Receding jaws and expanding skull during the evolutionary process of the hominid face made anthropologists remark that ‘the braincase is expanding at the expense of the jaws’. It is the shape of the face and the facial expressions that predominantly delineate human species from the rest of the primates. The concept of beauty of face varies with race, culture and region. Sharp, harmonious and balanced features are hallmarks of beauty. Growth pattern of the facial skeleton is genetically and developmentally modulated. The genetic factor is not easy to be manipulated, as it is imprinted in the genes. Facial syndromes and congenital defects are mostly genetically determined, and they are hence prenatal. Orthognathic surgery is a surgical modality for the correction of facial deformities. This chapter discuss the etiological factors of facial deformity.