We wish to thank Dr Yongwen Guo for his interest and thoughtful review of our article in the AJO-DO . The exposures or interventions we used in our study were facial type, sex of the target persons, and midline deviations, and the outcome measure was the level of attractiveness. The purpose of a target person or model as in this study was to control or neutralize all physical attributes except the exposures. The recruitment of suitable models for studies in the United States can often be challenging. After you have institutional review board approval and the study is completed sometimes 6 months or more later, the models may no longer be available to sign a specific photo release for the journal. Also, many models do not want their photos shown, altered, and scrutinized in professional journals, and then critiqued outside the parameters of the study, especially since they are usually not compensated, as in this study. We had inclusion criteria of (1) adequate tooth display upon smiling (100% maxillary incisor display), (2) general frontal symmetry, (3) no obvious dental abnormalities or irregularities (crowding or spacing), (4) a facial pattern considered to be mesoprosopic, and (5) age between 18 and 29 years. Ultimately, we recruited 2 orthodontic residents.

Dr Guo is correct as we mentioned in our “Discussion” that a limitation of our study was that we did not record the gender of the raters as male or female.

Although refinement of our study could be the addition of another exposure or intervention—the level of attractiveness of the target persons as Dr Guo alludes to—this was a pilot study to encourage others to do follow-up studies. It has been demonstrated that attractiveness could be a factor in perceptions of midline deviations. We were aware of that, and that is why we tried to select relatively average-looking models. Chang et al suggested that attractive models are allowed less midline deviation. However, adding another exposure would have made this study more challenging.

We take exception with Dr Guo’s personal evaluation of the level of attractiveness of one of our models. The models graciously allowed their photos to be used in our study. We hope that a critique of models will not be standard practice; this may make recruitment of models difficult. As early as 1980, Berscheid pointed out that the evaluation of attractiveness can be done in a quantitative way with reliability and validity, but not based on 1 evaluation. Importantly, as pointed out by Berscheid, we have an extraordinarily distorted view of beauty because of the mass media, comparisons with celebrities, and a global view of beauty, so Dr Guo’s view of our male model is most likely biased.

We would encourage Dr Guo to replicate our study using models with different levels of attractiveness and identifying the gender of the raters. We would be eager to see the published results.