Objectives: To investigate the influence of personality traits in addition to quality of life (QoL) on the decision to accept orthognathic surgery. Materials and Methods: A total of 108 patients (68% female) aged 14–53 years (median, 18 years ; interquartile range, 17–25.75 years), with skeletal malocclusions of Index of Orthognathic Functional Treatment Need grades 3–5 (moderate to very great need for surgery) were included in this cross-sectional study. Personality traits of extraversion, neuroticism, agreeableness, openness, consciousness, perfectionism, and self- esteem and dimensions of Orthognathic Quality of Life Questionnaire were compared between patients who accepted orthodontic preparation for orthognathic surgery and those who refused (n = 55 vs 53). Results: Patients who accepted the suggested surgical procedure had higher age, perfectionism, facial esthetic (FE) concern, social aspect, and impairment of oral function (OF) as well as lower self-esteem with small to medium effect sizes (P ≤ .040 ; r = 0.198–0.399). Other personality traits and awareness of dentofacial deformity did not differ between the groups. In multiple logistic regression analysis, while controlling for sex, perfectionism, and self-esteem, the following predictors of acceptance of orthognathic surgery were higher: FE concern (odds ratio [OR], 3.4 ; 95% confidence interval [CI], 1.3–9.1), OF (OR, 3.0 ; 95% CI, 1.0–8.6), and age ≥18 years (OR, 2.7 ; 95% CI, 1.0–7.1 ; P < .001). Conclusions: Extraversion, neuroticism, agreeableness, conscientiousness, and openness do not significantly affect a patient's decision to accept orthognathic surgery. The influence of self-esteem and perfectionism is primarily on perception of alteration of QoL induced by dentofacial deformity.