3D stereophotogrammetry quantitative lip analysis

Quantitative Assessment of Lip Morphology in Patients With and Without Cleft Lip and Palate Using 3-Dimensional Stereophotogrammetry

This study aimed to assess and quantify the morphologic characteristics of the lips and the lower third of the face in cleft and noncleft patients, utilizing three-dimensional (3D) stereophotogrammetry. Sixty patients were included in the study, comprising 30 unilateral cleft lip and palate patients (G1, 24 female, 6 male; aged 20 to 60 y, mean age 44.0±12.0 y) and 30 noncleft patients (G2, 23 female, 7 male; aged 20 to 59 y, mean age 43.5±12.0 y). Anthropometric landmarks were identified on the facial surface. Three-dimensional stereophotogrammetry was employed to capture images. Statistical analysis was conducted to compare the groups, with a significance level set at 0.05. The comparative analysis revealed statistically significant differences in 5 linear and 6 angular measurements. Linear measurements such as philtrum width, upper and lower cutaneous lip height, mandibular ramus length, and midfacial depth exhibited significant differences between cleft and noncleft patients. Similarly, angular measurements, including upper lip angle, Cupid's bow angle, lower/medium face convexity, lip seal, nasolabial angle, and left gonial angle, displayed statistically significant disparities. These findings underscore the ongoing surgical challenges in the comprehensive rehabilitation of patients with clefts, highlighting the critical need for continued advancements in treatment strategies.

Anthropometry and Current Aesthetic Concept of the Lower Third of the Face and Lips in Caucasian Adult Population: A Systematic Review and Meta-Analysis

BACKGROUND

The lack of standardization of the norms and aesthetic concept of the lower third of the face and lips creates challenges in reconstructive surgery and aesthetic procedures. A large-scale, anthropometric measurements summary poses an alternative for establishing universal patterns.

METHODS

A systematic review was conducted by searching PubMed, Embase, Google Scholar and Web of Science using keywords: lip, face, aesthetics, beauty, anthropometry and Caucasian. Seventy records were included in the review and checked in detail in terms of available data.

RESULTS

The study contains a meta-analysis of twelve parameters with sufficient quantitative data-lip width, nose width, facial width, lower third of the face height, midline mandible height, total height of the upper and lower lip, upper and lower vermilion height, cutaneous upper lip height and nasolabial and mentolabial angle.

CONCLUSIONS

The review provides a detailed database of primary anthropometric studies of lips and perioral regions of the healthy Caucasian population. The attractiveness of the region is focused on uniformity of proportions. Notably, results acquired with different methods of measurement are not interchangeable. Despite many published anthropometric studies, systems for conducting the measurements and reporting the results are not sufficiently unified to quantitatively assess meticulous key aesthetic clinical parameters.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Facial Analysis of Patients with Unilateral or Bilateral Cleft Lip and Palate Using 3D Stereophotogrammetry

OBJECTIVES

To evaluate the quantitative values of linear and angular facial anthropometrics in patients with unilateral cleft lip and palate (UCLP) and compare them with those of patients with bilateral cleft lip and palate (BCLP) using three-dimensional (3D) facial imaging.

DESIGN

Retrospective, observational, and cross-sectional study.

SETTING

Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP).

PATIENTS/ PARTICIPANTS

In total, 61 non-syndromic patients with CLP who underwent multidisciplinary treatment and rehabilitated with a prosthesis were enrolled and divided into those with UCLP (G1; n = 31) and those with BCLP (G2; n = 30).

INTERVENTION

Facial images were captured using a 3D camera after landmarks were marked on each patient's face. The software evaluated linear and angular parameters. Statistical tests were applied. Significance was determined as P < 0.05.

MAIN OUTCOME MEASUREMENTS

Overall, 22 linear and 13 angular measurements were evaluated.

RESULTS

The nasal length (P = 0.08), middle third of the face (P = 0.06), base nose width (P < 0.001), nasal root width (P < 0.001), nasal tip angle (P = 0.018), philtrum width (P < 0.001), lower face width (P = 0.039) and midfacial depth (P = 0.040) were significantly higher in G2; the upper cutaneous lip height was significantly higher in G1. Sexual dimorphism was observed except for linear measurements (linear distance between the labiale superius and labiale inferius landmarks, nasal root width, and upper cutaneous lip length) and angular measurements.

CONCLUSIONS

G2 had a greater length and width of nose and nasal root, nasal tip angle, philtrum width, and lower face width, midfacial depth, and midface third than G1. These findings also revealed the presence of sexual dimorphism.

Upper lip characteristics and associated excessive gingival display etiologies in adults: Race and sex differences

BACKGROUND

This cross-sectional study aimed to examine upper lip (UL) and smile characteristics and soft tissue excessive gingival display (EGD) etiologies (hypermobile upper lip [HUL], altered passive eruption [APE], and short upper lip [SUL]) in a nondental adult population and to analyze interracial (Black and White) and intersex differences.

METHODS

Community participants, non-Hispanic Blacks (NHB) and non-Hispanic Whites (NHW), were recruited and examined for UL vertical dimensions at rest and maximum smile and for HUL, APE, and SUL. Associations between gingival display (GD) or EGD and UL anatomical characteristics, HUL, APE, and SUL were analyzed.

RESULTS

Participants included 66 NHB and 65 NHW adults. Ergotrid height (greater among NHW; p = 0.019) averaged 14.0 mm. Upper lip vermilion length (ULVL), total UL length, internal lip length, total UL length during smile, and UL mobility averaged 8.6, 22.5, 23.1, 16.6, and 5.9 mm, respectively (all significantly greater in NHB; p ≤ 0.012). SUL prevalence was 4.6%, found only among NHW. Lip length change from rest to smile (LLC) averaged 26.2% (significantly greater in females; p = 0.003). HUL prevalence was 10.7% (NHB 13.1%, NHW 3.5%; p = 0.024). NHB had significantly greater GD (p ≤ 0.017). EGD and APE prevalence (6.9% for both) showed significant interracial and intersex differences (p ≤ 0.014). Multivariate logistic regression analyses indicated that LLC and HUL were the most consistently significant EGD determinants.

CONCLUSIONS

UL anatomical and functional characteristics and soft tissue-related EGD etiologies exhibit significant interracial and intersex differences, with UL mobility/hypermobility being the most consistently significant determinant of GD.

Development and Validation of a Comprehensive Perioral Evaluation Method Using Three-Dimensional Stereophotogrammetry

BACKGROUND

The non-invasive three-dimensional (3D) stereophotogrammetry is widely used in anthropometry for medical purpose. Yet, few studies have assessed its reliability on measuring the perioral region.

OBJECTIVES

This study aimed to provide a standardized 3D anthropometric protocol for the perioral region.

METHODS

38 female and 12 male Asians were recruited (mean age 31.6 ± 9.6 years). Two sets of 3D images using the VECTRA 3D imaging system were acquired for each subject, and two measurement sessions for each image were performed independently by two raters. 25 landmarks were identified, and 28 linear, 2 curvilinear, 9 angular and 4 areal measurements were evaluated for intrarater, interrater, and intramethod reliability.

RESULTS

Our results showed high reliability of 3D imaging-based perioral anthropometry by mean absolute difference (0.57 and 0.57 unit), technical error measurement (0.51 and 0.55 unit), relative error of measurement (2.18% and 2.44%), relative technical error of measurement (2.02% and 2.34%), and intraclass correlation coefficient (0.98 and 0.98) for intrarater 1 and intrarater 2 reliability; respectively 0.78 unit, 0.74 unit, 3.26%, 3.06% and 0.97 for interrater reliability; and respectively 1.01 unit, 0.97 unit, 4.74%, 4.57% and 0.95 for intramethod reliability.

CONCLUSIONS

This standardized protocol utilizing 3D surface imaging technologies are feasible and highly reliable in perioral assessment. It could be further applied for diagnostic purpose, surgical planning and therapeutic effect evaluation in clinical practice in relation to perioral morphologies.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Gender- and Age-Related Characterization of Lip Morphology: A Three-Dimensional Analysis in a Chinese Population

BACKGROUND

Establishing facial anthropometric reference values is essential for diagnosis of deformity, assessment of aging, and planning for aesthetic and reconstructive treatment.

OBJECTIVES

This study aimed to provide detailed perioral anthropometric data in relation to sex and age in Chinese persons with a standardized 3-dimensional protocol.

METHODS

Three-dimensional facial photographs were obtained of 60 male and 64 female healthy Chinese participants ages 20 to 35 and 50 to 65 years old, as well as 2 acromegaly patients, with the VECTRA 3D camera. A standardized evaluation was performed to locate 37 perioral landmarks and generate corresponding measurements, including 26 linear distances, 5 ratios, 2 curvatures, 4 areas, and 9 angles. Measurements of different age groups and of different genders were compared, as were measurements of healthy individuals with those of acromegaly patients.

RESULTS

Sex discrepancy was noted in philtrum length, width, and area, lip width, and vermilion and cutaneous upper lip area; these were larger in Chinese males than females. However, vermilion heights were similar in both genders. With age, philtrum and cutaneous upper lip height and area, lip width, and angles related to cupid's bow significantly increased, whereas vermilion height and mouth corner angles decreased, and philtrum width, vermilion areas, and lip protrusion remained unchanged. Compared to healthy Chinese patients, acromegaly patients had a larger value for most measurements. Perioral rejuvenation based on detailed 3-dimensional anthropometry showed good results.

CONCLUSIONS

Chinese males have wider but not thicker lips than females, and aging features thin, flattened, and wide vermilions with a lengthened philtrum in both genders. These data can serve as a reference standard for disease diagnosis, aesthetic procedures, and reconstructive lip surgeries.

LEVEL OF EVIDENCE: 4

The Proportional Relationship Among the Aesthetic Units of the Upper Lip: A 3-Dimensional Morphological Analysis of Young Adults

A deep understanding of the proportional relationship among the crucial aesthetic units of the upper lip is essential for lip treatment procedures, yet limited information can be found. The authors used 3-dimensional (D) photogrammetry to analyze the proportional features involving different lip structures. One hundred sixty volunteers (aged 18-35 y) were included, and standardized frontal view 3D images were obtained. A series of anthropometric parameters were measured, including linear, angular, and ratio parameters. The authors took the philtrum as one structure of particular concern. The philtrum was classified into 4 groups according to the shape of philtral columns, and philtrum depth was measured. The authors analyzed the correlations between the philtrum and the vermillion lip. They found significant differences in philtrum depth among different type groups. A significant negative correlation between philtral depth and philtrum length was found, which indicated that a long philtrum was more likely to be accompanied by a flat philtrum with shallow depth. The philtrum width was significantly correlated with the mouth width with a mean ratio of 0.25. The authors also found a significantly negative correlation between philtral depth and angle of Cupid's bow's peak (Achp), and a positive correlation between Achp and mouth width. This study used 3D photography to quantitatively analyze proportional characteristics among labial aesthetic units in young Chinese adults. The results showed that the philtrum and the vermillion lip morphology were closely related, providing helpful references in perioral procedures.

Asymmetry index for the photogrammetric assessment of facial asymmetry

INTRODUCTION

Facial asymmetry is common and can be clinically related to dental malocclusion, facial bone development, muscular imbalance, and soft tissues thickness, which should be assessed during diagnosis to choose proper treatment options. This study aimed to quantify the amount of symmetry/asymmetry in previously defined symmetrical and asymmetrical subjects, analyzing full-face 3-dimensional images.

METHODS

Seventy-six orthodontic patients' 3-dimensional face images were obtained with the 3dMD Trio-system (Atlanta, Ga) and processed with the Geomagic Control (64-bit; 3D Systems, Rock Hill, SC) software. Patients were divided into symmetrical and asymmetrical groups through a surface-based technique. Sixteen facial landmarks were positioned, an asymmetry index was calculated for each landmark, and an evaluation diagram of facial asymmetry was created through the asymmetry index mean and standard deviation of symmetrical and asymmetrical landmarks.

RESULTS

The asymmetry index mean varied from 0.05 to 1.51 in the symmetrical group and from 0.05 to 2.84 in the asymmetrical group. This study suggests that landmarks located in the lower third of the face have a greater asymmetry index than other landmarks.

CONCLUSIONS

The landmark-based technique does not exhibit statistically significant differences among asymmetrical and symmetrical patients for some landmarks. This approach provides useful information about the localization and the extension of asymmetry, in which bilateral landmarks showed a higher amount of asymmetry than median landmarks.

The Concept of an Ideal Lips of Caucasian Male: An Anthropometric Analysis of the Lower Third of the Face

BACKGROUND

The lips play a significant role in determining the aesthetic perception of a human face. However, there is little data on the perioral region morphometry of attractive males.

OBJECTIVES

This study investigates the morphology of the lower third of the face, including the lips and jawline, of attractive young Caucasian males.

METHODS

A complex semi-automatic photogrammetric analysis of faces of male photo models (n=300) of the Caucasian race, aged 18-39 years old, was performed. Linear, angular, and surface area parameters were evaluated. In addition, an Average Body Contours (ABC) image was created, providing the graphical summarization of facial size and shapes of all analyzed individuals.

RESULTS

The height of the lower third of the face equaled 0.35 ± 0.03 of the total facial height. The average lip width was 50.98 ± 3.74 mm. The upper vermilion height was found significantly lower than the lower vermilion height (5.9 ± 1.62 vs. 11.15 ± 1.88 mm, p<0.01). The lip obliquity angle was found to be 1.01 o ± 0.73 o. The area surface of the lower lip vermilion was considerably larger than the vermilion of the upper lip (p<0.01).

CONCLUSIONS

The vast amount of morphometric data, including the novel presentation method as an ABC image, on the attractive male's lower third of the face, may provide the surgeons with practical guidelines for lips surgical and nonsurgical rejuvenation procedures. It may also support the perioral region reconstruction and sex reassignment surgery in achieving satisfactory results.

Lip Anthropometry of Healthy Turkish Young Adults

ABSTRACT

The lips play an important role in evaluating and recognizing the craniofacial complex and our perception of facial beauty and attractiveness. The aim of this study was to evaluate the anthropometric measurements of the lips of Turkish young adults and to look for sexual dimorphism. Anterior view photographs were taken of 100 females and 100 males who volunteered to participate in the study. Seven landmarks were determined, stomion (st), sublabiale (sl), subnasale (sn), labiale superius (ls), labiale inferius (li), crista philtre (cp), and chelion (ch). Then, using these landmarks, lower lip height (st-sl), upper lip height (sn-st), philtrum length (sn-ls), upper vermilion height (ls-st), lower vermilion height (li-st), cutaneous lower lip height (li-sl), philtrum width (cp-cp), and mouth width (ch-ch) were measured. It was observed that there was a statistical difference between genders in the parameters of st-sl, sn-st, sn-ls, li-sl, and ch-ch (P = 0.001, for these parameters). Besides, using these distances, 6 anthropometric ratios (ls-st/li-st, sn-ls/ls-st, li-sl/li-st, sn-st/st-sl, cp-cp/ch-ch, and ls-li/ch-ch) were calculated. Among the ratios investigated, sn-ls/ls-st, li-sl/li-st, and cp-cp/ch-ch were statistically significantly larger in males compared females (P = 0.012, P = 0.002, and P = 0.001, respectively). We believe that the results obtained in this study regarding lip anthropometry will help determine the standard values that can be used for the Turkish population aged 18 to 25.

Age- and Sex-Related Changes in Labial Dimensions of Sudanese Youngs of Arab Descent: A Three-Dimensional Cross-Sectional Study

Proper evaluation of facial features during growth and development requires the knowledge of anthropometric reference values validated for ethnicity, sex and age. In order to provide information concerning the normal sex-related size of the lips during childhood and young adulthood in Sudanese people of Arab descent, the three-dimensional coordinates of nine labial soft tissue landmarks were obtained by a laser scanner in 332 male and 386 female healthy Northern Sudanese subjects aged 3-30 years. Six labial linear distances, the vermilion height to mouth width ratio, vermilion areas and lip volumes were calculated and averaged for age and sex. Comparisons were performed by factorial analysis of variance (p < 0.01). All labial dimensions significantly increased with age. Significant effects of sex were found for four measurements only, with very small effect size; nonetheless, lips and their parts grew faster in females than in males at almost all ages. Philtrum width was the first linear distance that attained adult values. The vermilion height to mouth width ratio was nearly constant across the age groups. Data collected in this study contribute to information about ethnic-specific lip morphology during growth and development. As orolabial features change over time with their own pattern, the relevant age-related trends should be properly considered for clinical treatment planning.

Scientific validation of three-dimensional stereophotogrammetry compared to the IGAIS clinical scale for assessing wrinkles and scars after laser treatment

Measuring outcomes from treatments to the skin is either reliant upon patient’s subjective feedback or scale-based peer assessments. Three-Dimensional stereophotogrammetry intend to accurately quantify skin microtopography before and after treatments. The objective of this study is comparing the accuracy of stereophotogrammetry with a scale-based peer evaluation in assessing topographical changes to skin surface following laser treatment. A 3D stereophotogrammetry system photographed skin surface of 48 patients with facial wrinkles or scars before and three months after laser resurfacing, followed immediately by topical application of vitamin C. The software measured changes in skin roughness, wrinkle depth and scar volume. Images were presented to three observers, each independently scoring cutaneous improvement according to Investigator Global Aesthetic Improvement Scale (IGAIS). As for the results, a trend reflecting skin/scar improvement was reported by 3D SPM measurements and raters. The percentage of topographical change given by the raters matched 3D SPM findings. Agreement was highest when observers analysed 3D images. However, observers overestimated skin improvement in a nontreatment control whilst 3D SPM was precise in detecting absence of intervention. This study confirmed a direct correlation between the IGAIS clinical scale and 3D SPM and confirmed the efficacy and accuracy of the latter when assessing cutaneous microtopography alterations as a response to laser treatment.

An Objective, Quantitative Assessment of Flexible Hyaluronic Acid Fillers in Lip and Perioral Enhancement

BACKGROUND

HARK is an FDA-approved flexible filler designed for lips.

OBJECTIVE

To quantitatively evaluate subject outcomes by measuring the change in lip texture, color (redness), lip fullness, and lip and perioral surface stretch (dynamic strain) after treatment.

METHODS AND MATERIALS

In this 8-week open-label, Phase IV multicenter study, subjects were treated with HARK in the lips and HARR and/or HARD in perioral wrinkles and folds as add-on treatment. Assessments included 2D photographic analyses of lip texture and color, and 3D photographic assessments of lip enhancement and dynamic strain.

RESULTS

HARK significantly improved lip texture (p ≤ .002), lip redness (p < .001), and added fullness to the lips (lip enhancement measurements; p < .001), at Week 8 after treatment. In addition, lower lip wrinkles were significantly reduced (p = .007) and there was a reduction in upper lip wrinkles (not statistically significant). Surface stretch (dynamic strain) in the lip and perioral region was significantly increased after treatment (p < .001).

CONCLUSION

This analysis provides an objective measure of the beneficial effects of flexible hyaluronic acid fillers in lip augmentation and perioral enhancement and demonstrates a significantly improved lip texture, red color, and fullness. A significant increase in surface stretch (dynamic strain) is indicative of tissue expansion and improvement in lip smoothness.

Three-Dimensional Facial Anthropometric Analysis With and Without Landmark Labelling: Is There a Real Difference?

INTRODUCTION

The actual role of landmarks labeling before three-dimensional (3D) facial acquisition is still debated. In this study, several measurements were compared among textured labeled (TL), unlabeled (NL), and untextured (NTL) 3D facial models.

MATERIALS AND METHODS

The face of 50 subjects was acquired through stereophotogrammetry. Landmark coordinates were extracted from TL, NL, and NTL facial models, and 33 linear and angular measurements were calculated, together with surface area and volume. Accuracy of measurements among TL, NL, and NTL models was assessed through calculation of relative technical error of measurement (rTEM). The intra- and inter-observer errors for each type of facial model were calculated.

RESULTS

Intra- and inter-observer error of measurements increased passing from textured to NTL and NL 3D models. Average rTEMs between TL models, and NTL and NL models were 4.5 ± 2.6% and 4.7 ± 2.8%, respectively, almost all measurements being classified as "very good" or "good." Only for orbital height and its inclination, mandibular ramus length, nasal convexity, alar slope angle, and facial divergence, rTEM was classified as "moderate" or "poor."

CONCLUSIONS

Accuracy and precision of measurements decrease when landmarks are not previously labeled; attention must be taken when measurements have a low magnitude or involve landmarks requiring palpation.

Lip repositioning surgery for gummy smile: 6-month clinical and radiographic lip dimensional changes

OBJECTIVES

The present case series aimed to examine lip repositioning surgery (LRS) outcomes related to changes in external and internal upper lip (UL) dimensions, utilizing both conventional clinical and novel radiographic approaches.

MATERIALS AND METHODS

Patients (n = 13) diagnosed with hypermobile UL (>8-mm mobility during smile) and excessive gingival display (≥4-mm) were included and assessed at baseline and 6 months postoperatively. Clinical parameters at rest included total lip and internal lip length (vestibular depth). At maximum smile included total lip, philtrum (ergotrid), and vermilion lengths. Cephalometric parameters included anterior maxillary height; lip length; nasolabial angle; anteroposterior lip thickness; internal lip length (vestibular depth); and vestibular fornix position (using novel approach employing radiopaque marker). Linear mixed-effect models, Pearson's correlation, and linear regression were used for statistical analyses.

RESULTS

LRS did not affect total UL length at rest (p = 0.418). It resulted in significant internal UL length decrease (-3.8 ± 2.1 mm, p < 0.001) and significant increases of vermilion length (1.9 ± 1.0 mm, p < 0.001) and anteroposterior lip thickness (0.7 ± 0.7 mm, p = 0.002). The clinical and radiographic measurements of total UL length at rest (r ≥ 0.734) and of internal UL length (r ≥ 0.737), and the two radiographic assessments of vestibular depth (r = 0.842), were strongly correlated.

CONCLUSIONS

LRS resulted in significant decrease of vestibular depth/internal UL length and in significant increases of UL vertical vermilion length and UL anteroposterior thickness, without affecting total UL length at rest.

CLINICAL RELEVANCE

The documented lip dimensional outcomes should help practitioners when treatment-planning LRS and counseling patients seeking treatment for hypermobile UL.

Evaluating the Anatomical Traits of Lip on Three-Dimensional Computed Tomography Images

BACKGROUND

Lips and mouth are the most recognizable parts of the lower face. The morphometry of the facial organs is important for the balance of the face. Besides congenital anomalies occur on the lips, some kinds of deformities might be seen because of trauma or carcinoma. In this respect, lips are in the study of plastic surgery, maxillofacial surgery and orthodontics. Lip morphology also takes an important role in forensic facial reconstruction (facial approximation).

MATERIALS AND METHODS

Twenty parameters on the soft tissue and 12 parameters on the hard tissue were measured on three dimensional (3D) computed tomography (CT) images belonging 50 individuals (25 female, mean age 35.40 ± 9.97; 25 male, mean age 34.32 ± 11.06).

RESULTS

Statistical significance was observed on 4 parameters measured at soft tissue and 6 parameters measured in hard tissue. Statistical significance was not seen between the measurements taken bilaterally. Fourteen equations were developed in order to estimate the lip morphometry using the morphometric traits of hard tissue.

CONCLUSION

We hope that the results of current study will be useful at surgery and forensic sciences.

Stereophotogrammetry to reveal age-related changes of labial morphology among Chinese women aging from 20 to 60

Background

The lip is of important aesthetic value and highly subjected to aging. Collecting anthropometric baseline data and understanding age‐related changes of labial morphology can help with diagnosis of deformity, assessment of aging, and planning of cosmetic procedures. Many studies have focused on Caucasians, while there is a lack of anthropometric data on Chinese women.

Methods

A total of 169 women were enrolled in this cross‐sectional study and divided into four consecutive age groups. Linear distances, angles, and surface area data were obtained via stereophotogrammetry. Intergroup comparisons between different age groups were performed to find age‐related differences.

Results

Lip width significantly increased with age while philtrum width seemed to show no obvious change. Cutaneous upper and lower lip height increased, lengthening the lip in the vertical dimension. Decrease of upper vermilion height and changes in angles indicated that aging process shortened the upper vermilion and flattened the vermilion border. Surface area also showed age‐related changes. Intergroup comparison showed no statistical significance in most variables between 20s and 30s or 30s and 40s, while age‐related changes in some variables were significant between 40s and 50s.

Conclusion

This study provided anthropometric data of labial morphology across a wide age range. Aging process affected a variety of labial anthropometric variables. Age‐related changes accelerated after 40 among Chinese women.

Trauma Can Induce Telangiectases in Hereditary Hemorrhagic Telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease of the fibrovascular tissue resulting in visceral vascular malformations and (muco-) cutaneous telangiectases with recurrent bleedings. The mechanism behind the disease is not fully understood; however, observations from HHT mouse models suggest that mechanical trauma may induce the formation of abnormal vessels. To assess the influence of environmental trauma (mechanical or light induced) on the number of telangiectases in patients with HHT, the number of telangiectases on the hands, face, and lips were counted on 103 HHT patients possessing at least three out of four Curaçao criteria. They were then surveyed for information concerning their dominant hand, exposure to sunlight, and types of regular manual work. Patients developed more telangiectases on their dominant hand and lower lip (Wilcoxon rank sum test: p < 0.001). Mechanical stress induced by manual work led to an increased number of telangiectases on patients’ hands (Mann–Whitney U test: p < 0.001). There was also a positive correlation between sun exposure and the number of telangiectases on the lips (Mann–Whitney U test: 0.027). This study shows that mechanical and UV-induced trauma strongly influence the formation of telangiectases in HHT patients. This result has potential implications in preventive measures and on therapeutic approaches for HHT.

Perception of upper lip augmentation utilizing simulated photography

BACKGROUND

No head to head comparison is available between surgical lip lifting and upper lip filler injections to decide which technique yields the best results in patients. Despite the growing popularity of upper lip augmentation, its effect on societal perceptions of attractiveness, successfulness and overall health in woman is unknown.

METHODS

Blinded casual observers viewed three versions of independent images of 15 unique patient lower faces for a total of 45 images. Observers rated the attractiveness, perceived success, and perceived overall health for each patient image. Facial perception questions were answered on a visual analog scale from 0 to 100, where higher scores corresponded to more positive responses.

RESULTS

Two hundred and seventeen random observers with an average age of 47 years (standard deviation, 15.9) rated the images. The majority of observers were females (n=183, 84%) of white race (n=174, 80%) and had at least some college education (n=202, 93%). The marginal mean score for perceived attractiveness from the natural condition was 1.5 points (95% confidence interval [CI], 0.9-2.18) higher than perceived attractiveness from the simulated upper lip filler injection condition, and 2.6 points higher (95% CI, 1.95-3.24) than the simulated upper lip lift condition. There was a moderate to strong correlation between the scores of the same observer.

CONCLUSIONS

Simulated upper lip augmentation is amenable to social perception analysis. Scores of the same observer for attractiveness, successfulness, and overall health are strongly correlated. Overall, the natural condition had the highest scores in all categories, followed by simulated upper lip filler, and lastly simulated upper lip lift.

Stereophotogrammetric analysis of labial morphology in a young adult Middle-Eastern population

INTRODUCTION

The majority of previous research delineating the morphological characteristics of the orolabial region has been on Caucasian populations, with very minor research on Mediterranean populations, and none on the Lebanese population.

AIM

The primary aim was to collect information on the gender-specific 3D morphology of the mouth and lips in young Middle Eastern adults. The secondary aim was to explore the presence of associations between orolabial morphology and age and body mass index (BMI), and to assess correlations between linear orolabial dimensions and area/volume measures.

METHODS

The study used non-invasive stereophotogrammetry to collect information on gender-specific 3D labial morphology (linear distances, areas, and volumes) for 122 adult Lebanese subjects, aged 18-30 years (47 males, 75 females). Associations between labial morphology and age and body mass index were assessed, in addition to correlations between linear orolabial dimensions and area/volume measures.

RESULTS

All linear, angular, area, and volume lip measurements displayed significant variability. Both lip area and volume were smaller in the upper than in the lower lip. Eighteen out of the 20 linear measurements were significantly larger in males. The ratio, area, and volume measurements mostly displayed no statistically significant gender dimorphism.

CONCLUSIONS

Alongside presenting the first documented report on anthropometric labial measurements of a young Lebanese adult population, this research highlights the presence of gender dimorphism in linear and angular measurements, but not in area and volume measurements, and a strong association between certain linear labial measurements and lip area and volume. In addition, it presents pilot data on the association between labial anthropometry and body mass index.

Assessing Normal Smiling Function Through 3D-3D Surfaces Registration: An Innovative Method for the Assessment of Facial Mimicry

Smiling has a great importance, both from a functional and an aesthetic point of view. The introduction of modern 3D acquisition and elaboration methods may provide additional help in the evaluation of facial mimicry. This study aims at proposing an innovative method to assess facial and labial movements in different types of smiles. Twenty healthy subjects (10 males, 10 females, mean age 27.5 years, SD 4.5 years), were recorded through a stereophotogrammetric system in neutral position and in three types of smiles: Mona-Lisa smile, canine smile, full-denture smile. All the 3D smiling models were superimposed on the corresponding neutral one and point-to-point root mean square (RMS) differences were computed. Labial surface areas in rest position and during each smile were calculated as well, together with the percentage modification in different types of smile. RMS values (facial and labial models), labial surface areas and percentage modifications were compared through ANCOVA tests to verify possible statistically significant differences according to sex and type of smile (p < 0.05). Intercanthal labial width was considered a covariate. RMS values progressively increased from Mona-Lisa to full-denture smile; statistically significant differences were found among all types of smiles, both for facial and labial models (p < 0.05), while no statistically significant sex and sex × smile interactions were found (p > 0.05). Labial surface and percentage of modification showed statistically significant differences according to both sex and type of smile (p < 0.05). The study provides a novel contribution to the field of sexual dimorphism in smiling. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Determining the 2-Dimensional Threshold for Perception of Artificial-Appearing Lips

Importance

Recognizing the perceptual threshold for artificial-appearing lips is important to avoid an undesirable outcome of treatment.

Objective

To characterize the quantitative measurements for the perceptual threshold of artificial- and unnatural-appearing lips.

Design, Setting, and Participants

Photographs of a female model's lips were digitally altered incrementally in 5 sets of features (the upper lip, lower lip, upper and lower lips, and shape of the Cupid's bow). From December 1, 2013, to January 30, 2014, participants viewed the photographs in random sequence using an online survey and responded to 2 questionnaires after each photograph. The participants were prompted to respond whether each altered photograph of the lips appeared to have received any cosmetic treatment, and whether the lips looked attractive and natural or artificial and unnatural. The measurement of each lip at which 50% of the observers perceived the lips as being treated and 50% of the observers perceived the lips as being artificial was determined. The difference in these 2 measurements was defined as dTA50, which represents the threshold differential between the perception of treated lips and artificial lips for 50% of the observers.

Main Outcomes and Measures

Survey responses of the participants to the appearance of the lips in the photographs.

Results

A total of 98 participants (76 females and 22 males; mean age, 42 years) provided usable responses to the survey. Each area of the lips had a unique quantitative measurement at which the observers perceived the lips as being treated and artificial. Enhancement of the upper lip alone had a narrower margin for artificial appearance (dTA50, 0.9 mm) compared with enhancement of both the upper and lower lips (dTA50, 1.5 mm). Any alteration to the Cupid's bow resulted in the narrowest margin for artificial appearance (dTA50, 0.3 mm). The difference in the perceptual threshold between the age of the observers was the most significant for the upper lip.

Conclusions and Relevance

The perceptual threshold for treated and/or artificial appearance is unique for each area of the lips.

Level of Evidence

NA.

A Quantitative Approach to Determining the Ideal Female Lip Aesthetic and Its Effect on Facial Attractiveness

Importance

Aesthetic proportions of the lips and their effect on facial attractiveness are poorly defined. Established guidelines would aid practitioners in achieving optimal aesthetic outcomes during cosmetic augmentation.

Objective

To assess the most attractive lip dimensions of white women based on attractiveness ranking of surface area, ratio of upper to lower lip, and dimensions of the lip surface area relative to the lower third of the face.

Design, Setting, and Participants

In phase 1 of this study, synthetic morph frontal digital images of the faces of 20 white women ages 18 to 25 years old were used to generate 5 varied lip surface areas for each face. These 100 faces were cardinally ranked by attractiveness through our developed conventional and internet-based focus groups by 150 participants. A summed ranking score of each face was plotted to quantify the most attractive surface area. In phase 2 of the study, 4 variants for each face were created with 15 of the most attractive images manipulating upper to lower lip ratios while maintaining the most attractive surface area from phase 1. A total of 60 faces were created, and each ratio was ranked by attractiveness by 428 participants (internet-based focus groups). In phase 3, the surface area from the most attractive faces was used to determine the total lip surface area relative to the lower facial third. Data were collected from March 1 to November 31, 2010, and analyzed from June 1 to October 31, 2016.

Main Outcomes and Measures

Most attractive lip surface area, ratio of upper to lower lip, and dimension of the lips relative to the lower facial third.

Results

In phase 1, all 100 faces were cardinally ranked by 150 individuals (internet-based focus groups [n = 130] and raters from conventional focus groups [conventional raters] [n = 20]). In phase 2, all 60 faces were cardinally ranked by 428 participants (internet-based focus groups [n = 408] and conventional raters [n = 20]). The surface area that corresponded to the range of 2.0 to 2.5 × 104 pixels represented the highest summed rank, generating a pool of 14 images. This surface area was determined to be the most attractive and corresponded to a 53.5% increase in surface area from the original image. With the highest mean and highest proportions of most attractive rankings, the 1:2 ratio was deemed most attractive. Conversely, the ratio of 2:1 was deemed least attractive, having the lowest mean at 1.61 and the highest proportion of ranks within 1 with 310 votes (72.3%).

Conclusions and Relevance

Using a robust sample size, this study found that the most attractive lip surface area represents a 53.5% increase from baseline, an upper to lower lip ratio of 1:2, and a surface area equal to 9.6% of the lower third of the face. Lip dimensions and ratios derived in this study may provide guidelines in improving overall facial aesthetics and have clinical relevance to the field of facial plastic surgery.

Level of Evidence

NA.

The labial aging process: a surface analysis-based three-dimensional evaluation

BACKGROUND

With increasing age, the smile becomes elongated and less appealing. Currently, several methods are proposed for analysis of lip morphology including lateral cephalograms, profile and frontal photographs, video images, and three-dimensional systems. Despite several descriptions of morphologic and histologic age-related changes in the literature, no scientific well-supported model of the labial aging process is reported.

METHODS

For this study, 33 healthy volunteers were selected and divided into two groups according to age: a youthful group (ages 21-34 years) and an aged group (ages 45-65 years). Their dental and labial stone casts were obtained, digitized, and virtually reproduced using a computerized electromechanical digitizer and applying nonuniform rational B-spline geometry. To obtain a synthetic parameter describing local surface deformation, average curvature and curvature variability indexes were computed and compared.

RESULTS

No significant age- or sex-related differences in the average curvature were detected. In contrast, the curvature variability was significantly greater in the young than in the aged subjects.

CONCLUSIONS

The labial arch surface remains macroscopically constant between the third and the sixth decades of life, but with local modifications that influence the standard deviation of its curvature. A high standard deviation described the protruding labial appearance of the young subjects, whereas a reduced one described the flat lips of the aged subjects.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Evolution of the 3-dimensional video system for facial motion analysis: ten years' experiences and recent developments

Since the implementation of the computer-aided system for assessing facial palsy in 1999 by Frey et al (Plast Reconstr Surg. 1999;104:2032-2039), no similar system that can make an objective, three-dimensional, quantitative analysis of facial movements has been marketed. This system has been in routine use since its launch, and it has proven to be reliable, clinically applicable, and therapeutically accurate. With the cooperation of international partners, more than 200 patients were analyzed. Recent developments in computer vision--mostly in the area of generative face models, applying active--appearance models (and extensions), optical flow, and video-tracking-have been successfully incorporated to automate the prototype system. Further market-ready development and a business partner will be needed to enable the production of this system to enhance clinical methodology in diagnostic and prognostic accuracy as a personalized therapy concept, leading to better results and higher quality of life for patients with impaired facial function.

Surface facial modelling and allometry in relation to sexual dimorphism

Sexual dimorphism is responsible for a substantial part of human facial variability, the study of which is essential for many scientific fields ranging from evolution to special biomedical topics. Our aim was to analyse the relationship between size variability and shape facial variability of sexual traits in the young adult Central European population and to construct average surface models of adult males and females. The method of geometric morphometrics allowed not only the identification of dimorphic traits, but also the evaluation of static allometry and the visualisation of sexual facial differences. Facial variability in the studied sample was characterised by a strong relationship between facial size and shape of sexual dimorphic traits. Large size of face was associated with facial elongation and vice versa. Regarding shape sexual dimorphic traits, a wide, vaulted and high forehead in combination with a narrow and gracile lower face were typical for females. Variability in shape dimorphic traits was smaller in females compared to males. For female classification, shape sexual dimorphic traits are more important, while for males the stronger association is with face size. Males generally had a closer inter-orbital distance and a deeper position of the eyes in relation to the facial plane, a larger and wider straight nose and nostrils, and more massive lower face. Using pseudo-colour maps to provide a detailed schematic representation of the geometrical differences between the sexes, we attempted to clarify the reasons underlying the development of such differences.

Stereophotogrammetric analysis of nasolabial morphology among Asian Malays: influence of age and sex

OBJECTIVE

It is clear that population-specific norms should be used when planning plastic and reconstructive surgery for selected patients. In this study, we aimed to generate nasal and labial reference values by applying a stereophotogrammetric technique. A further aim was to investigate the effect of sexual dimorphism, age-related changes, and the interrelation between nasal and labial morphology.

DESIGN

Cross-sectional study.

SETTING

The data were collected from different locations on the Malaysian peninsula.

PARTICIPANTS

A total of 276 Asian Malays (138 males and 138 females) were included in this study, and a three-dimensional system was used for capturing data. The sample was divided into three age groups: 13 to 14, 15 to 17, and 18 to 36 years.

MAIN OUTCOME MEASURE(S)

Twenty-five dimensions of the nose and lips were measured and analyzed separately in males and females.

RESULTS

Significant differences between males and females were identified in 11 distances, and significant effects of age were found in most of the dimensions (p < .05). Significant correlations between the nasal and labial dimensions were recorded, particularly between lateral lip height and width of the ala insertion. A principal component analysis showed interrelationships between the nasal width distances and upper lip height.

CONCLUSION

This study has provided a new three-dimensional database for nose and lip morphology in Malays and demonstrated patterns of variation that can be used by surgeons to make comparisons within and between different human populations and also to develop treatment plans for their patients.

Photographic protocol for image acquisition in craniofacial microsomia

Craniofacial microsomia (CFM) is a congenital condition associated with orbital, mandibular, ear, nerve, and soft tissue anomalies. We present a standardized, two-dimensional, digital photographic protocol designed to capture the common craniofacial features associated with CFM.

Soft tissue response to mandibular advancement using 3D CBCT scanning

This prospective longitudinal study assessed the 3D soft tissue changes following mandibular advancement surgery. Cranial base registration was performed for superimposition of virtual models built from cone beam computed tomography (CBCT) volumes. Displacements at the soft and hard tissue chin (n = 20), lower incisors and lower lip (n = 21) were computed for presurgery to splint removal (4-6-week surgical outcome), presurgery to 1 year postsurgery (1-year surgical outcome), and splint removal to 1 year postsurgery (postsurgical adaptation). Qualitative evaluations of color maps illustrated the surgical changes and postsurgical adaptations, but only the lower lip showed statistically significant postsurgical adaptations. Soft and hard tissue chin changes were significantly correlated for each of the intervals evaluated: presurgery to splint removal (r = 0.92), presurgery to 1 year postsurgery (r = 0.86), and splint removal to 1 year postsurgery (r = 0.77). A statistically significant correlation between lower incisor and lower lip was found only between presurgery and 1 year postsurgery (r = 0.55). At 1 year after surgery, 31% of the lower lip changes were explained by changes in the lower incisor position while 73% of the soft tissue chin changes were explained by the hard chin. This study suggests that 3D soft tissue response to mandibular advancement surgery is markedly variable.

3D digital stereophotogrammetry: a practical guide to facial image acquisition

The use of 3D surface imaging technology is becoming increasingly common in craniofacial clinics and research centers. Due to fast capture speeds and ease of use, 3D digital stereophotogrammetry is quickly becoming the preferred facial surface imaging modality. These systems can serve as an unparalleled tool for craniofacial surgeons, proving an objective digital archive of the patient's face without exposure to radiation. Acquiring consistent high-quality 3D facial captures requires planning and knowledge of the limitations of these devices. Currently, there are few resources available to help new users of this technology with the challenges they will inevitably confront. To address this deficit, this report will highlight a number of common issues that can interfere with the 3D capture process and offer practical solutions to optimize image quality.

Accuracy and reproducibility of a 3-dimensional stereophotogrammetric imaging system

PURPOSE

To test the accuracy and reproducibility of a 3-dimensional (3D) stereophotogrammetric imaging system for measuring the facial soft tissues of healthy subjects.

MATERIALS AND METHODS

Three-dimensional soft tissue facial landmarks were obtained from the faces of 10 adult subjects, by use of a 3D stereophotogrammetric imaging system (Vectra; Canfield Scientific, Fairfield, NJ). Sixteen linear measurements were computed. Systematic and random errors between operators, calibration steps, and acquisitions were calculated.

RESULTS

No systematic errors were found for all performed tests (P > .05, paired t test). The method was repeatable, and random errors were always lower than 1 mm, except for the distance from cheilion to cheilion. Repeated sets of acquisition showed random errors up to 0.91 mm, without systematic biases.

CONCLUSION

The 3D stereophotogrammetric imaging system can assess the coordinates of facial landmarks with good precision and reproducibility. The method is fast and can obtain facial measurements with few errors.

Cranial base superimposition for 3-dimensional evaluation of soft-tissue changes

INTRODUCTION

The recent emphases on soft tissues as the limiting factor in treatment and on soft-tissue relationships in establishing the goals of treatment has made 3-dimensional (3D) analysis of soft tissues more important in diagnosis and treatment planning. It is equally important to be able to detect changes in the facial soft tissues produced by growth or treatment. This requires structures of reference for superimposition and a way to display the changes with quantitative information.

METHODS

In this study, we outlined a technique for quantifying facial soft-tissue changes viewed in cone-beam computed tomography data, using fully automated voxel-wise registrations of the cranial base surface. The assessment of soft-tissue changes is done by calculation of the Euclidean surface distances between the 3D models. Color maps are used for visual assessment of the location and the quantification of changes.

RESULTS

This methodology allows a detailed examination of soft-tissue changes with growth or treatment.

CONCLUSIONS

Because of the lack of stable references with 3D photogrammetry, 3D photography, and laser scanning, soft-tissue changes cannot be accurately quantified by these methods.

An index for quantitative assessment of lip augmentation

BACKGROUND

Lip dimensions and their relation to the whole face have been discussed mainly in the dental literature. There have been few attempts to scientifically measure the degree of lip augmentation, regardless of method.

OBJECTIVES

The authors describe a Lip Index that will allow reliable, quantitative analysis of the human lip complex, which is necessary to assess the efficacy and duration of attempts at lip augmentation.

METHODS

The authors developed a Lip Index as the basis for objective measurements of the effect and duration of lip augmentation with dermal fillers. Measurements may be taken directly from the patient, from standardized photos, or from the computer screen. Using a metric ruler, the height of the vermilion in the middle of the Cupid's bow is first measured (in mm) on the frontal view. The point of maximum protrusion of the vermilion is then measured (in mm) on a standardized side view perpendicular to a vertical line connecting the base of the columella to the fold demarcating lower lip and chin. Vermilion height multiplied by horizontal protrusion directly correlates with the central volume of the lips, upper and lower.

RESULTS

The easily applied ruler provided consistent measures before and after the injection of dermal fillers or soft implants. Adding upper and lower lip indices resulted in the Overall Lip Index for each patient, which was found to be approximately 50 in average females of Caucasian descent, about 100 in females of Asian descent, and nearly 200 in females of African descent.

CONCLUSIONS

The Lip Index allows for the practical evaluation of the clinical effects and duration of dermal filler injectables or implants. Quantitative assessments of results over time are easy to calculate, without the need for complex measurements or sophisticated analyses.

A review of facial image analysis for delineation of the facial phenotype associated with fetal alcohol syndrome

The facial anomalies associated with fetal alcohol syndrome (FAS), some of which are also present in individuals with less severe forms of the broader category of fetal alcohol spectrum disorders (FASD), are typically identified with the aid of linear distance measurements taken between facial landmarks. Digital facial imaging methods are increasingly being used in syndrome delineation. Distance measurements derived from stereo-photogrammetry and facial surface imaging have been used to study the FAS facial anomalies. Geometric morphometric methods capture the spatial arrangement between landmarks, providing a statistical platform for comparison of facial shapes, and have been shown to hold promise for characterizing the FAS facial shape. We review the progression in the use of imaging and image analysis methods in studies on the facial phenotype associated with FAS.

Contribution of lip proportions to facial aesthetics in different ethnicities: a three-dimensional analysis

BACKGROUND

Lip augmentations are commonly performed procedures in the United States, with annual numbers surpassing 100 000. While lips contribute to facial beauty, the relative influence of this feature to whole facial appeal has not yet been established. What is also of increasing interest is the consideration of ethnic differences in the evaluation of beauty. However, most current anthropometric measurements refer to Caucasians, and their use in the treatment of Asian American patients would be inappropriate.

METHODS

Three-dimensional models of 197 male and female Caucasian, Chinese and Korean subjects were created using surface-imaging technology. The lips and corresponding faces from these models were ranked according to subjective aesthetic appeal by 20 male and female raters of various ages, occupations and ethnicities. The raters' results were subsequently compared with individually measured lip parameters.

RESULTS

Rankings between lips and their corresponding whole faces differed greatly. Lips that were rated as the most attractive were smaller than average in midline upper lip surface heights, bilateral paramedian lip surface heights, upper lip angles and volume in the lower lip. Both Asian groups exhibited significantly different lip parameters and lip-projection volumes from that of Caucasians.

CONCLUSIONS

The results from this study suggest that there are indeed measurable differences in the baseline Asian lip morphology as compared with Caucasians. Tailoring lip enhancement treatment to each individual's anatomy, ethnic background and personal goals can optimise outcomes. What is also of interest is that lips did not contribute as much to facial attractiveness as previously thought.