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Purpose <p>This cross-sectional survey study investigated how two-dimensional (2D) versus three-dimensional (3D) facial representations influence perceived facial attractiveness, treatment need, and treatment modality selection across a range of sagittal and vertical facial patterns.</p> Methods <p>Standardized facial images of one male and one female subject were digitally modified independently in the anteroposterior (AP) and vertical dimensions using FaceGen software to generate nine variations per subject (three sagittal × three vertical), resulting in 18 facial depictions. Two anonymous surveys were constructed using REDCap: a 2D survey with static frontal and profile images and a 3D survey with rotating facial models. Each survey included the same set of modified faces presented in different visualization formats. A total of 400 evaluators including students, dentists, specialists, and laypeople recruited from a university-based population participated in the study. Participants rated facial attractiveness using a visual analog scale and assessed perceived treatment need using a 5-point ordinal scale. For profiles requiring treatment, participants selected the preferred modality (orthodontic treatment alone vs combined orthodontic–surgical treatment). Statistical comparisons between 2 and 3D assessments were performed using Wilcoxon rank-sum and Fisher exact tests.</p> Results <p>Three-dimensional visualization significantly influenced esthetic perception and clinical decision-making. Among male profiles, selected Class II and Class III patterns were rated more attractive in 3D, whereas others were rated less attractive compared with 2D images. Female Class II and Class III profiles consistently demonstrated higher attractiveness scores in 3D (<i>P</i> &lt; 0.001). Perceived treatment need was generally lower in 3D evaluations, with increased “no need” ratings for several profiles (e.g., Class I and Class II) and a reduction in “very great need” ratings for severe Class III patterns. Three-dimensional visualization also reduced the frequency of combined orthodontic–surgical treatment recommendations, with more profiles considered suitable for orthodontic treatment alone.</p> Conclusions <p>Compared with static 2D images, 3D representations modify facial morphology perception and are associated with less severe treatment modality selections, suggesting that integration of 3D facial imaging into orthodontic diagnosis and treatment planning may lead to different clinical management decisions.</p>

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Two-dimensional vs three-dimensional facial visualization: effects on perceived attractiveness, treatment need, and modality selection across sagittal and vertical facial patterns

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月2日

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  • Mitali Chitre Carlisle,
  • Josue Botello-Escalante,
  • Kelin Zhong,
  • Chia-Ling Kuo,
  • Anita Gohel,
  • Calogero Dolce,
  • Xianrui Yang,
  • Sarah Abu Arqub

摘要

Purpose

This cross-sectional survey study investigated how two-dimensional (2D) versus three-dimensional (3D) facial representations influence perceived facial attractiveness, treatment need, and treatment modality selection across a range of sagittal and vertical facial patterns.

Methods

Standardized facial images of one male and one female subject were digitally modified independently in the anteroposterior (AP) and vertical dimensions using FaceGen software to generate nine variations per subject (three sagittal × three vertical), resulting in 18 facial depictions. Two anonymous surveys were constructed using REDCap: a 2D survey with static frontal and profile images and a 3D survey with rotating facial models. Each survey included the same set of modified faces presented in different visualization formats. A total of 400 evaluators including students, dentists, specialists, and laypeople recruited from a university-based population participated in the study. Participants rated facial attractiveness using a visual analog scale and assessed perceived treatment need using a 5-point ordinal scale. For profiles requiring treatment, participants selected the preferred modality (orthodontic treatment alone vs combined orthodontic–surgical treatment). Statistical comparisons between 2 and 3D assessments were performed using Wilcoxon rank-sum and Fisher exact tests.

Results

Three-dimensional visualization significantly influenced esthetic perception and clinical decision-making. Among male profiles, selected Class II and Class III patterns were rated more attractive in 3D, whereas others were rated less attractive compared with 2D images. Female Class II and Class III profiles consistently demonstrated higher attractiveness scores in 3D (P < 0.001). Perceived treatment need was generally lower in 3D evaluations, with increased “no need” ratings for several profiles (e.g., Class I and Class II) and a reduction in “very great need” ratings for severe Class III patterns. Three-dimensional visualization also reduced the frequency of combined orthodontic–surgical treatment recommendations, with more profiles considered suitable for orthodontic treatment alone.

Conclusions

Compared with static 2D images, 3D representations modify facial morphology perception and are associated with less severe treatment modality selections, suggesting that integration of 3D facial imaging into orthodontic diagnosis and treatment planning may lead to different clinical management decisions.