The literature on the effectiveness of facial surgery for persons with Down syndrome was reviewed. Research based on impressions of involved persons (e.g., parents and doctors) generally provided evidence for the surgery's effectiveness. However, studies that used before-after research designs, control groups, indirect measures, and ratings of less involved persons were less supportive of the operation's positive effects. Certain of these studies indicated that the operation failed to achieve its goals. Furthermore, in evaluations of the operation, investigators generally did not critically examine the assumptions upon which the operation is based and the professional and social implications of facial surgery for persons with Down syndrome.