The challenge over the next decade in understanding craniofacial anomalies will revolve around a better understanding of genetics and the relationship with phenotypes. The rapid advances in molecular genetics need to be complemented with equally seismic advances in recording and understanding the varieties of craniofacial anomalies. This will require advances in imaging, measurement and interpretation. This keynote speech will integrate recent advances in our understanding of aetiology in relation to the interrogation of gene banks associated with cleft lip and palate and the issues of facial imaging in relation to diagnosis and potential advances in screening for parental contribution in these anomalies.