Clinical anthropometry and canons of the face in historical perspective

Limited Applicability of Neoclassical Facial Canons in Tibetan Youth: 2D Photogrammetry Evaluation

Neoclassical facial proportion canons have long served as benchmarks for defining facial beauty across diverse populations. However, their applicability varies significantly among ethnic groups. This study critically evaluates the validity of these canons among young Tibetan adults in China, with a particular focus on vertical and horizontal facial proportions. A total of 455 young Tibetan students (136 men and 319 women) between the ages of 18 and 25 years enrolled at Tibet University participated in the study. Standardized frontal and lateral facial photographs were obtained for analysis. Most neoclassical facial canons demonstrated limited applicability to the Tibetan population, as none fully adhered to the 3-section facial canon. The lower facial 3-section canon was identified in 1.5% of men and 1.3% of women. The naso-orbital canon was observed in 11.8% of men and 34.9% of women, the naso-oral canon in 0% of men and 2.2% of women, and the naso-facial canon in 0.7% of men and 3.8% of women. Significant sex differences were identified (P < 0.05). Overall, the upper facial third exceeded the middle and lower thirds, while the intercanthal distance surpassed the eye fissure length in the majority of subjects. Neoclassical facial canons are largely inapplicable to the Tibetan population, particularly in the context of cosmetic or surgical planning. Despite demonstrating slightly higher applicability in women, the overall validity of these canons remains low. The distinct facial features of the Tibetan population necessitate the development of population-specific aesthetic standards, providing valuable insights into their unique facial morphology.

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

BACKGROUND

The demand for lip-redefining procedures has been rising in recent years, thus creating the need for reliable and detailed reference sources on aesthetic female lips. This study investigates the morphology of the lower third of the face, including the lips and jawline, of attractive young Caucasian females.

METHODS

A semi-automatic photogrammetric analysis of the faces of professional female photograph models (n=400) of the Caucasian race aged 18-39 was performed. Angular, linear, and surface area parameters were evaluated. A graphical summarization of the average facial shape of all analyzed attractive females was generated as an average body contours (ABC) image.

RESULTS

The height of the lower third of the face equaled 0.32 ± 0.02 of the total facial height. The average lip width was 48.06 ± 3.34 mm. The upper vermilion height was found to be significantly lower than the lower vermilion height (6.47 ± 1.36 vs. 11.64 ± 1.46 mm, p < 0.01). The lip obliquity angle was found to be 1.05° ± 0.79°. The area surface of the upper lip vermilion was considerably smaller than the vermilion of the lower lip (p < 0.01).

CONCLUSIONS

This is one of the largest studies on attractive Caucasian females' lips and lower face morphology. The data it provides, including the graphical presentation of the aesthetic lower face as an ABC image, may provide physicians with valuable guidelines for lips rejuvenation and reconstruction procedures.

LEVEL OF EVIDENCE III

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 .

Blood Pressure/Heart Rate-Derived Ratios as Indices of Health and Cardiovascular Pathology

This communication, based on a review of the relevant literature on ratios deriving from blood pressure and heart rate measurements, and their conformance/nonconformance to the mathematical golden rule (ie, 1.681), proposes that such ratios, particularly emanating from large numbers of home blood pressure and heart rate measurements obtained by the patients themselves or their caretakers, may constitute new risk markers, useful in the assessment of health and cardiovascular pathologies, prognosis of morbidity and mortality, and implementation to clinical practice and research.

There Is no Universal Standard of Beauty

This article discusses the various factors that contribute to facial beauty and the different contexts in which they are significant. The authors examine the roles of the golden ratio, ideal proportions, symmetry, and specific facial features in what constitutes an attractive face. They also investigate the influence of cultural and evolutionary perspectives on facial beauty and the impact of social media on our perception of beauty. The article provides a comprehensive overview of the topic and emphasises the significance of facial beauty and its impact on our lives. The authors acknowledge that the concept of beauty is difficult to define with absolute precision, and that the objective-subjective argument regarding facial beauty remains unsolved. However, they argue that physical attributes undoubtedly influence perceptions of attractiveness, but beauty extends beyond surface-level features. They also suggest that embracing diversity in beauty standards fosters a more inclusive society that celebrates the unique qualities of every person.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 .

Facial modeling and measurement based upon homologous topographical features

Measurement of human faces is fundamental to many applications from recognition to genetic phenotyping. While anthropometric landmarks provide a conventional set of homologous measurement points, digital scans are increasingly used for facial measurement, despite the difficulties in establishing their homology. We introduce an alternative basis for facial measurement, which 1) provides a richer information density than discrete point measurements, 2) derives its homology from shared facial topography (ridges, folds, etc.), and 3) quantifies local morphological variation following the conventions and practices of anatomical description. A parametric model that permits matching a broad range of facial variation by the adjustment of 71 parameters is demonstrated by modeling a sample of 80 adult human faces. The surface of the parametric model can be adjusted to match each photogrammetric surface mesh generally to within 1 mm, demonstrating a novel and efficient means for facial shape encoding. We examine how well this scheme quantifies facial shape and variation with respect to geographic ancestry and sex. We compare this analysis with a more conventional, landmark-based geometric morphometric (GMM) study with 43 landmarks placed on the same set of scans. Our multivariate statistical analysis using the 71 attribute values separates geographic ancestry groups and sexes with a high degree of reliability, and these results are broadly similar to those from GMM, but with some key differences that we discuss. This approach is compared with conventional, non-parametric methods for the quantification of facial shape, including generality, information density, and the separation of size and shape. Potential uses for phenotypic and dysmorphology studies are also discussed.

Facial Aesthetic Ideals: A Literature Summary of Supporting Evidence

BACKGROUND

To achieve the goal of enhancing facial beauty it is crucial for aesthetic physicians and plastic surgeons to have a deep understanding of aesthetic ideals. Although numerous aesthetic criteria have been proposed over the years, there is a lack of empirical analysis supporting many of these standards.

OBJECTIVES

This aim of this review was to undertake the first exploration of the empirical evidence concerning the aesthetic ideals of the face in the existing literature.

METHODS

A comprehensive search in MEDLINE, Embase, Scopus and CENTRAL databases was conducted for primary clinical studies reporting on the classification of the facial aesthetic units as per the Gonzales-Ulloa facial aesthetic unit classification from January 1962 to November 2022.

RESULTS

A total of 36 articles were included in the final review: 12 case series, 14 cohort studies, and 10 comparative studies. These described the aesthetic ideals of the following areas: forehead (6 studies; mean level of evidence, 3.33); nose (9 studies; mean level of evidence, 3.6); orbit (6 studies; mean level of evidence, 3); cheek (4 studies; mean level of evidence, 4.07); lips (6 studies; mean level of evidence, 3.33); chin (4 studies; mean level of evidence, 3.75); ear (1 study; level of evidence, 4).

CONCLUSIONS

The units that were most extensively studied were the nose, forehead, and lip, and these studies also appeared in journals with higher impact factors than other subunits. Conversely, the chin and ear subunits had the fewest studies conducted on them and had lower impact factors. To provide a useful resource for readers, it would be prudent to identify and discuss influential papers for each subunit.

LEVEL OF EVIDENCE: 3

Facial Analysis for Gender Affirmation/Gender-Related Facial Analysis

There are anthropometric differences between the bony and integumentary facial features of male and female individuals. When compared to males, female faces in general are more heart-shaped, with a shorter and smoother forehead, a smaller more defined nose, and a tapered chin.

Preference for Averaging in East Asian Faces: A Source of Potential Guidance in Aesthetic Plastic Surgery

Background

Relatively little research has been done on the application of objective tools in guiding Ethnic Plastic Surgery in Asian patients. The evolutionary psychology theory of koinophilia, or love of average features, presents the basis for a solution to build a foundation for crowd-sourced East Asian aesthetic standards.

Objectives

The authors hypothesize that the averaged composite face in a cohort will be viewed as significantly more attractive than their respective cohort.

Methods

Cohorts were created based on the gender of the individual in the photograph (40 females and 40 males of East Asian descent). Two surveys were created, 1 for the female cohort and the other for the male. The surveys assessed the aesthetic preference of each photograph using a Likert scale ranging from 1 to 7. Surveys were distributed using the popular crowdsourcing program Amazon Mechanical Turk (Amazon, Seattle, WA).

Results

The authors received 875 respondents for the male cohort survey and 876 respondents for the female cohort survey. For both the female and male cohorts, the composite images had a statistically significantly higher rating (P < .001) than the mean of the other images. Among other significant demographic findings, when considering both ethnicity and location of residence, Asian raters living in Asia preferred the composite significantly more than Asian raters living in North America (P < .001).

Conclusions

Raters' preference for the composite average face is in concordance with the evolutionary psychology literature. Thus, this study affirms the utility of using facial composites to guide surgeons in identifying aesthetic standards for patients of East Asian descent.

Facial profile of young indian women from Maharashtra-A cross-sectional pilot study

Context

The anthropometric facial clinical proportions are used in the field of orthodontics, maxillofacial and plastic surgery for aesthetic or abnormality corrections. There is lack of enough literature on the facial profiles of Indians.

Aim

To assess correlations between facial parameters and stature of young Maharashtrian women by using anthropometry.

Settings and Design

It is a cross-sectional observational pilot study at Maharashtra Institute of Dental Sciences & Research, after approval from the Institutional Ethical Committee.

Methods and Material

The study included 15 students of 21-23 years age selected by simple randomisation. The facial parameters were measured by sliding vernier calipers after identifying facial landmarks by stickers. Facial height (FH) in thirds; upper FH (UFH), middle FH (MFH) and lower FH (LFH); facial width (FW) and stature or overall height (OH) were calculated to define average facial features.

Statistical Analysis

Multiple pairwise statistics and simple linear regression analyses were done for various dependent variables.

Results

The means of UFH, MFH, LFH and total facial heights (TFH) were found to be 5.2 ± 0.54, 5.35 ± 0.34, 5.16 ± 0.44 and 15.7 ± 0.98 cm, respectively. The TFH showed a moderate correlation with stature (P ≤ 0.05, r = 0.64) and a strong correlation with lower lip length (P = 0.001, r = 0.78). Facial width showed a negative correlation with facial shape (P ≤ 0.05).

Conclusions

The selected sample showed the statistically insignificant difference between UFH, MFH and LFH indicating equitable distribution among Indian women of Maharashtrian origin of 21-23 year age group. Longer TFH is positively correlated with higher stature and longer lower lip length.

Application of 3-Dimensional White-Light Scanning to Observe the Lip and Nose Morphology of Chinese Children

OBJECTIVE

To establish a database and study the growth and development of Chinese children's nasolabial units by 3-dimensional (3D) white-light scanning technology.

MATERIALS AND METHODS

From January 2018 to January 2019, 528 patients were selected preoperatively in our hospital, without cranial or maxillofacial deformities. The patients were placed in supine positions in a state of sedation, and the authors used a 3D white-light scanner to scan the children's faces to measure the 3D morphological structure of their nasolabial areas. The results were presented with Graphpad Prism 8.0.2 to explore correlations and analyze trends.

RESULTS

The selected Chinese children consisted of 356 males (67.4%) and 172 females (32.6%). All nasolabial subunits grew fastest at 0 to 2 years old and at a slower rate from 2 to 15 years old, whereas the relevant growth of different sex was similar among contemporaries.

CONCLUSIONS

Three-dimensional white-light scanning can quickly and accurately gain 3D imaging of nasolabial soft tissue to build a normal morphology database. Furthermore, every nasolabial subunit grows fastest at the age of 0 to 2 years.

Analysis of Neoclassical Canons in Adult Kenyans of Indian Descent

Study Design: Descriptive cross-sectional. Objective: To establish anthropometric norms and test the validity of four neoclassical canons among Kenyans of Indian descent. Methods: Using direct anthropometric landmarks, 3 vertical and 4 horizontal measurements were made on the faces of 130 adult Kenyans of Indian descent. The mean of each anthropometric measurement was calculated and a student t-test was used to identify significant gender differences. These results were compared to four neoclassical canons and the percentage of each canon and its variants were recorded. A chi-square test was then performed to assess any gender differences between these findings. Results: When comparing sexes, the anthropometric means of males were larger than those of females except for eye fissure length. In addition, only the upper third displayed sexual dimorphism. As for the neoclassical canons, the orbital canon was found to apply to 20.0% of males and 21.6% of females, followed by the naso-oral canon found in 16.4% of males and 17.6% of females, and the orbito-nasal canon present in 14.5% of males and 18.9% of females. The vertical canon was not found to be applicable to any participant. Conclusion: The facial morphometric measurements in this population differ from the described neoclassical canons since they do not apply to the majority of these individuals. Therefore surgeons should be guided by the observed population-specific differences during reconstructive and facial aesthetic surgery.

Keloid masking a parotid tumor: A rare case presentation

A 37-year-old Nigerian woman presented with an itchy and occasionally painful scar that appeared after the healing of an acne lesion over the left parotid region, 13 years ago. She noticed a progressive increase; however, there was no history of facial weakness. Examination revealed a keloid lesion overlying a firm nontender mass. Ultrasound scan and fine-needle aspiration cytology indicated a benign tumor of the left parotid. Superficial parotidectomy was performed, and the histology revealed a keloid overlying a pleomorphic adenoma. This is an unusual presentation of keloid which developed over a pleomorphic adenoma. Hence, we report the above case for its rarity.

The use of race-based terminology in the rhinoplasty literature

PURPOSE OF REVIEW

To provide an overview of the use of race-based terminology in the rhinoplasty literature.

RECENT FINDINGS

The rhinoplasty literature is often indexed by race, with common usage of the terms Ethnic/Non-Caucasian/Nonwhite; African American/of African descent; Hispanic/Latinx; and Asian to refer to certain patient populations. There are wide variations in facial features within these populations, but specific traits may be more prevalent in patients with certain backgrounds. More recently, in particular within the 'Asian rhinoplasty' literature, titles have pivoted to include specific anatomic characteristics of interest, which offers a more objective way of discussing this topic.

SUMMARY

The use of race and ethnicity to describe facial and nasal anatomy in the rhinoplasty literature introduces subjectivity and diminishes the validity of the rhinoplasty literature. We advocate the usage of specific physical and anatomic descriptions rather than race and ethnicity within the rhinoplasty literature.

Quantitative analysis of facial proportions and facial attractiveness among Asians and Caucasians

It has been proposed that the proportions of the human face are crucial for facial aesthetics. If this is the case, we should describe the relationship among proportions of face components quantitatively. This study aims to develop a mathematical model of facial proportions to provide a quantitative description of facial attractiveness. Furthermore, we expect that plastic surgeons can use models in clinical work to enhance communication efficiency between doctors and patients. Face alignment technique was used to analyse 5500 frontal faces with diverse properties (male/female, Asian/Caucasian, ages) to obtain the ratios among the nose length ($ {N}_{L} $), the nasal base width ($ N $), and the inner canthus width ($ {E}_{I} $). A mathematical model ($ {N}_{L}^{2} = a{E}_{I}\mathrm{*}{N}_{L}+b{E}_{I}\mathrm{*}N+cN\mathrm{*}{N}_{L} $) was developed to describe the relationship among these proportions. To validate the effectiveness of this approach, we simulated the post-operative photos using Adobe Photoshop. Our findings show that the ratio of nose length to nose width, the ratio of inner canthus width to nose length and the ratio of inner canthus to nose width play a significant role in determining facial attractiveness. These results provide a possible strategy to quantitatively describe the relationship among human face proportions.

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.

What is Beauty?

PURPOSE

In the current study, the authors attempt to thoroughly investigate the concept of beauty from different perspectives in different historical periods and offer their personal thoughts about it.

METHODS

The authors performed a comprehensive and across-the-board literature review about 'beauty', including beauty from a philosophical perspective, beauty perception by human mind, beauty from a biopsychological perspective, beauty of the face, body and breast, models of beauty and beauty in cosmetic surgery.

RESULTS

From Plato to modern neuro-psychological studies, the concept of beauty has always been a theme for adamant debates and passionate thoughts. Different aspects of beauty, from intellectual to pure physical, have received a tremendous amount of attention. The true definition of the concept of beauty is still ambiguous, and there is not a unanimous explanation for it. It seems that the definition of beauty differs in every individual's mind and over the history of humankind.

CONCLUSION

Although beauty is a very important concept and the seek for achieving it is a very natural behavior, one must remember that the importance of beauty should not overshadow the fact that every human being is made up of similar internal organs. We strongly encourage the reader to look beyond the hedge, to be aware that each of us is made up of internal organs, beyond the external appearance. 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 Table of Contents or online Instructions to Authors www.springer.com/00266.

Craniofacial Anthropometry of Healthy Turkish Young Adults: Analysis of Head and Face

ABSTRACT

The aim of this study was to evaluate the craniofacial anthropometric measurements of Turkish young adults between the ages of 18 and 25. Anterior view and side profile photographs were taken of 100 females and 100 males who volunteered to participate in the study and had no craniofacial anomalies, history of facial trauma, or history of orofacial surgery. Thirteen landmarks on the face and head were chosen, and these landmarks were identified on the photographs. Then, using these landmarks, a total of 19 distance measurements were made, 16 from the anterior view, and 3 from the side profile. There were statistically significant differences between the sexes in 13 parameters: 2 parameters (t-n and ft-ft) being higher in females and 11 parameters (v-n, v-t, t-gn, sn-gn, n-gn, st-gn, sl-gn, fz-fz, z-z, tr-tr and go-go) being higher in males. Also, 7 facial anthropometric ratios were calculated. There were statistically significant differences between the genders in all ratios. The literature reveals that craniofacial anthropometric measurements have been performed on many different populations and that there are numerous differences between the results of the studies conducted. We are of the opinion that the results obtained in this present study will contribute to the literature by helping to determine the standard values for the Turkish population between the ages of 18 and 25, which can be used in diagnosis, treatment and postoperative evaluation in areas such as forensic science, orthodontics, clinical genetics, maxillofacial surgery, and plastic surgery.

Comparative Study of Anthropometric Nasal Anslysis Based on Han Nationality Young Female Adults in Central China

BACKGROUND

The data of nasal anthropometric measurements could help surgeons perform preoperative or postoperative assessments and decide surgical strategies of the nose plastic surgery and related cosmetic rhinoplasty. The aim of the study was to describe the average values of the nasal anthropometric measurements in Han Nationality young female population in Central China.

METHODS

All 430 Han Chinese young females were obtained for this study, and their anthropometric features were measured including weight, height, 11 items of linear distance and 4 angles. Seven proportion indices of the soft tissue of the external nose were determined. Related results were compared with the result of other available literature about nasal anthropometry in Han Nationality young females from different regions of China and the other racial/ethnic nasal anthropometry in the world populations.

RESULTS

The means of the linear measurements of the external nose in this study were as follows: nasal height (48.9 mm), nasal bridge length (43.3 mm), morphological facial height (110.4 mm), facial width (125.1 mm), intercanthal width (35.9 mm), nasal tip protrusion (21.1 mm), nasal width (35.5 mm), nasal ala length (27.9 mm), nasal ala thickness (4.1 mm), columella height (8.9 mm), columella width (6.0 mm). The means of the angular measurements of the nose were as follows: nasofrontal angle (143.3 degree), nasofacial angle (34.1 degree), nasal tip angle (80.4 degree), nasolabial angle (97.3 degree).

CONCLUSIONS

There were regional differences of the external nasal anthropometric of the Han Nationality young female adults in China and the racial/ethnic differences of that compared with the some races/ethnic around the world. This study could provide credible and objective reference material for plastic and maxillofacial surgeons for the external nasal soft tissue evaluation and planning of the cosmetic nasal surgery in the Han Nationality young female adults in Central China.

The Changing Face of Beauty: A Global Assessment of Facial Beauty

Beauty is difficult to define. The US population becomes more diverse by the day. Thus, traditional stereotypes of beauty in various ethnic groups become less applicable as diversity increases. Often, new and uniquely beautiful facial features and proportions emerge as different ethnicities converge. With the increased diversity in facial appearance comes increased variability in patients' goals. A successful cosmetic surgeon will cultivate an understanding of aesthetic ideals in different ethnic groups, nurture discussions with patients to determine their aesthetic goals, devise a surgical plan for each patient, and develop and refine the necessary surgical skills to perform the procedure.

Surgical Management of the Nose in Relation With the Fronto-Orbital Area to Change and Feminize the Eyes' Expression

Gender affirmation surgeries in male-to-female transition patients include breast augmentation, genital construction, and facial feminization. Facial features serve an integral role in identifying an individual's gender, with certain characteristics perceived as feminine or masculine.The nose, as the centerpiece of the middle third of the face, is an important component of facial attractiveness and gender identity. Thus, reduction rhinoplasty is a mainstay of the facial feature remodeling (FFRS) and facial feminization surgery (FFS).The authors usually divide the surgery planning in 2 steps, obviously depending on each patient needs, but generally speaking, the authors do the upper part of the head in one stage and the mandible and face lift in another.If the patient only requires frontal bone surgery and softening of the orbital rims, the authors always perform the nose surgery in this stage. If a mandible reduction is needed, combined with a face-lift, the authors do it in another procedure, usually separated between 7 to 10 days from the other surgery. In these cases, the authors begin with the lower part of the face on the first stage and then, the frontal bone and rhinoplasty on the second.The fronto naso-orbital complex is one of the main facial areas that determine the identification of facial gender, the nose plays a crucial role in FFS of the middle third. The main goal of rhinoplasty in FFRS is to change masculine nasal features to feminine ones by performing dorsal reduction, tip refinement, and narrowing the nasal bones, most often using an external approach and cartilaginous grafts to provide good tip support and long-term stability. Lip-lift and frontonasal recontouring can be technically complementary to rhinoplasties associated with facial features remodeling and feminization.

Caucasian Mediterranean patients seeking rhinoplasty-Anthropometric measurements and prevalence of major deformities

OBJECTIVE

To describe the average values of the nasal anthropometric measurements of Caucasian Mediterranean patients seeking rhinoplasty and evaluate the major nasal deformities.

DESIGN

Prospective, observational and cross-sectional study.

SETTING

Centro Hospitalar do Porto.

PARTICIPANTS

A 100 Caucasian Mediterranean patients seeking rhinoplasty.

OUTCOMES

Standardized photography was used to obtain nasal anthropometric measurements and to evaluate the major nasal defects. Data regarding age, gender, skin type and Fitzpatrick scale were also collected.

RESULTS

There was a statistically significant difference in the means values of palpebral fissure, intercanthal width, upper lip height, nasal root width, morphological nose width, nose height, nasal tip projection and nasofrontal-hump and nasofrontal-supratip angles between females and males. The major nasal deformity was dorsal hump (78.0%), followed by rinomegalia (53.0%) and boxy bulbous tip (47.0%).

CONCLUSION

The present study shows statistically significant gender differences between anthropometric nasal measurements and the mean values are greater than standard values obtained on general population. This might be one of the reasons why Caucasian Mediterranean patients seek aesthetical rhinoplasty. On both genders, dorsal hump, rinomegalia and boxy bulbous tip were the major nasal defects. This emphasize the importance of rhinoplasty techniques designed to reconstruct nasal dorsum and nasal tip on Caucasian Mediterranean patients. To the best of our knowledge, our study is the first study of digital anthropometric nasal analysis and evaluation of major nasal defects specifically in Caucasian Mediterranean patients who applied for rhinoplasty. With this results, we provide a reference material for the evaluation of the Caucasian and Mediterranean patient when planning a cosmetic nasal surgery.

Is it possible to define the ideal lips?

SUMMARY

The lips are an essential component of the symmetry and aesthetics of the face. Cosmetic surgery to modify the lips has recently gained in popularity, but the results are in some cases disasterous. In this review, we describe the features of the ideal lips for an individual's face. The features of the ideal lips with respect to facial anatomy, important anatomical landmarks of the face, the facial proportions of the lips and ethnic and sexual differences are described. The projection and relative sizes of the upper and lower lips are as significant to lip aesthetics as the proportion of the lips to the rest of the facial structure. Robust, pouty lips are considered to be sexually attractive by both males and females. Horizontal thirds and the golden ratio describe the proportions that contribute to the beauty and attractiveness of the lips. In young Caucasians, the ideal ratio of the vertical height of the upper lip to that of the lower lip is 1:1.6. Blacks, genetically, have a greater lip volume. The shape and volume of a person's lips are of great importance in the perception of beauty by humans. The appearance of the lips in part determines the attractiveness of a person's face. In females, fuller lips in relation to facial width as well as greater vermilion height are considered to be attractive.

Forehead and Orbital Rim Remodeling

Facial features remodeling surgery is performed to obtain feminization of the face that corresponds to the gender perceived by patients. This includes techniques and findings to remodel the forehead and orbital rim to change the expression of the eyes, correction of the frontonasal angle in relation to rhinoplasty, hairline feminization, and eyebrow lift to correct the position and aesthetic dissatisfaction or the effects of aging.

The Evaluation of Anthropometric Measurements of Young Polish Women's Faces

Face proportions are under constant evaluation during prosthetic or surgical diagnostics and treatment. The aim was to evaluate the proportions of the faces of young Polish women as compared with other ethnic groups.

MATERIALS AND METHODS

The evaluation included 60 photographs of the faces of women, average age 17.9 years. En face images were made with the camera lens situated at the same distance from the photographed subjects. Using Adobe Photoshop software, midsaggital and even anthropometric points were determined in the photographs and then the distance between these points was measured. Four relationships between vertical measurements, 3 between horizontal measurements, and 4 proportions between vertical and horizontal measurements were calculated. The results were evaluated in comparison with the golden ratio (1.618) and the measurements performed for native Americans and Latin American beauty contests winners described in the relevant literature.

RESULTS

The result for the average vertical face proportion value of the examined women was close to the golden ratio (GR) and amounted to 1.592 for the proportions between nasion-stomion and stomion-gnation (98% of GR) and 1.372 for nasion-subnasale and subnasale-gnation (85% of GR).Average measurement results for young Polish women's faces were not statistically significantly different for 6 out of 11 relationships under evaluation as compared with the population of native American females and only 2 face proportions were the same as for beauty contests winners from Latin America.

CONCLUSION

Face proportions of young Polish women were different from those of the females living in the American continent.

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.

Ethnic Rhinoplasty in Female Patients: The Neoclassical Canons Revisited

BACKGROUND

Despite the substantial amount of research devoted to objectively defining facial attractiveness, the canons have remained a paradigm of aesthetic facial analysis, yet their omnipresence in clinical assessments revealed their limitations outside of a subset of North American Caucasians, leading to criticism about their validity as a standard of facial beauty. In an effort to introduce more objective treatment planning into ethnic rhinoplasty, we compared neoclassical canons and other current standards pertaining to nasal proportions to anatomic proportions of attractive individuals from seven different ethnic backgrounds.

METHODS

Beauty pageant winners (Miss Universe and Miss World nominees) between 2005 and 2015 were selected and assigned to one of seven regionally defined ethnic groups. Anteroposterior and lateral images were obtained through Google, Wikipedia, Miss Universe, and Miss World Web sites. Anthropometry of facial features was performed via Adobe Photoshop TM. Individual facial measurements were then standardized to proportions and compared to the neoclassical canons.

RESULTS

Our data reflected an ethnic-dependent preference for the multiple fitness model. Wide-set eyes, larger mouth widths, and smaller noses were significantly relevant in Eastern Mediterranean and European ethnic groups. Exceptions lied within East African and Asian groups.

CONCLUSION

As in the attractive face, the concept of the ideal nasal anatomy varies between different ethnicities. Using objective criteria and proportions of beauty to plan and execute rhinoplasty in different ethnicities can help the surgeon plan and deliver results that are in harmony with patients' individual background and facial anatomy.

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 .

Facial preservation following extreme mummification: Shrunken heads

Shrunken heads are a mummification phenomenon unique to South America. Ceremonial tsantsa are ritually reduced heads from enemy victims of the Shuar, Achuar, Awajún (Aguaruna), Wampís (Huambisa), and Candoshi-Shapra cultures. Commercial shrunken heads are comparatively modern and fraudulently produced for the curio-market, often using stolen bodies from hospital mortuaries and graves. To achieve shrinkage and desiccation, heads undergo skinning, simmering (in water) and drying. Considering the intensive treatments applied, this research aims to identify how the facial structure can alter and impact identification using post-mortem depiction. Sixty-five human shrunken heads were assessed: 6 ceremonial, 36 commercial, and 23 ambiguous. Investigations included manual inspection, multi-detector computerised tomography, infrared reflectography, ultraviolet fluorescence and microscopic hair analysis. The mummification process disfigures the outer face, cheeks, nasal root and bridge form, including brow ridge, eyes, ears, mouth, and nose projection. Melanin depletion, epidermal degeneration, and any applied staining changes the natural skin complexion. Papillary and reticular dermis separation is possible. Normal hair structure (cuticle, cortex, medulla) is retained. Hair appears longer (unless cut) and more profuse following shrinkage. Significant features retained include skin defects, facial creases, hairlines and earlobe form. Hair conditions that only affect living scalps are preserved (e.g. nits, hair casts). Ear and nose cartilage helps to retain some morphological information. Commercial heads appear less distorted than ceremonial tsantsa, often presenting a definable eyebrow shape, vermillion lip shape, lip thickness (if mouth is open), philtrum form, and palpebral slit angle. Facial identification capabilities are considered limited, and only perceived possible for commercial heads.

Satisfaction with facial profile aesthetics: are norms overrated?

This study aimed to explore to what extent adults perceive deviations from the norm of a balanced profile with normal occlusion as reducing satisfaction with facial appearance and having a psychosocial impact. This cross-sectional study included 225 Caucasian subjects (64% women) aged 18-42 years. Their facial profiles were analyzed photogrammetrically and they were classified into three categories: within, below, or above the standard range for the Croatian population with a normal occlusion. Psychosocial issues were assessed by self-reported satisfaction with facial appearance and domains from the Orthognathic Quality of Life Questionnaire: social aspects of dentofacial aesthetics (SA), facial aesthetics concern (FA), and awareness of dentofacial aesthetics (AW). Men with a concave profile were less satisfied with their faces than those with a flat or convex profile (P<0.05). A reduced upper lip height in men resulted in a lower level of satisfaction and increased FA score, when compared to men with a normal or increased upper lip height (P<0.05). In women, a reduced middle third of the face increased AW (P=0.045). Deviations from a well-balanced facial profile, as well as the morphology of the nose and lip, do not increase psychosocial issues to a great extent. The range of acceptable facial characteristics is evidently much broader than the norms.

Golden ratio: A subtle regulator in our body and cardiovascular system?

Golden ratio, which is an irrational number and also named as the Greek letter Phi (φ), is defined as the ratio between two lines of unequal length, where the ratio of the lengths of the shorter to the longer is the same as the ratio between the lengths of the longer and the sum of the lengths. The so-called formula is a mathematical ratio and there exist a variety of examples in natural and man-made structures of great beauty. Moreover, golden ratio is expressed throughout the human body in some ways, including digits, uterus, teeth, and cardiovascular system. Although the association of Fibonacci series or golden ratio with systems and organs of human being has not been assessed in depth yet, the mainstream regulation of cardiovascular system seems to be associated with golden ratio. This raises the idea that there might have been a fine and subtle regulator in our body. In this article, we aimed to elaborate the relationship between the existence of golden ratio and the human body and to discuss the golden ratio and its association with cardiovascular system.

Anthropometric Analysis of the Face

BACKGROUND

Facial anthropometric analysis is essential for planning cosmetic and reconstructive facial surgery, but has not been available in detail for modern Greeks. In this study, multiple measurements of the face were performed on young Greek males and females to provide a complete facial anthropometric profile of this population and to compare its facial morphology with that of North American Caucasians.

MATERIALS AND METHODS

Thirty-one direct facial anthropometric measurements were obtained from 152 Greek students. Moreover, the prevalence of the various face types was determined. The resulting data were compared with those published regarding North American Caucasians.

RESULTS

A complete set of average anthropometric data was obtained for each sex. Greek males, when compared to Greek females, were found to have statistically significantly longer foreheads as well as greater values in morphologic face height, mandible width, maxillary surface arc distance, and mandibular surface arc distance. In both sexes, the most common face types were mesoprosop, leptoprosop, and hyperleptoprosop. Greek males had significantly wider faces and mandibles than the North American Caucasian males, whereas Greek females had only significantly wider mandibles than their North American counterparts.

CONCLUSIONS

Differences of statistical significance were noted in the head and face regions among sexes as well as among Greek and North American Caucasians. With the establishment of facial norms for Greek adults, this study contributes to the preoperative planning as well as postoperative evaluation of Greek patients that are, respectively, scheduled for or are to be subjected to facial reconstructive and aesthetic surgery.

Evaluation of facial divine proportion in North Indian Population

OBJECTIVE

To evaluate the facial divine proportion and its relationship with facial attractiveness in North Indian population.

MATERIALS AND METHODS

For evaluation of various facial proportions, standardized frontal facial photographs of total 300 subjects between 18 and 30 years of age were obtained. Black and white copies of these photographs were presented in front of an evaluation jury for assigning scores of facial attractiveness and finally 130 attractive subjects were selected. These subjects were divided into two groups, Group I (attractive females n = 65) and Group II (attractive males n = 65) and they were further analyzed for various parameters of facial proportions. Unpaired Student's t-test was used to compare both groups.

RESULTS

Group I showed that five of seven vertical facial proportions were close to divine proportion (1.618) whereas only two vertical proportions in Group II were close to it. Transverse facial proportions in both groups deviated more from divine proportion (1.618) and were closer to silver proportion (1.414).

CONCLUSIONS

Most of the facial proportions of attractive females in the North-Indian population were close to the divine proportion. Thus, facial divine proportion could be an important factor in the perception of facial attractiveness of North-Indian attractive females.

Comparison of aesthetic facial criteria between Caucasian and East Asian female populations: An esthetic surgeon's perspective

Objective aesthetic criteria are important for patient evaluation and analysis during aesthetic surgeries, while successful aesthetic surgeries must take into account the underlying ethnic differences. The aim of this study is to help surgeons and scientists better plan facial aesthetic surgeries and understand the aesthetic needs according to different patients by reviewing and comparing the current aesthetic principles and preferences in Caucasian and East Asian populations. PubMed and The Cochrane Library were searched using keywords regarding anthropometric measurements. Only original clinical studies and reviews written in English and Chinese and those that focused on the objective assessment of facial aesthetics in Caucasian and East Asian female populations were retained for review. Reference lists of the selected articles were also reviewed for eligible studies. Sixty-five articles that described objective aesthetic criteria in Caucasian and East Asian female populations were found through PubMed, among which 47 included Caucasian populations and 18 included East Asian populations. Compared with White women, East Asian women prefer a small, delicate, and less robust face, lower position of double eyelid, more obtuse nasofrontal angle, rounder nose tip, smaller tip projection, and slightly more retruded mandibular profile. Various differences exist between objective facial aesthetic criteria in Caucasian and East Asian populations. Further studies that focus on the objective aesthetic criteria of facial attractiveness in different ethnicities need to be conducted, especially in Asian countries. Level V: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Multiracial Facial Golden Ratio and Evaluation of Facial Appearance

This study aimed to investigate the association of facial proportion and its relation to the golden ratio with the evaluation of facial appearance among Malaysian population. This was a cross-sectional study with 286 randomly selected from Universiti Sains Malaysia (USM) Health Campus students (150 females and 136 males; 100 Malaysian Chinese, 100 Malaysian Malay and 86 Malaysian Indian), with the mean age of 21.54 ± 1.56 (Age range, 18–25). Facial indices obtained from direct facial measurements were used for the classification of facial shape into short, ideal and long. A validated structured questionnaire was used to assess subjects’ evaluation of their own facial appearance. The mean facial indices of Malaysian Indian (MI), Malaysian Chinese (MC) and Malaysian Malay (MM) were 1.59 ± 0.19, 1.57 ± 0.25 and 1.54 ± 0.23 respectively. Only MC showed significant sexual dimorphism in facial index (P = 0.047; P<0.05) but no significant difference was found between races. Out of the 286 subjects, 49 (17.1%) were of ideal facial shape, 156 (54.5%) short and 81 (28.3%) long. The facial evaluation questionnaire showed that MC had the lowest satisfaction with mean score of 2.18 ± 0.97 for overall impression and 2.15 ± 1.04 for facial parts, compared to MM and MI, with mean score of 1.80 ± 0.97 and 1.64 ± 0.74 respectively for overall impression; 1.75 ± 0.95 and 1.70 ± 0.83 respectively for facial parts. In conclusion: 1) Only 17.1% of Malaysian facial proportion conformed to the golden ratio, with majority of the population having short face (54.5%); 2) Facial index did not depend significantly on races; 3) Significant sexual dimorphism was shown among Malaysian Chinese; 4) All three races are generally satisfied with their own facial appearance; 5) No significant association was found between golden ratio and facial evaluation score among Malaysian population.

Three-dimensional facial analyses of Indian and Malaysian women

CONTEXT

Facial measurements serve as a valuable tool in the treatment planning of maxillofacial rehabilitation, orthodontic treatment, and orthognathic surgeries. The esthetic guidelines of face are still based on neoclassical canons, which were used in the ancient art. These canons are considered to be highly subjective, and there is ample evidence in the literature, which raises such questions as whether or not these canons can be applied for the modern population.

AIMS

This study was carried out to analyze the facial features of Indian and Malaysian women by using three-dimensional (3D) scanner and thus determine the prevalence of neoclassical facial esthetic canons in both the groups.

SUBJECTS AND METHODS

The study was carried out on 60 women in the age range of 18-25 years, out of whom 30 were Indian and 30 Malaysian. As many as 16 facial measurements were taken by using a noncontact 3D scanner.

STATISTICAL ANALYSIS USED

Unpaired t-test was used for comparison of facial measurements between Indian and Malaysian females. Two-tailed Fisher exact test was used to determine the prevalence of neoclassical canons.

RESULTS

Orbital Canon was prevalent in 80% of Malaysian women; the same was found only in 16% of Indian women (P = 0.00013). About 43% of Malaysian women exhibited orbitonasal canon (P = 0.0470) whereas nasoaural canon was prevalent in 73% of Malaysian and 33% of Indian women (P = 0.0068).

CONCLUSIONS

Orbital, orbitonasal, and nasoaural canon were more prevalent in Malaysian women. Facial profile canon, nasooral, and nasofacial canons were not seen in either group. Though some canons provide guidelines in esthetic analyses of face, complete reliance on these canons is not justifiable.

Anthropometric Measurements Usage in Medical Sciences

Morphometry is introduced as quantitative approach to seek information concerning variations and changes in the forms of organisms that described the relationship between the human body and disease. Scientists of all civilization, who existed until today, examined the human body using anthropometric methods. For these reasons, anthropometric data are used in many contexts to screen for or monitor disease. Anthropometry, a branch of morphometry, is the study of the size and shape of the components of biological forms and their variations in populations. Morphometrics can also be defined as the quantitative analysis of biological forms. The field has developed rapidly over the last two decades to the extent that we now distinguish between traditional morphometrics and the more recent geometric morphometrics. Advances in imaging technology have resulted in the protection of a greater amount of morphological information and have permitted the analysis of this information. The oldest and most commonly used of these methods is radiography. With developments in this area, CT and MRI have also been started to be used in screening of the internal organs. Morphometric measurements that are used in medicine, are widely used in the diagnosis and the follow-up and the treatment of the disease, today. In addition, in cosmetology use of these new measurements is increasing every day.

The validity of three neo-classical facial canons in young adults originating from the Arabian Peninsula

Introduction

Understanding facial harmony and proportions is essential for facial reconstructive procedures and orthognathic surgery planning. In the literature, the neoclassical facial canons have been revisited in populations including North American whites and African Americans. The purpose of this study was to establish a baseline for selected facial anthropometric measurements and test the validity of 3 neoclassical facial canons in a cohort of young Saudi adults originating from the Arabian Peninsula.

Methods

The study group consisted of 168 healthy, esthetically pleasing Saudi Arabian dental students originating from the Arabian Peninsula (93 males and 75 females, age 20–24 years). Using a caliper, three neoclassical facial canons were measured; the vertical thirds of the face, the orbital canon (intercanthal distance = eye fissure length), and the orbito-nasal canon (intercanthal distance = nasal width) and analyzed using Student’s t-test, general linear modeling, and pairwise comparison of means.

Results

The upper, middle, and lower thirds were not equal in measurement to each other (p < 0.0001). Sex dimorphism was observed in the lower facial third and nasal width measurements, with both larger in men (both p < 0.0001). The majority of subjects had longer upper and lower thirds than middle thirds, with 91.4% of males and 88% of females demonstrating a larger lower third than middle third. The most frequent variation in the orbital canon was a wider intercanthal distance than eye fissure length (55.9% of males and 74.7% of females). The most frequent variation in the orbito-nasal canon was a wider nasal width than intercanthal distance (92% of males and 56% of females).

Conclusions

Although these individuals are esthetically pleasing, they do not exhibit equal facial thirds or conform to orbital or orbito-nasal canons. The three neoclassical canons studied could not be validated in young adults originating from the Arabian Peninsula. Thus, the esthetic goals in reconstructive and orthognathic surgery should respect this ethnic variation.

Agreement between cranial and facial classification through clinical observation and anthropometric measurement among Envigado school children

BACKGROUND

To evaluate the agreement between cranial and facial classification obtained by clinical observation and anthropometric measurements among school children from the municipality of Envigado, Colombia.

METHODS

This cross-sectional study was carried out among 8-15-year-old children. Initially, an indirect clinical observation was made to determine the skull pattern (dolichocephalic, mesocephalic or brachycephalic), based on visual equivalence of right eurion- left eurion and glabella-opisthocranion anthropometric points, as well as the facial type (leptoprosopic, mesoprosopic and euryprosopic), according to the left and right zygomatic, nasion and gnation points. Following, a direct measurement was conducted with an anthropometer using the same landmarks for cranial width and length, as well as for facial width and height. Subsequently, both the facial index [euryprosopic (≤80.9%), mesoprosopic (between 81% - 93%) and leptoprosopic (≥93.1%)] and the cranial index [dolichocephalic (index ≤ 75.9%), mesocephalic (between 76% - 81%), and brachycephalic (≥81.1%)] were determined. Concordance between the indices obtained was calculated by direct and indirect measurement using the Kappa statistic.

RESULTS

A total of 313 students were enrolled; 172 (55%) were female and 141 (45%) male. The agreement between the direct and indirect facial index measurements was 0.189 (95% CI 0.117-0261), and the cranial index was 0.388 (95% CI 0.304-0.473), indicating poor concordance.

CONCLUSIONS

No agreement was observed between direct measurements conducted with an anthropometer and indirect measurements via visual evaluation. Therefore, the indirect visual classification method is not appropriate to calculate the cranial and facial indices.

Smile design: rules, tools and strategies to help plan aesthetic restorative dentistry

This article is intended to provide dentists with a framework to help in objectively assessing upper anterior aesthetic restorations. Not all of the areas discussed will be equally important in all cases, and a degree of subjectivity, based on clinical experience, is essential. There has been a huge increase in settlements in cases when aesthetic treatment has not led to patient satisfaction. The author hopes that this type of approach, in conjunction with good patient communication and detailed records, will minimise the potential for litigation, should problems arise. Success or failure is largely defined during the planning stage.

The role of the golden proportion in the evaluation of facial esthetics

OBJECTIVE

To demonstrate if one or more golden relationships between different measurements of the human face exist.

MATERIALS AND METHODS

To make our measurements, we used three-dimensional (3D) stereophotogrammetry, which has proved to be the "gold standard" in the field of facial anthropometry. We obtained 3D stereophotogrammetric facial acquisitions of 400 healthy young adult subjects, then had them scored by an Evaluation Jury. Each subject received an esthetic evaluation ranging from 0 to 40. Individuals with a score larger than 28 were considered very attractive (VA), and individuals with a score lower than 12 were considered not attractive (NA). Fifteen subjects per group were chosen by chance, with a final total group of 60 subjects: 15 VA males, 15 NA males, 15 VA females, and 15 NA females. For each subject, a set of facial distances was obtained from the stereophotogrammetric facial reconstruction, and 10 ratios were computed. The effects of sex and attractiveness were tested by analysis of variance. Additionally, Student's t-tests verified if the ratios were statistically different from the golden ratio.

RESULTS

For nine ratios, no significant effects of sex or attractiveness were found. Only the eye-mouth distance/height of the mandible ratio was significantly influenced by sex (P = .035) and attractiveness (P = .032). Seven out of 10 ratios were statistically different from the hypothetical value of 1.618, and only three of them were similar to the golden ratio.

CONCLUSIONS

Ratios between 3D facial distances were not related to attractiveness. Most of the facial ratios were different from the golden ratio.

Philtral columns and nostril shapes in nigerian children: a morphometric and aesthetic analysis

Background. The upper lip-nose complex contributes significantly to the concept of symmetry and proportion of the face. A study of the morphology and aesthetic preferences of the lip-nose complex will provide a database that will serve as a guide for reconstruction. Subjects and Methods. Hundred Nigerian children participated in this study. Demographic data and standard photographs of the philtral column and nostrils were obtained. Sixty volunteers were recruited to evaluate the photographs. Each volunteer was asked to rank the photographs based on their aesthetic preference. Results. The morphology of the philtral columns was classified into four groups: (1) triangular, (2) concave, (3) flat, and (4) parallel. The nostril shape was also classified into four groups: (1) triangular, (2) round, (3) teardrop, and (4) rectangular. In both genders, the triangular shape of philtral column was the most common. There are significant age differences in the aesthetic rankings of philtral columns and nostril shapes. Conclusion. Our study establishes the basal values for the morphometric and aesthetic parameters of the lip-nose complex of 5- and 6-year-old children in Nigeria. We hope our results and reconstructive surgery will intersect at a point to treat disfigurements of the philtrum and nostrils successfully.