The purpose of this study was twofold: to determine whether professionals and laypersons differ in their perceptions of facial esthetic improvement in patients who have undergone orthodontics and orthognathic surgery; and to detrmine whether patient rankings by the judges are related to the plane (horizontal or vertical) in which the skeletal changes are made. For the first part of the study, composite photos of 19 female patients who underwent bilateral sagittal split osteotomy (BSSO) advancement procedures were presented to three groups of judges, oral and maxillofacial surgeons, orthodontists, and laypersons, who were asked to rank the patients in order of improvement in facial appearance. For part 2 of the study, composite photos of 19 female patients who had Le Fort I superior repositioning and BSSO advancement were presented to a similar group of judges who were likewise asked to evaluate the patients' esthetic improvement. Mean rankings of the patients were calculated and comparisons made among all judging groups. A similar analysis was performed for the perdcent unimproved scores. Data sets were ordered based on the patients' skeletal changes in the x (horizontal) and y (vertical) axes, and tests for statistical significance were performed. The three judging groups rated the patients similarly overall. Surgeons tended to score patients with large horizontal changes higher than did the orthodontists and laypersons. Laypersons consistently gave out lower scores than the professional groups. All three judging groups found patients with small x- and y-axis changes to be less improved than those with large x- and y-axis changes. However, one in five laypersons found patients to be unimproved following surgery, regardless of the amount of skeletal change.