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

Truth Lies in the Depths: Novel Insights into Facial Aesthetic Measurements from a U.S. Survey Panel

BACKGROUND

Aesthetic facial bone surgery and facial implantology expand the boundaries of conventional facial surgery that focus on facial soft tissue. This study aimed to reveal novel aesthetic facial measurements to provide tailored treatment concepts and advance patient care.

METHODS

A total of n=101 study participants (46 females and 55 males) were presented with 120 patient portraits (frontal images in natural head posture; 60 females and 60 males) and asked to assess the facial attractiveness (scale 0-10; "How attractive do you find the person in the image?") and the model capability score (MCS; scale 0-10; "How likely do you think the person in the image could pursue a modelling career?"). For each frontal photograph, defined facial measurements and ratios were taken to analyse their relationship with the perception of facial attractiveness and MCS.

RESULTS

The overall attractiveness rating was 4.3 ± 1.1, while the mean MCS was 3.4 ± 1.1. In young males, there was a significant correlation between attractiveness and the zygoma-mandible angle (ZMA)2 (r= - 0.553; p= 0.011). In young and middle-aged females, MCS was significantly correlated with facial width (FW)1-FW2 ratio (r= 0.475; p= 0.034). For all male individuals, a ZMA1 value of 171.79 degrees (Y= 0.313; p= 0.024) was the most robust cut-off to determine facial attractiveness. The majority of human evaluators (n=62; 51.7%) considered facial implants a potential treatment to improve the patient's facial attractiveness.

CONCLUSION

This study introduced novel metrics of facial attractiveness, focusing on the facial skeleton. Our findings emphasized the significance of zygomatic measurements and mandibular projections for facial aesthetics, with FI representing a promising surgical approach to optimize facial aesthetics.

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 .

Evaluation and Comparison of Facial Appearance Using the Golden Ratio: An Anthropometric Study in Preschool and School-Going Children of Santhal Tribe in West Bengal

Introduction Golden ratio and beauty are two inseparable sides of the same coin and have been studied for centuries by the Greeks. This divine ratio is defined as an invincible parameter in aesthetic dentistry to measure looks, symmetry, and balance. Being beautiful and handsome also boosts confidence in today's children and therefore is a top priority for young growing kids. However, there is no study done to define facial measurements based on the golden ratio in preschool and school-going children that can succor aesthetics in formative years. The purpose of this research was to evaluate facial proportions in the vertical dimension, quantify them in reference to the golden ratio, and analyze the association with gender among preschool and school-going children of the Santhal tribe in the Bankura district. Materials and methods A total of 399 subjects, 198 children of 3-5 years with primary teeth and 201 children of 6-12 years with mixed dentition, were selected from schools in villages of Bankura district, West Bengal, India. The subjects were made to relax in a sitting position and a digital vernier caliper was used to record the following vertical facial parameters: total facial height (TFH), trichion-gnathion distance (Tr-Gn), and subnasale-gnathion distance (Sn-Gn). The total facial height was correlated with sexual dimorphism and dentition. The ratio of Tr-Sn/Sn-Gn was calculated and compared with the golden ratio. The ratio was classified as normal (if it was between 1.6 and 1.699, i.e., normal to the golden ratio value), long (if it was more than 1.699, i.e., more than the golden ratio value), or short (if it was below 1.6, i.e., less than the golden ratio value). This facial analysis based on the golden ratio was correlated to sexual dimorphism and dentition. The data were recorded, compared with gender, and statistically analyzed using the unpaired t-test and Chi-square test. Results The total facial height was larger in males than females in both primary and mixed dentition; however, the value was highly significant in primary dentition. Tr-Sn/Sn-Gn ratios were lower in the long facial category in both males and females in both preschool and school-going children. The values were statistically significant in these ratios for both dentitions. Conclusion The majority of children in the Santhal tribe of Bankura in West Bengal did not conform to the golden ratio and showed long faces. There was a significant association of facial features with sexual dimorphism. Clinical significance The early prediction of facial features in children and its confirmation with the established golden ratio can be considered an imperative parameter to comprehend facial aesthetics and symmetry.

Post-oncological full-thickness eyelid defect reconstruction: An aesthetical overview

Purpose of the current study was to introduce a new detailed aesthetical subunit (ASU) involvement chart to localize the defect configuration on the eyelids, and, to evaluate the aesthetical and functional outcomes of the post-oncological full-thickness eyelid defect reconstruction surgery by using a modified aesthetical rating guideline. Medical records of subjects who were diagnosed with a primary malignant full thickness eyelid tumor involving the eyelid margin and underwent full-thickness eyelid defect reconstruction surgery between April 2016 and May 2022 were retrospectively reviewed. Age, sex, pathological diagnosis, follow-up time, the ASU of the eyelid involvement, and surgical methods used to reconstruct the anterior and posterior lamella were examined from medical records. The reconstructed eyelid photos were scored according to the modified aesthetical rating guideline to analyze the aesthetical and functional outcomes of the surgeries. A total of 31 subjects were included to the study, and the overall mean aesthetical score was 3.5. Seventeen subjects with aesthetical scores greater than 3.5 were included in the more aesthetically pleasing (AP) group, and 14 subjects with aesthetical score less than 3.5 were included in less AP group. Anterior lamella repair was mainly performed using myo-cutaneous flaps in the more AP group and multiple flap combinations in the less AP group (P: 0.13). Posterior lamella reconstruction was performed using tarso-conjunctival tissue in both groups. In more AP group, tissue scarring, lash line disruption, eyelid thickness, and retraction or ectropion scores were significantly higher when compared with less AP group (P:0.03, P:0.03, P:0.02, and P:0.01, respectively). Subjects with fair eyelash color were significantly more common in more AP group (P: 0.009). The ASU involvement chart and outcomes of the current study may aid novice surgeons to determine which method will provide the best result for an individual patient for full-thickness eyelid defect repair and may offer some insight into the different surgical techniques used for repairing similar wounds.

Evaluation of the anterior and overall tooth ratios in the Saudi population versus Bolton's standards

Understanding tooth-size discrepancy is essential in the process of diagnosis of maxillary and mandibular relationship. Due to the high incidence of tooth-size disproportion, Practitioners should consider the high incidence of tooth-size disproportion when planning treatment for their patients, as in many cases, this can be a hindrance to obtaining an ideal result. This study aimed to determine the anterior and overall tooth ratios in the Saudi population and compare them with Bolton's standards. A total of 356 patients were recruited. For the anterior ratio, around 25% of the patients had a ratio equal to Bolton's standards (77.2%). Most subjects (53.7%) had a ratio above 77.2%, and the remaining (20%) had a ratio below 77.2%. The mean amount of anterior mandibular excess was 2.17 ± 2.12 mm, and the mean amount of anterior maxillary excess was 2.16 ± 2.08 mm. For the overall ratio, less than half of the participants (43%) had a ratio equal to Bolton's standards (91.3%). Almost 34% had a ratio above 91.3%, while 23% of the participants had a ratio below 91.3%. The mean amount of overall mandibular excess was 2.54 ± 2.37 mm, and the mean amount of overall maxillary excess was 3.31 ± 3.33 mm. The majority of the study sample had an overall and anterior Bolton ratio that is different from the norms of Bolton's standards, with a tendency for increased overall and anterior ratios. Having specific standards for the Saudi population is important for better clinical assessment and treatment outcomes.

Intra- and Interrater Agreement of Face Esthetic Analysis in 3D Face Images

The use of three-dimensional (3D) facial scans for facial analysis is increasing in maxillofacial treatment. The aim of this study was to investigate the consistency of two-dimensional (2D) and 3D facial analyses performed by multiple raters. Six men and four women (25-36-year-old) participated in this study. The 2D images of the smiling and resting faces in the frontal and sagittal planes were obtained. The 3D facial and intraoral scans were merged to generate virtual 3D faces. Ten clinicians performed facial analyses by investigating 14 indices of 2D and 3D faces. Intra- and interrater agreements of the results of 2D and 3D facial analyses within and among the participants were evaluated. The intrarater agreement between the 2D and 3D facial analyses varied according to the indices. The highest and lowest agreements were found for the dental crowding index (0.94) and smile line curvature index (0.56) in the frontal plane, and Angle's classification (canine) index (0.98) and occlusal plane angle index (0.55) in the profile plane. In the frontal plane, the interrater agreements were generally higher for the 3D images than for the 2D images, while in the profile plane, the interrater agreements were high in the Angle's classification (canine) index however low in the other indices. Several occlusion-related indices were missing in the 2D images because the posterior teeth were not observed. Esthetic analysis results between 2D and 3D face images can differ according to the evaluation indices. The use of 3D faces is recommended over 2D images to increase the reliability of facial analyses, as it can fully assess both esthetic and occlusion-related indices.

Does 3-dimensional facial attractiveness relate to golden ratio, neoclassical canons, 'ideal' ratios and 'ideal' angles?

Background

The established recommendations and guidelines regarding ideal measurements for an attractive face are mostly based on data gathered among Caucasian population. The aim of this study was to examine the relationship between perception of 3-dimensional facial attractiveness and golden ratio, neoclassical canons, ‘ideal’ ratios and ‘ideal’ angles in Hong Kong Chinese.

Methods

Thirty 3-D photographs (15 males and 15 females) were shown to 101 laypersons and 60 patients seeking orthognathic treatment. The photographs were rated based on a 100 mm visual analogue scale (VAS) from 0 (very unattractive) to 100 (very attractive).

Results

More than half of the measurements (42/77) in females and thirty-two measurements in males were found to be significantly different from the ideal target value (p < 0.05) upon the comparison of the attractive faces with golden ratio, neoclassical canons, ‘ideal’ ratios and ‘ideal’ angles. Meanwhile, correlation tests between VAS scores and the parameters detected significant results (p < 0.05) in only six ratios, eight angles, one neoclassical canon and one proportion.

Conclusions

Despite several renowned ‘ideal’ parameters of attractive faces that have been recommended in the literature, only a few of them were found to be significantly correlated with attractive faces in Hong Kong Chinese.

Divine Proportions in the Assessment of Facial Esthetics—Antiquity vs Contemporary: A Systematic Review

Objective:

The objective of this research was to systematically evaluate evidence regarding the correlation between divine proportions and facial esthetics.

Materials and Methods:

An extensive literature search was performed in multiple electronic databases such as PubMed, Medline, Embase, ScienceDirect, and ProQuest which included articles published from May 1982 to March 2021 in the English language. Furthermore, only randomized clinical trials and original research studies were included. The risk of bias in the included studies was assessed by using the Cochrane risk-of-bias tool ROBVIS (Risk-of-bias VISualization tool).

Results:

A total of 2,736 articles were retrieved and 974 duplicate records were eliminated; subsequently, articles were screened based on title and abstracts, inclusion and exclusion criteria from which a total of 14 original articles were included in the systematic review. Of the 14 included studies, 5 studies showed a low risk of bias, 6 studies showed a moderate risk of bias, and 3 showed a high risk of bias. Four studies showed a positive correlation and 10 studies showed a negative correlation between divine proportions and facial esthetics.

Conclusion:

The evidence from this study suggests that there exists a weak correlation between divine proportions and facial esthetics. Hence, divine proportions are not absolute determinants and are only partially related to facial attractiveness. Further high-quality cross-sectional studies with a strong methodology are needed to establish the correlation between divine proportions and facial esthetics and to support this evidence. Trial registration number: PROSPERO CRD42022302308

Analysis of the effect magnitude of different parameters on smile attractiveness

OBJECTIVE

To evaluate the effect magnitude of different parameters on smile attractiveness.

MATERIALS AND METHODS

A reference and 13 images were produced by manipulating 13 parameters. Image rating was performed with a 4-point Likert scale from least attractive (1) to most attractive (4). Image raters included laypeople, dental students, dentists, and dental specialists. Friedman and Wilcoxon image were used for estimate of effect size. Parameters were classified into small (0.10- < 0.30), medium (0.30- < 0.5), or large (≥0.50).

RESULTS

A total of 1040 people participated with good consistency (α = 0.861), and moderate reliability (0.64-0.7). The reference image had the highest rank (laypeople:11.79, dental background: 12.55). For effect size; gingival margin level (-0.11, -0.01), teeth width proportion (-0.09, -0.10), inverted smile arch (-0.09, -0.21), commissure line cant (-0.15, -0.17) and low smile (-0.24, -0.23) had small effect size; occlusal plane cant (-0.36, -0.49), midline cant (-0.36, -0.48), and midline shift (-0.37, -0.49) had medium effect size; diastema (-0.55, -0.54) and color (-0.56, -0.56) had large effect size for the laypeople and dental groups. High smile (-0.42, -0.51), incisor edge symmetry (-0.46, -0.54) had medium effect size in laypeople group and large effect size in the dental group. Width to length tooth proportion (-0.26, -0.39) had small effect size in the laypeople group and medium effect size in the dental group.

CONCLUSIONS

Smile parameters had different effect magnitude on smile attractiveness and were classified into small, medium, or large parameters. Neither laypeople nor professionals have a collective judgment on what constitutes a beautiful smile.

CLINICAL SIGNIFICANCE

This study investigated the effect magnitudes of 13 smile parameters and presented a small, medium, and large smile parameters classification. It should provide the clinician with an insight into the expected effect each parameter has on the smile.

Evaluation of Dental Golden Ratio in Terms of Facial Esthetics

Aim and Objectives:

This cross-sectional study examined the Bolton index of 6 maxillary anterior teeth and the facial esthetic ratios in the Turkish population with healthy facial appearance.

Materials and Methods:

Face photographs of the subjects, taken using a DSLR camera, were fixed in the Frankfort horizontal plane. The measurements were made on the images using ImageJ 1.52a software and certain ratios of face and teeth were calculated such as Bolton index (BI). Differences between genders were evaluated and comparisons with golden ratio of 1.618 were conducted on SPSS.

Results:

Males had significantly higher upper, middle, lower, and total facial height compared to females ( P < .001, P = 0.0257, P = .0243, P < .001, respectively). Right to left distance of labial commissure (LC)/distance from the distal edge of right canine to the distal edge of left canine ratio had golden proportion. Ratio of naso-menton length to facial width showed golden ratio only in males. The ratio of the width of upper middle incisor to the width of canine tooth also showed golden ratio in both genders.

Conclusions:

The present study presents noteworthy data about facial and teeth ratios of the young adult Turkish population that will guide plastic surgeons and orthodontists in clinical practice.

Quantitating the art and science of esthetic clinical success

BACKGROUND

Beginning with the biobehavioral bases of esthetic experiences, this article presents a quantitative analytic review of the motives and methods of providers and consumers of orthodontic treatment.

METHOD

A primary focus is determining the anthropometric bases of self and others' perceived preference and satisfaction with changes in facial appearance. These quantitative analyses have been based on determining the frequency and magnitude of reliability and validity measures of diagnosis, treatment, and satisfaction outcome. Socioeconomic considerations are also quantitated regarding the discrepancy between objective need for treatment as determined for example by the Index of Orthodontic Treatment Need and the subjective demand for treatment.

RESULTS

The major contribution of this article is the quantitation of the components of esthetic experience from sensation of perception using psycho physical methods, such as Perceptometrics, for determining the morphological basis of perceived facial attractiveness adjusted for ethnocultural differences updated by 3-dimensional and artificial intelligence technology. Recent quantitation of smile components has also added to the measures of esthetically successful treatment. Further contribution of orthodontists to mental and physical health is demonstrated by the differences between perceived personality attributes in profile and full-frontal views of symmetric and asymmetric faces. Such information can facilitate the clinician's ability to determine the ideational representation of the patients' perceived pre- and post-treatment outcome.

CONCLUSION

The quantitative analysis of the motives and methods involved in the orthodontic treatment process has been combined with the neurophysiological correlates of producing and observing/evaluation of the esthetic experiences of both patients and orthodontists/dentists.

Comparison of facial esthetic standards between Latin American and Asian populations using 3D stereophotogrammetric analysis

OBJECTIVE

The aim of this study was to compare the facial esthetic standards between Paraguayan and Korean beauty pageant contestants as well as to evaluate the deviation in Farkas proportion indexes (PI) from the golden ratio for each group using three-dimensional (3D) stereophotogrammetric analysis.

METHODS

3D soft tissue images of 34 Miss Paraguay (MP) and 54 Miss Korea (MK) pageant contestants were obtained. The 3D images were digitized and 52 measurements and ratios were calculated. One-way multivariate analysis of variance was applied to compare the two groups. One-sample t-test was applied to assess the differences between the PI of each group and the golden ratio.

RESULTS

The MP group showed greater mouth width, total vermilion perimeter, and lower lip protrusion (P < 0.001) than the MK group. Meanwhile, the MK group showed longer forehead height and total facial height (P = 0.002 and P < 0.001, respectively). All Farkas PIs in each group showed significant differences from the golden ratio except for PI19 (upper/lower vermilion heights).

CONCLUSIONS

Paraguayans favor rectangular faces with wide mouths and large lips, especially the lower lips, whereas Koreans prefer long tapered faces with small mouths and lips. All proportion indexes were significantly different from the golden ratio except for PI19. Therefore, it would be beneficial for clinicians to consider the differences in ethnic preferences in facial esthetics during diagnosis and treatment planning.

Modification of the position of the angulus oris with a rotation flap and a YV flap in lip reconstruction

Functionally, the lip serves to prevent food and drink from spilling out of the beginning of the gastrointestinal tract, and it is also used for vocalization. In addition, the lip has cosmetic importance as part of the face involved in making expressions, and in many cultures, it is considered to be sexually appealing. The results of lip reconstruction procedures must therefore be both functionally and cosmetically satisfactory. When the orbicularis oris muscle and oral mucosa are excised, functional reconstruction is prioritized. In contrast, if there are no functional problems, cosmetic reconstruction is the main focus. This case involved the reconstruction of a right upper lip defect caused by a dog bite. When the skin defect was covered with a local flap, the right angulus oris shifted medially, so we incorporated a YV flap at the right angulus oris to modify its position and allow for a cosmetically satisfactory result. We believe that this method can be used not only for cases in which asymmetry of the angulus oris is expected to occur at the time of lip reconstruction, but also for cases in which it has already occurred in the initial operation.

The Mathematical Analysis of the Aesthetically Pleasing Eyelid

PURPOSE

To analyze and quantify the characteristics and parameters of the eyelid and adnexa of males and females and correlate these findings to an aesthetically pleasing score.

METHODS

This is an Institutional Review Board approved study involving healthy male and female volunteers. The margin-to-reflex distance, palpebral fissure, inferior scleral show, tarsal platform show, and brow fat span were measured using Image J digital photographic analysis and the images were scored by 110 non-ophthalmologists. The eyelid parameters were compared between the groups with Student t tests and the total aesthetic score was correlated to the measured parameters with Pearson's correlation coefficients (r). This study was HIPAA-compliant with protection of individually identifiable information.

RESULTS

Twenty male and 22 female participants were included and divided into 2 groups based on the aesthetic score. The average aesthetic score was 3.06 for males and 3.36 for females. None of the eyelid parameters were found to be significantly significant between the 2 male groups. In females, both inferior scleral show and tarsal platform show were significantly lower in the more aesthetic group. A greater margin-to-reflex distance correlated with increased aesthetic appeal. The ratio of brow fat span/tarsal platform show was not significantly different between the 2 female groups.

CONCLUSIONS

Quantifying goals are important for the surgical and nonsurgical management of the eyelid and periorbita. Beauty is considered to be subjective and is comprised of various criteria. However, this study reveals that the female sex may have certain quantifiable goals for eyelid parameters that are considered more aesthetically pleasing.

The Esthetic Difference of Chinese Beauty Evaluated by Two Different Human Races Based on Three-Dimensional Average Face Analysis

Supplemental Digital Content is available in the text

Purpose:

The aim of this study was to establish a new method of facial soft tissue analysis based on 3dMDface system and to find the different esthetic preferences of Chinese beauties from the Chinese and Indian evaluators perspective.

Methods:

Three-dimensional facial images of 242 females and 168 males were evaluated and ranked by 8 Chinese and nine Indians using a 10-point visual analog scale (VAS). Total 120 subjects in 2 panels (from Chinese perspective and Indian perspective) including 30 male and 30 female faces with top 30 scores were analyzed with the “average face” method respectively. Then 17 linear measurements, 13 curve measurements and 14 ratios of 4 average faces were calculated and compared with the divine proportion.

Results:

Distinct differences were founded based on the average face analysis. Similar total facial types were preferred by both Chinese and Indian evaluators, while Indian evaluators preferred a wider male face with a protrusive lower lip. Delicate noses with lower nose ridge but protrusive lower lips in females were more acceptable by Indian evaluators. The differences of linear measurements were limited in 2.0 mm except the facial width, lower facial width, upper facial height and forehead height while curve measurements differ distinctly as the table shows. No ratios equal to the divine proportion were founded.

Conclusion:

The 3D Average face based on stereophotogrammetry is a feasible method to analyze the facial characters and discrepancy of esthetic preferences. Chinese and Indian evaluators have some certain differences when judging beauties. Attractive faces have some certain ratios but not the divine proportion.

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.

Evaluation of "Golden Proportion" in Saudi individuals with natural smiles

Background

The Golden Proportion (GP) has been considered by many as the most harmonious recurrent tooth-to-tooth ratio and has long been proposed as an aesthetic guideline for restoring/replacing maxillary anterior teeth. Researchers investigated GP in various populations.

Purpose

The aim of the current study was to investigate the occurrence and prevalence of the GP between the perceived widths of maxillary anterior teeth in a Saudi population with natural smiles.

Materials and Methods

A total of 360 Saudi dental students (180 males and 180 females) with natural smiles and who met the inclusion criteria were included in the study. Frontal photographs were captured for all participants while maximally smiling using a digital camera with standardized settings. Photo-editing software was used to measure the perceived mesiodistal width of each anterior maxillary tooth in all digital images. Paired and student t-tests were performed to detect side and/or gender differences respectively. Calculated ratios of the perceived mesiodistal widths of the teeth were compared with their respective GP values using a one sample t-test. Statistical significance was set at 5%.

Results

For both genders, there were significant differences (P < 0.001) between the calculated ratios and the golden ratios. No side differences in the GP were detected. Males had wider teeth than females however significant differences between genders was detected for the centrals (P < 0.001) only.

Conclusions

Width ratios of the maxillary anterior teeth did not follow the GP for the examined Saudi population. Males had wider anterior teeth with the centrals exhibiting a significant gender-based difference. There was no side-dependent variation for both genders.

Proportions of the aesthetic African-Caribbean face: idealized ratios, comparison with the golden proportion and perceptions of attractiveness

Background

In the absence of clear guidelines for facial aesthetic surgery, most surgeons rely on expert intuitive judgement when planning aesthetic and reconstructive surgery. One of the most famous theories regarding “ideal” facial proportions is that of the golden proportion. However, there are conflicting opinions as to whether it can be used to assess facial attractiveness. The aim of this investigation was to assess facial ratios of professional black models and to compare the ratios with the golden proportion.

Methods

Forty photographs of male and female professional black models were collected. Observers were asked to assign a score from 1 to 10 (1 = not very attractive, 10 = very attractive). A total of 287 responses were analysed for grading behaviour according to various demographic factors by two groups of observers. The best graded photographs were compared with the least well-graded photographs to identify any differences in their facial ratios. The models’ facial ratios were calculated and compared with the golden proportion.

Results

Differences in grading behaviour were observed amongst the two assessment groups. Only one out of the 12 facial ratios was not significantly different from the golden proportion.

Conclusions

Only one facial ratio was observed to be similar to the golden proportion in professional model facial photographs. No correlation was found between facial ratios in professional black models with the golden proportion. It is proposed that an individualistic treatment for each ratio is a rather better method to guide future practice.

Assessment of facial analysis measurements by golden proportion

Introduction

The face is the most important factor affecting the physical appearance of a person. In facial aesthetics, there is a specific mathematical proportion, which is called golden proportion, used to measure and analyse facial aesthetic qualities in population.

Objectives

The aim of this study was to measure the facial soft tissue proportions which would help to constitute a standard for facial beauty and diagnose facial differences and anomalies and to compare these proportions to the golden proportion.

Methods

One hundred and thirty-three (133) Turkish patients 18–40 years of age (61 females, 72 males) were involved in the study. Analysis of the photographs was performed by the same physician, and a software programme was used (NIH Image, version 1.62). Facial proportions were measured and differences from the golden proportions were recorded and grouped as normal (1.6–1.699), short (<1.6) and long (>1.699).

Results

According to the facial analysis results, the trichion–gnathion/right zygoma–left zygoma was assessed: 33.1% of the patients were in normal facial morphology, 36.8% were in long facial morphology and 30.1% were in short facial morphology, according to this proportion. The trichion–gnathion/right zygoma–left zygoma proportion was significantly higher in males than females (p < 0.001). Statistically significant difference was noted in gender groups, according to the trichion–gnathion/right zygoma–left zygoma and the right lateral canthus–left lateral canthus/right cheilion–left cheilion proportions (p = 0.001, p = 0.028).

Conclusion

Facial proportion assessments in relation to the golden proportion showed that a statistically significant difference was observed between gender groups. Long facial morphology was observed more in males (51.4%); normal (41%) and short (39.3%) facial morphology were more common in females. The measurements and proportions for facial balance in our study population showed that the facial width and height proportions deviated from the golden proportion.

Art or Science? An Evidence-Based Approach to Human Facial Beauty a Quantitative Analysis Towards an Informed Clinical Aesthetic Practice

BACKGROUND

Patients often seek guidance from the aesthetic practitioners regarding treatments to enhance their 'beauty'. Is there a science behind the art of assessment and if so is it measurable? Through the centuries, this question has challenged scholars, artists and surgeons.

AIMS AND OBJECTIVES

This study aims to undertake a review of the evidence behind quantitative facial measurements in assessing beauty to help the practitioner in everyday aesthetic practice.

METHODS

A Medline, Embase search for beauty, facial features and quantitative analysis was undertaken.

SELECTION CRITERIA

Inclusion criteria were studies on adults, and exclusions included studies undertaken for dental, cleft lip, oncology, burns or reconstructive surgeries. The abstracts and papers were appraised, and further studies excluded that were considered inappropriate. The data were extracted using a standardised table. The final dataset was appraised in accordance with the PRISMA checklist and Holland and Rees' critique tools.

RESULTS

Of the 1253 studies screened, 1139 were excluded from abstracts and a further 70 excluded from full text articles. The remaining 44 were assessed qualitatively and quantitatively. It became evident that the datasets were not comparable. Nevertheless, common themes were obvious, and these were summarised.

CONCLUSION

Despite measures of the beauty of individual components to the sum of all the parts, such as symmetry and the golden ratio, we are yet far from establishing what truly constitutes quantitative beauty. Perhaps beauty is truly in the 'eyes of the beholder' (and perhaps in the eyes of the subject too).

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 .

Extraction of maxillary canines: Esthetic perceptions of patient smiles among dental professionals and laypeople

INTRODUCTION

Maxillary canines are generally considered important both cosmetically and functionally. Most claims on the importance of maxillary canines, however, have been based on expert opinions and clinician-based studies. There are no scientific studies in the literature reporting on their cosmetic importance or how laypeople perceive a smile treated by maxillary canine extractions. Our objective was to investigate whether there is any difference in the perceptions of patients' smiles treated by extracting either maxillary canines or first premolars, as judged by orthodontists, dentists, and laypeople.

METHODS

This retrospective study included 24 participants who had unilateral or bilateral extraction of maxillary permanent canines and fixed appliances in the maxillary and mandibular arches to comprehensively correct the malocclusion, selected from orthodontic patients treated at Chesterfield Royal Hospital NHS trust in the United Kingdom over the last 20 years. The control group of patients had extraction of maxillary first premolars followed by fixed appliances and finished to an extremely high standard judged by the requirement that they had been submitted for the Membership in Orthodontics examination. The finished Peer Assessment Rating scores for this group were less than 5. The end-of-treatment frontal extraoral smiling and frontal intraoral views were presented for both groups. The photographs were blinded for extraction choice and standardized for size and brightness using computer software (Adobe Photoshop CC version 14.0; Adobe Systems, San Jose, Calif). The work file was converted to an editable pdf file and e-mailed to the assessors. The assessor panel consisted of 30 members (10 orthodontists, 10 dentists, and 10 laypeople), who were purposely selected. The measures were rated on a 10-point Likert scale.

RESULTS

The attractiveness ratings were not statistically significantly different between the canine extraction and premolar extraction groups, with a mean difference of 0.33 (SD, 0.29) points. A 1-way repeated-measures analysis of variance to test the difference in scores among the laypeople, orthodontists, and dentists (n = 30) showed no statistically significant difference (Wilks lambda = 0.835; P = 0.138), and the Bonferroni test indicated that no pair-wise difference was statistically significant.

CONCLUSIONS

No statistically significant difference was found in the smile attractiveness between canine extraction and premolar extraction patients as assessed by general dentists, laypeople, and orthodontists. Further high-quality studies are required to evaluate the effect of canine extraction and premolar substitution on functional occlusion.

Lay preferences for dentogingival esthetic parameters: A systematic review

STATEMENT OF PROBLEM

An objective definition of the characteristics that render a smile esthetically acceptable in the eye of laypeople is lacking.

PURPOSE

The purpose of this systematic review was to identify, appraise, and synthesize the available evidence on the opinion of laypeople regarding the dentogingival characteristics that render a smile esthetically acceptable. The evidence was collected by surveying with standardized digitally modified smile images.

MATERIAL AND METHODS

Four databases were used to search English language studies published between January 1996 and December 2015. This was complemented by a manual search of 8 dental journals. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, 2 independent reviewers extracted the relevant characteristics of lay evaluators, the images evaluated, and the outcomes measure. Included studies were assessed in agreement with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Outcomes were treated as a continuous variable, and when more than 1 article provided information on a parameter, the weighted arithmetic mean was calculated.

RESULTS

After 8851 articles were screened, 20 studies were included. Those studies addressed 20 different dentogingival esthetic parameters. The total number of participants interviewed was 3107. According to the Olmos classification, 6 studies had a high level of quality, and 14 studies had a moderate level of quality. The 2 reviewers agreed on all the quality assessments. In the articles reviewed, central incisors clearly played a key role in smile esthetics. Almost all dental, gingival, and occlusal parameters are related to the proportion, shape, and position of central incisors and their relation to the adjacent dental structures.

CONCLUSIONS

The present review provides the estimated thresholds of tolerability and ideal values of smile parameters determined by laypeople. This may guide clinicians in evidence-based diagnosis and the planning of dental esthetic treatments.

Effects of malocclusions on facial attractiveness and their correlations with the divine proportion

PURPOSE

The aim of this study was to evaluate the effects of malocclusions on facial attractiveness and to determine if it was correlated with the divine proportion.

METHODS

Standard frontal facial photos were taken from 335 subjects in natural head position. Facial attractiveness of the subjects was evaluated by 10 dental students using a 10-point visual analog scale (VAS). All of the evaluations were arranged in order, and 30 attractive subjects with the highest score and 30 nonattractive subjects having the lowest score were chosen. On the frontal photos of these subjects, 13 landmarks were determined and 12 ratios were measured. Two way ANOVA was used to determine the effects of malocclusions on facial attractiveness, Student's t test was used to compare the facial proportions of the attractive and nonattractive subjects, and one sample t test was used to define the relationships between the divine proportion and facial ratios.

RESULTS

No statistically significant difference was found between malocclusion groups in terms of facial attractiveness. Of the 12 facial ratios, significant differences were found between attractive and nonattractive subjects regarding trichion-menton/nasion-menton, subnasale-menton/stomion-menton, nasion-subnasale/stomion-menton, nasion-subnasale/nasal width, and trichion-menton/right-left frontotemporale ratios. All of the ratios except nasion-subnasale/stomion-menton in the attractive group and subnasale-menton/stomion-menton and nasion-menton/nasion-trichion in the nonattractive group were found to be different from the divine proportion.

CONCLUSIONS

Sagittal skeletal malocclusions evaluated by ANB angle are not effective on facial attractiveness. Facial ratios used in this study have little effect on attractiveness, and are different from the divine proportion.

A three-dimensional photogrammetric analysis of the facial esthetics of the Miss Korea pageant contestants

Objective

The aims of this study were to measure and compare the facial dimensions of the Miss Korea pageant contestants and a selected group of women from the general population by using three-dimensional (3D) image analysis, as well as to compare various facial ratios to the golden ratio within each group.

Methods

Three-dimensional images of 52 Miss Korea pageant contestants (MK group) and 41 young female adults selected from the general population (GP group) were acquired. Fifty-four variables and ratios were measured and calculated. Intergroup comparisons were performed using multivariate analysis of variance.

Results

Compared to the GP group, the MK group showed greater total facial height and eye width, lesser lower-facial height, and lesser facial, lower-facial, and nasal widths. Moreover, compared to the GP group, the MK group had more protruded noses with greater nasolabial angle, greater vertical curvature of the foreheads, lesser horizontal curvature of the cheek, and lesser lower-lip-and-chin volume.

Conclusions

The MK group had longer faces but smaller lower lips and chins than did the GP group. The golden ratio was not matching the current facial esthetic standards. These data might be beneficial for treatment planning of patients undergoing orthognathic and plastic surgeries.

Vertical and horizontal facial proportions of Indian American men

The importance of understanding all gender facial differences is critical in providing a successful cosmetic outcome. Men are a growing segment of the cosmetic industry. Understanding of the male face and its appropriate treatment with minimally invasive cosmetic procedures are essential. The aim was to investigate various facial ratios in Indian American men and to compare them with the Indian and Caucasian norms. Additionally, we wanted to evaluate whether these values satisfy golden and silver ratios. Direct facial anthropometric measurements were made using a digital caliper in 100 Indian American men students (18–30 years) at the American University of Antigua (AUA), Antigua. A set of facial ratios were calculated and compared with coefficients of variation (CV). Most of the facial ratios had small CV thus making them highly reliable due to reduced intra-sample variability. The upper face to face height and mandibulo upper face height indices were close to golden ratios whereas mandibulo lower face height, upper face height biocular width, and nasal indices were close to silver ratios. There was significant difference in most of the values when compared with previous studies. The present facial ratios data can be used as a reference value for Indian American men.

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.

Evaluation of various anthropometric proportions in Indian beautiful faces: A photographic study

Introduction

The subject of beauty has been the topic of much debate throughout history, and methods for the evaluation of beauty have been the focus of many research projects. The evaluation of beauty is influenced by factors which include various linear measurements, angles, ratios, and proportions. We evaluated several ratios in Indian Population after locating various landmarks on beautiful Indian faces.

Aims and Objectives

The aim of the present study was to evaluate various facial proportions of Indian beauties using their frontal photographs in natural head position to establish anthropometric norms in beautiful Indian females. To evaluate whether these values satisfy golden and silver proportions. To compare these values with Caucasian anthropometric norms.

Materials and Methods

Frontal photographs of 30 female celebrities were downloaded from the internet. Photographs of only those Indian beauties that have been declared winners of either national or international beauty contests by a designated panel of judges were included in this study. Hardcopy of these photographs was taken in 5 inch by 3.5 inch format, all the measurements done and ratios calculated.

Results

Measurements were tabulated and values for various ratios were calculated to establish norms. Coefficient of variation was also evaluated.

Conclusion

All the ratios were found to be consistent than others which made it possible to assess beauty objectively rather than arbitrarily. Most of the values did not match the golden and silver proportion. In comparison with Caucasian population, we found that there is significant difference in most of the values.

Quantitative analysis of orofacial development and median clefts in Xenopus laevis

Xenopus has become a useful tool to study the molecular mechanisms underlying orofacial development. However, few quantitative analyses exist to describe the anatomy of this region. In this study we combine traditional facial measurements with geometric morphometrics to describe anatomical changes in the orofacial region during normal and abnormal development. Facial measurements and principal component (PC) analysis indicate that during early tadpole development the face expands primarily in the midface region accounting for the development of the upper jaw and primary palate. The mouth opening correspondingly becomes flatter and wider as it incorporates the jaw elements. A canonical variate analysis of orofacial and mouth opening shape emphasized that changes in the orofacial shape occur gradually. Orofacial anatomy was quantified after altered levels of retinoic acid using all-trans retinoic acid or an inhibitor of retinoic acid receptors or by injecting antisense oligos targeting RALDH2. Such perturbations resulted in major decreases in the width of the midface and the mouth opening illustrated in facial measurements and a PC analysis. The mouth opening shape also had a gap in the primary palate resulting in a median cleft in the mouth opening that was only illustrated quantitatively in the morphometric analysis. Finally, canonical and discriminant function analysis statistically distinguished the orofacial and mouth opening shape changes among the different modes used to alter retinoic acid signaling levels. By combining quantitative analyses with molecular studies of orofacial development we will be better equipped to understand the complex morphogenetic processes involved in palate development and clefting.

Clive Bell's "Significant Form" and the neurobiology of aesthetics

Though first published almost one century ago, and though its premise has been disputed, Clive Bell’s essay on aesthetics in his book Art still provides fertile ground for discussing problems in aesthetics, especially as they relate to neuroesthetics. In this essay, I begin with a brief account of Bell’s ideas on aesthetics, and describe how they focus on problems of importance to neuroesthetics. I also examine where his premise falls short, and where it provides significant insights, from a neuroesthetic and general neurobiological point of view.