer. As more and more faces were entered, the composite of these faces became more and more attractive. From this, they concluded that attractive faces are only average. The "average" face may very well conform to the divine proportion. However, some faces are strikingly beautiful, and Alley and Cunningham in their study attempted to explain these attributes. Individuals who are blessed with attractive features are treated differently in our society. Ackerman states, "Attractive people do better: in school, where they receive more help, better grades and less punishment; at work, where they are rewarded with higher pay, more prestigious jobs and faster promotions; in finding mates, where they tend to be in control of the relationship and make most of the decisions; and among strangers, who assume them to be more interesting, honest, virtuous and successful." Many would find this special treatment objectionable and unfair. The irony is that beautiful individuals make up a very small percentage of the population; they have very little power to dictate how society should act and behave. Various disciplines have studied the nature of facial beauty. Individually, they provide partial answers; however, when viewed together, they begin to weave provocative insights as to its biologic significance. It is intricately related to divine proportion, and all living creatures have the genetic potential to develop toward it. The appreciation for this proportion is primitive and inborn; it is a biologic mechanism by which all living creatures are attracted to potential mates who conform to this strict proportion because they are biologically strong, healthy, and fertile. To date, there is no other profession other than ours that has the knowledge and the expertise to treat facial problems. We have a keen interest in facial and dental esthetics. We understand occlusion, TMJ anatomy, and facial-skeletal relationship to soft tissue profile. Unlike plastic surgery, where the soft tissues are artificially recontoured for better esthetics, we can make real and substantial skeletal changes. We are able to correct the architectural framework of the face to its physiologically correct position. In so doing, we cannot only improve our patients' appearance, but improve their health as well. There are those in our profession who are afraid of changes. They will not accept what has been presented with the usual excuse that they are "anecdotal" and not supported in the scientific world with rat and monkey studies. Although the concepts presented are complicated and controversial, I have attempted to present them clearly and simply with many references. There will be those, however, who will stubbornly continue to disbelieve the efficacy of functional appliance and TMD therapy even though in the real world there are many successes with human patients. With time, the truth will become self-evident. Finally, it is not my intent to say that everyone should look alike. Superficial variations and differences appropriate to certain climatic conditions and other environmental factors are often necessary for the survival of the species. Additionally, in rare instances, some Skeletal Type II individuals have shorter mandibles than normal. To reposition these mandibles forward closer to the anterior arc may create a "dual" bite situation. In other rare instances, Skeletal Type III individuals may have longer mandibles than normal. To reposition these mandibles posteriorly closer to the anterior arc may cause impingement of TMJ spaces and TMD. As more and more information is gathered, it is becoming clear that the physical, emotional, and psychological health of our patients are intimately related to the cranio-mandibular a