A 3D anthropometric analysis of the orolabial region in Chinese young adults

Ethnic Considerations When Planning Lip Augmentation

Ideal standards of beauty including preferred lip characteristics vary between ethnicities. Although plump, well-defined lips are globally associated with youth, variation exists with regard to the perceived ideal lip volume and proportions between ethnicities. Proportions that may be assessed when planning lip augmentation include the upper-to-lower lip ratio, philtrum length, upper and lower vermilion heights, the ratio between the philtrum height and that of the upper vermilion, and the lip height-to-lip width ratio.It is important that accurate assessments of patients are made pre- and postaugmentation. However, many aesthetic assessment tools are based on Caucasian models with limited use in other ethnicities. We present a review of the ideal lip characteristics and assessment techniques accounting for ethnicity, with a view to providing practitioners an evidence-based approach to lip assessment and treatment planning for patients of all backgrounds.

Acquisition of Precision and Reliability of Modalities for Facial Reconstruction and Aesthetic Surgery: A Systematic Review

The foundation of reconstructive and cosmetic surgery is a confluence of advanced technologies, plethora of procedures, inventive modifications, and planned strategies. In surgical planning, the most crucial steps for treating a patient are evaluating the facial morphometry and recognizing the deviations from the baseline values of facial parameters. Various imaging and non-imaging modalities and sub-modalities contribute to diagnosis, treatment planning, and follow-up care. These techniques are an important milestone of pre-, peri-, and postoperative care in facial reconstruction. The current research aims to comprehensively explain imaging and non-imaging technologies encompassing both innovative and traditional approaches in facial reconstruction. PubMed, Scopus, and Web of Science were searched from 1990 to 2022, and systematic review was conducted in accordance with the PRISMA recommendations. Undoubtedly, various factors impact the selection of facial analysis acquisition approaches and their prospective. The surgical team must understand such modalities' potential for diagnosis and treatment. The evolution of three-dimensional imaging has been fueled because of the need for devices with high speed, small size, and several functions. Automation with more efficiency and precision is the way of the future for three-dimensional imaging. Stereophotogrammetry can clearly quantify the field of facial analysis. All the publications under consideration came to the same conclusion: Canfield's Vectra three-dimensional imaging devices can provide accurate, repeatable stereophotogrammetric pictures. Although a few minor mistakes were recorded, most examined devices are deemed reliable and accurate tools for Plastic surgeons.

A Guide to Bilateral Cleft Lip Markings: An Anthropometric Study of the Normal Cupid's Bow

OBJECTIVE

The aim of this study was to define the ratio of the heights of the vermilion between the peaks and trough of the Cupid's bow and hence assist in defining the point of closure on the lateral lip element to achieve a balanced Cupid's bow in bilateral lip repair based on our findings.

DESIGN

This study is a retrospective observational study of the anthropometrics of the upper lip's Cupid's bow. Three-dimensional (3D) images of toddlers between 2009 and 2016 were extracted from a normative 3D image database of toddlers at the Royal Children's Hospital, Melbourne.

PATIENTS

Participants from the normative 3D image database at the age of 1 year were studied. This excluded any patients with prior trauma or surgical intervention of the nasolabial region.

INTERVENTION

Landmarks measured were right and left crista philtri (cphR and cphL), labial superius (ls), stomion (sto), right and left chelion, and labial fissure (lf).

OUTCOME

Vermilion height of the right peak, trough, and left peak of the Cupid's bow was calculated by analyzing the vertical linear distance between cphR-lf, ls-sto, and cphL-lf. The ratio between the median and paramedian heights were recorded.

RESULTS

The paramedian height of the upper lip vermilion is consistently greater than the midline height. There was no significant sexual dysmorphism between ratio of paramedian to midline height on the right (P = .538) and left (P = .410).

CONCLUSION

We describe an anthropometric observation of the vermilion relationship at the Cupid's bow and define a specific lateral lip marking for bilateral cleft lip repair based on our anthropometric findings.

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.

Measurement of three-dimensional changes in lip vermilion in adult female patients after orthodontic extraction: a retrospective longitudinal study

Background

3D facial scanning has changed the way facial aesthetic is evaluated and has numerous advantages for facial analysis. The specific relationship between lip vermilion morphological changes after orthodontic extraction treatment has not been fully explained. The objective of this study was to evaluate 3D morphological changes after orthodontic extraction treatment in lip vermilion of adult females with dentoalveolar protrusion using a structured light-based scanner.

Methods

Forty-two female subjects (25.2 ± 1.9 years) were recruited as the treatment group; these patients had undergone extraction treatment and achieved better sagittal profiles. Twenty female subjects (25.5 ± 2.1 years) were enrolled in the non-treatment group; these patients did not require any orthodontic treatment. The follow up time for the treatment group was more than 24 months and for the non-treatment group was more than 12 months. 3D facial scans were captured using 3D CaMega. Six landmarks (Ls, Li, R.Chp, L.Chp, R.Ch, and L.Ch), three linear measurements (mouth height, philtrum width, and mouth width), and three area measurements (upper, lower, and total vermilion area) were measured. The spatial deviations of three volumetric measurements (upper, lower, and total vermilion) were constructed for quantitative analysis. Color-coded displacement map were constructed for visualization of the soft-tissue displacement as qualitative evaluation.

Results

Mouth height and philtrum width decreased (-0.93 mm and − 1.08 mm, respectively) significantly (p = 0.008 and p = 0.027, respectively), and no significant (p = 0.488) change in mouth width was observed in the treatment group. The lower and total vermilion surface areas decreased (-51.00mm² and − 69.82mm², respectively) significantly (p = 0.003 and p = 0.031, respectively) in the treatment group, but no statistically significant (p = 0.752) change was detected in the upper vermilion. In the treatment group, significant retractions were observed in the color-coded displacement map, and three volumetric measurements of vermilion changed significantly (p = 0.012, p = 0.001 and p = 0.004, respectively). Significant differences were found between the treatment group and the non-treatment group in the linear, area and volumetric measurements.

Conclusions

This study established a method for qualitative and quantitative evaluation of the lip vermilion. Significant 3D retraction of the lip vermilion after the extraction treatment was found, with morphological variation between upper and lower vermilion.

Analysis of correlation of 3-dimensional lip vermilion morphology and dentoskeletal forms in young Chinese adults on the basis of sex and skeletal patterns

INTRODUCTION

The objective of this research was to evaluate the correlation between 3-dimensional (3D) lip vermilion (LV) morphology and skeletal patterns as well as incisor measurements in young Chinese adults.

METHODS

In all, 240 young adults were enrolled; these included 80 patients each with skeletal Class I, Class II, and Class III malocclusions, respectively. Each sagittal skeletal pattern included 40 male and 40 female subjects. Twenty-two 3D LV measurements were obtained from 3D facial scans. Skeletal and incisor measurements were evaluated on lateral cephalograms. Correlation and regression analysis were performed between soft and hard tissue measurements.

RESULTS

Six of 22 LV measurements showed significant differences between male and female subjects. The 3D LV morphology showed significant differences with respect to different skeletal patterns and sex. Adults with skeletal Class III malocclusion tended to have thinner upper vermilion and fuller lower vermilion than subjects with skeletal Class II and III malocclusion. The mandibular plane angle negatively correlated with the upper-lower vermilion midsagittal curve length and surface area ratio in adults with skeletal Class I and II malocclusion, yet the vertical facial skeletal type showed no correlation in adults with skeletal Class III malocclusion. The vermilion angle, central bow angle, vermilion height, vermilion midsagittal curve length, vermilion height and width ratio, and vermilion surface area showed a significant correlation with incisor measurements. Regression analysis found that the ANB angle was an important factor affecting the upper and lower vermilion midsagittal curve length and surface area ratio. Further, the vermilion height and height and width ratio were closely correlated with the interincisal (U1/L1) angle, whereas the central bow angle was closely correlated with the maxillary incisor torque.

CONCLUSIONS

Most LV morphology variables were correlated to skeletal patterns and incisor measurements. Skeletal Class III malocclusion showed significant differences in vermilion morphology. Both the sagittal and vertical skeletal pattern have effects on vermilion proportion. The incisor torque was closely correlated to vermilion shape and central bow angle and might influence the vermilion esthetics. However, the proportion of the upper and lower vermilion was mainly affected by the ANB angle.

Validity and reproducibility of the 3D VECTRA photogrammetric surface imaging system for the maxillofacial anthropometric measurement on cleft patients

OBJECTIVES

To validate the accuracy and reproducibility of linear measurements of three-dimensional (3D) images and to compare the measurements with the direct anthropometry method on cleft lip and palate (CLP) patients.

MATERIALS AND METHODS

Nineteen linear facial measurements were derived from 16 standardized surface landmarks obtained from 37 cleft patients (20 males, 17 females; mean age 23.84 years, standard deviation ± 6.02). They were taken manually with calipers and were compared with the digitally calculated distance on the 3D images captured using the VECTRA-M5 360° Imaging System with pre-marked landmarks. Another pair of 19 linear measurements were computed on the 3D images 2 weeks apart for intra- and inter-observer agreements. Statistical analyses used were paired t test, the Bland-Altman analysis, and the intra-class correlation coefficient (ICC) index.

RESULTS

Most of the linear measurements showed no statistically significant differences between the proposed method and direct anthropometry linear measurements. Nevertheless, bias of the 3D imaging system is present in the linear measurements of the nose width and the upper vermillion height. The measurements' mean biases were within 2 mm, but the 95% limit of agreement was more than 2 mm. Intra- and inter-observer measurements generally showed good reproducibility. Four inter-observer measurements, the upper and lower face heights, nose width, and pronasale to left alar base were clinically significant.

CONCLUSIONS

Measurements obtained from this 3D imaging system are valid and reproducible for evaluating CLP patients.

CLINICAL RELEVANCE

The system is suitable to be used in a clinical setting for cleft patients. However, training of the operator is strictly advisable.

Three-dimensional changes in lip vermilion morphology of adult female patients after extraction and non-extraction orthodontic treatment

Objective

To investigate the three-dimensional lip vermilion changes after extraction and non-extraction orthodontic treatment in female adult patients and explore the correlation between lip vermilion changes and incisor changes.

Methods

Forty-seven young female adult patients were enrolled in this study (skeletal Class III patients were excluded), including 34 lip-protruding patients treated by extraction of four first premolars (18 patients requiring mini-implants for maximum anchorage control and 16 patients without mini-implants) and 13 patients requiring non-extraction treatment. Nine angles, seven distances, and the surface area of the lip vermilion were measured by using pre- and post-treatment three-dimensional facial scans. Linear and angular measurements of incisors were performed on lateral cephalograms.

Results

There were no significant changes in the vermilion measurements in the non-extraction group. The vermilion angle, vermilion height, central bow angle, height/width ratio, and vermilion surface area decreased significantly after the orthodontic treatment in the extraction groups, but the upper/lower vermilion proportion remained unchanged. Significant correlations were found between the changes in incisor position and those in vermilion angles, vermilion height, and surface area.

Conclusions

Extraction of the four first premolars probably produced an aesthetic improvement in lip vermilion morphology. However, the upper/lower vermilion proportion remained unchanged. The variations in the vermilion were closely related to incisor changes, especially the upper incisor inclination changes.

Craniofacial Anthropometric Profile of East Asians

Facial anthropometric data has significant ethnic variation. East Asia, comprised of fourteen countries, represents a significant proportion of the global population. This systematic review presents the facial anthropometric data collected from these countries. The systematic review was conducted in accordance with PRISMA guidelines. An electronic search of the MEDLINE database returned 3054 articles. Twenty articles were considered eligible for inclusion. Nine studies were conducted in China, 1 in Indonesia, 2 in Japan,3 in Korea, 4 in Malaysia, and 1 was a multicentre study conducted in China, Japan, Thailand, and Vietnam. Qualitative and quantitative parameters were extracted from the20 studies. No data was found for the other East Asian countries. There is a paucity of facial anthropometric data for East Asian countries despite their high burden of craniofacial anomalies and a strong demand for cosmetic facial surgery, both of which would benefit from the collection of robust craniofacial norms. It is in the interest of both the craniofacial surgeon and the East Asian patient to collect baseline facial anthropometric data for this population.

Anthropometric labial analysis of Han Chinese young adults

BACKGROUND

Facial features vary in size and proportions between different races. This study aimed to measure the anthropometric variables of the labial region in Han Chinese young adults.

MATERIALS AND METHODS

A total of 900 college students (475 male and 425 female) of Chinese Han ethnicity from the northern China were included. Measurements of the labial region included 14 linear items and seven proportions.

RESULTS

All the linear measurements of the males were significantly higher than those of the females (all P < 0.001). Significant gender differences were found in the philtrum morphology, philtrum width, upper vermilion-cutaneous lip, lower vermilion-cutaneous lip, and vermilion. There are significant differences in the anthropometric variables of the labial region between male and female Han Chinese young adults.

CONCLUSIONS

These data may be used as a reference standard for labial reconstructive and aesthetic surgery.

Anthropometric Analysis of the Nigerian Face: Any Conformity to the Neoclassical Canons?

This study defines the facial anthropometric and aesthetic measurements in young Nigerians. This is a prospective cohort study involving facial anthropometric measurement in young adults without craniofacial abnormalities. Ten anthropometric measurements (upper facial height (tr-n), mid-facial height (n-sn), lower facial height (sn-gn), height of auricle (sa-sba) bilaterally, intercanthal width (en-en), palpebral fissure width (en-ex) bilaterally, face width (zy-zy), nose width (al-al), mouth width (ch-ch) and the interincisal distance) were determined. Proportions were compared with neoclassic cannons, published North American and Asian norms 151 individuals consisting of 50 males and 51 females with age range from 16 to 31 (23.9 + 2.49) were enrolled. Only 1% of the study population had equal facial thirds, the midface was the shortest of the facial thirds and the male gender generally had larger mean values of the facial dimensions than the female gender. About half of the participants had the lower third > upper third > middle third, the intercanthal width was equal to the nasal width in only about a tenth of the participants and less than the nasal width in majority (88.1%) of the participants and the mean interincisal distance was 51.1 (SD ± 6.997). The anthropometric measurements from this Nigerian study do not conform to the neoclassical cannons. Racially sensitive facial canons and measurements are advocated during reconstructive and aesthetic interventions in the craniofacial region.

Philtrum length and intercommissural distance measurements at mixed dentition period

Anthropometric measurements of the lip and mouth are of great importance in clinical dysmorphology as well as reconstructive plastic surgery. In this study, the philtrum length (PhL) and intercommissural distance (ICmD) nomograms for Egyptian children in the mixed dentition period were established. A group of 1,338 Egyptian students in primary schools (735 boys and 603 girls) were included in the study. The students were at mixed dentition period and their ages ranged from 7 to 12 years. Anthropometric norms of PhL and ICmD were developed with significant sex difference in certain groups. A ratio between PhL and ICmD was developed. These data will help facilitate both objective and subjective evaluation of the lip and mouth for proper diagnosis of orofacial anomalies and variations as well as for ideal treatment plans.

Lip Measurements and Preferences in Asians and Hispanics: A Brief Review

Objective: Most literature regarding lip augmentation refers to Caucasian anthropometric measurements, but ethnic differences affect facial dimensions and the evaluation of beauty. Specifically with regard to Asians and Hispanics, dermatology does not have much literature on the subject. This review investigates the differences in lip measurements and preferences of Asians and Hispanics compared with those of Caucasians. Design: A literature search of other fields, including plastic surgery, maxillofacial surgery, orthodontics, and forensic anthropology, was conducted, and relevant articles were selected that applied to the discussion of lip measurements and preferences in Asians and Hispanics. Results: Lip measurements do appear to differ between Asians, Hispanics, and Caucasians, and ethnic background appears to influence lip preferences. Conclusions: It is inappropriate to use Caucasian measurements and generalizations in lip preferences when determining what is "ideal" when aesthetically augmenting lips among Asians and Hispanics. Ultimately, it is important to take into account the goals, anatomy, and ethnic background of each individual patient before performing lip augmentation.

The facial morphology in Down syndrome: A 3D comparison of patients with and without obstructive sleep apnea

Obstructive sleep apnea (OSA) occurs at a high prevalence in patients with Down syndrome (DS). A polysomnogram, which is often cumbersome and challenging, remains the gold standard method of diagnosing OSA. OSA in patients with DS is often attributed to skeletal and soft-tissue structural alterations that are characteristic of the DS phenotype; as such, we hypothesized that assessing anthropometric facial measurements may be predictive of OSA in patients with DS. We used the 3dMDface sterophotography system to capture and create 3D facial images, and we subsequently identified facial landmarks using a single, experienced investigator and utilizing proprietary software to calculate inter-landmark distances and angles. We compared our findings with similar data for neurotypically developing participants. We further compared the findings in participants with DS with and without OSA. Participants with DS had maxillomandibular hypoplasia with smaller ear, nose, and eye measurements compared to neurotypically developing peers. We found no statistically significant differences in 3D photogrammetric measurements between participants with DS with or without OSA.

A predictive model for obstructive sleep apnea and Down syndrome

Obstructive sleep apnea (OSA) occurs frequently in people with Down syndrome (DS) with reported prevalences ranging between 55% and 97%, compared to 1-4% in the neurotypical pediatric population. Sleep studies are often uncomfortable, costly, and poorly tolerated by individuals with DS. The objective of this study was to construct a tool to identify individuals with DS unlikely to have moderate or severe sleep OSA and in whom sleep studies might offer little benefit. An observational, prospective cohort study was performed in an outpatient clinic and overnight sleep study center with 130 DS patients, ages 3-24 years. Exclusion criteria included previous adenoid and/or tonsil removal, a sleep study within the past 6 months, or being treated for apnea with continuous positive airway pressure. This study involved a physical examination/medical history, lateral cephalogram, 3D photograph, validated sleep questionnaires, an overnight polysomnogram, and urine samples. The main outcome measure was the apnea-hypopnea index. Using a Logic Learning Machine, the best model had a cross-validated negative predictive value of 73% for mild obstructive sleep apnea and 90% for moderate or severe obstructive sleep apnea; positive predictive values were 55% and 25%, respectively. The model included variables from survey questions, medication history, anthropometric measurements, vital signs, patient's age, and physical examination findings. With simple procedures that can be collected at minimal cost, the proposed model could predict which patients with DS were unlikely to have moderate to severe obstructive sleep apnea and thus may not need a diagnostic sleep study.

Cephalometric Soft Tissue Standard and Gender Dimorphism in Nasal Prominence estimated By Holdaway's Analysis in Patients visiting College of Dentistry, Aljouf University

INTRODUCTION

The objectives were to see the nasal prominence norm and the gender dimorphism in nasal prominence measured by Holdaway's soft tissue analysis.

MATERIALS AND METHODS

The sample size was 100 (50 males and 50 females). The subjects included in the study were of Saudi origin with class I skeletal and dental relationship and all teeth present. The age group of the patients was between 18 and 28 years. The radiographs were traced and analyzed by two students and cross-checked by an orthodontist. The nasal prominence was measured according to the technique described by Holdaway.

RESULTS

The descriptive statistics were calculated for both male and female groups. The mean value of nasal prominence when male and female samples were combined was 14.08 mm. No statistically significant difference was found (p = 0.083) when genders were compared. The level of significance was set at p < 0.05.

CONCLUSION

No statistically significant difference was found when genders were compared. The value for males was normal while the value for females was less than Holdaway's normal.

CLINICAL SIGNIFICANCE

These values would aid in treatment planning for orthognathic surgery and orthodontic treatment.

Nasal Morphology of the Chinese: Three-Dimensional Reference Values for Rhinoplasty

OBJECTIVE

To determine normative nasal measurements for Chinese young adults, conditioned on demographics.

STUDY DESIGN

A cross-sectional descriptive study.

SETTING

A university hospital.

SUBJECTS AND METHODS

Three-dimensional (3D) photographs were captured from 103 Chinese subjects between 18 and 35 years of age using a commercial stereophotographic system. Anthropometric landmarks were identified on these 3D surface images, and measurements suitable for nasal analysis were performed and contrasted against established Caucasian norms. Gender differences in anthropometric dimensions were also analyzed.

RESULTS

Normative data for these measurements are made available. Linear nasal measurements, except those for mid-columella length, were significantly larger in men than in women; further, the nasal tip angle and nasofrontal angle were significantly larger in Chinese women. Contrasts of these new data against published Caucasian norms revealed dimensions that differ for these 2 groups. The Chinese normative mean values for morphological nose width, nasal tip angle, nasofrontal angle, and alar slope angle exceeded those reported for North American Caucasians.

CONCLUSIONS

Gender-specific normative data for the Chinese nose were established in this study to provide a useful tool for surgeons in dealing with rhinoplasty. Moreover, the Chinese nasal anthropometric measurements in this study are broader and flatter than those reported for North American Caucasians.