Today's orthodontist has many treatment options to choose from in reaching goals of treatment. Virtually all of these treatment options are designed to reach the same general orthodontic treatment goal that is class I occlusion with good facial esthetics. However each treatment choice almost always has an effect on the face and facial cosmetics. This is very true with orthodontic treatment and may be even more dramatic with combined orthodontic and orthognathic surgical cases. Sometimes our treatment goals may be at cross-purposes to facial cosmetics.