Nowadays, the place of psychiatrist is currently admitted in facial plastic surgery, but is still discussed in reconstructive surgery. This page will stress the importance of a cooperation between surgeon and psychiatrist, preoperatively in orthognathic surgery. After a brief review of literature, we will try to precise when psychiatrist's advice would help, preoperatively, maxillofacial surgeon. On the other end, we will see that psychiatrist having in charge patients with major facial deformity can head them to undergo a reparatrice surgery. A clinical case will end this paper.