During a recent conference in europe, I took the opportunity to roam the backstreets to admire some grand old castles and churches that date back hundreds of years. It amazed me that even after the gruesome test of time and cascades of ever changing elements, these buildings still struck me as timeless and amazingly beautiful. All different, but individually and perfect. I believe that the architects and builders from the era that created these works placed much emphasis on establishing a rigid and yet dynamic foundation before layering on the various external aspects that gave each one their artistic character. The same principle should be applied to human facial aesthetics. One must start with a balanced skeletal foundation first before addressing the external elements in order to create an aesthetically pleasing face. Having a perfect set of eyes, nose or lips planted on a flat, sunken, or disproportioned facial skeleton will somehow still not “look right”. There are two main ways of improving the facial skeleton. One is with placement of facial implants and the other is by making alterations to the facial bone itself. Orthognathic surgery, or jaw surgery aims to correct and establish the ideal positional relationship between the upper jaw (maxilla) and the lower jaw (mandible). It is both functional and cosmetic. It is functional in the sense that the upper and lower teeth, which are attached to their respective jaws, have to be also brought into the correct alignment, in order to provide a correct bite. That is why orthognathic surgery is always planned and prepared in conjunction with an orthodontist. This type of surgery is not small, and occasionally, large movements to the facial skeleton have to be incurred to correct a deformity. Often times however, a small degree of movement or a slight tilt in angulation is all that is required to bring about a dramatic change in the overall facial appearance.