Facial Proportions &
Now the question is,
do you need Chin Augmentation? If so, what area would you like
enhanced? Is it the chin only or also the jaw line? What
"look" are you trying to achieve and do you desire a very prominent
chin, rejuvenation or subtle improvement? You can take a photo of yourself
and draw a line from the most prominent part of your brow (between the eyebrows)
to your chin. A balanced chin to brow ratio would be a vertical line
from these two points. However, females can "get away" with
having a smaller, or slightly deficient chin.
Beauty is not an exact science but according to some Plastic Surgeons
there is a specific proportion system that the "ideal" face
tends to hover at. This includes facial height, width and
symmetry. First the face is evaluated from its frontal view and
then its lateral (side view). There are steps that can determine
the facial lateral width or projection (as in your profile) and there is
the oblique assessment for contours such as the cheek bones, chin and
(noun), plural -tries
[Latin symmetria, from Greek, from symmetros symmetrical, from syn- +
metron measure -- more at MEASURE] First appeared 1541
1 : balanced proportions; also : beauty of form arising from balanced
2 : the property of being symmetrical; especially : correspondence in
size, shape, and relative position of parts on opposite sides of a
dividing line or median plane or about a center or axis
*You will more than likely need a good Online
Medical Dictionary to translate the terminology used. This
dictionary will load in a new window for your convenience.
Just remember, if you
don't "pass" any one of these evaluations -- don't take it to heart.
No one is truly symmetrical. Remember that beauty is also about
make it a good one! We
shall begin with a few popular, "ideal" Chin Formulas.
Forms Of Chin Analyses Are As Follows:
upon the Horizontal plane or line [:
a plane used in craniometry, a science dealing with cranial measurement,
that is determined by the highest point on the upper margin of the opening
of each external auditory meatus and the low point on the lower
margin of the left orbit and that is used to orient a human skull or head
usu. so that the plane is horizontal -- called also Frankfort horizontal,
Line (or Frankfort Plane)
determine the Frankfort Horizontal Line (red horizontal line), a lateral
photograph is taken and a vertical line is drawn from just in front of
your glabella to your chin.
This line would ideally be perfectly vertical [although
in women, some surgeons believe the chin can be slightly behind this
line and still look feminine and proportionate].
The next line is drawn horizontally from right at the supratip to
above the auricular canal, right above the tragus.
credit: The above
excerpts, in their entirety, are from the Dept. of Otolaryngology, UTMB, Grand
Rounds, Chin and Malar Implants, September 6, 1995 Resident physician, Michael
Bryan, M.D. faculty, Karen Calhoun, M.D.
Frontal View Evaluation
below articles, Frontal View Evaluation and Lateral View
Evaluation are from FACIAL ANALYSIS; Dept of Otolaryngology,
UTMB, Galveston, TX - October 1, 1997.
Vertical height - It has
been well described that vertical height can be evaluated by
dividing the face into equal thirds.
The boundaries of the
upper third are the trichion and the glabella, with the mid third
extending from the glabella to the subnasale and the lower third
from the subnasale to the menton. The lower third can be
further subdivided into thirds with the stomion marking the
inferior boundary of the upper third, and the lower lip and chin
forming the lower two-thirds. While some have advocated evaluating
only the mid and lower face in men with receding hairlines, others
have stated that the appropriate superior border for the upper
third can be determined in these cases by locating the most
superior movement of the frontalis muscle.
Step 2. Width
The easiest way to evaluate the
relative width of facial structures is to divide the face into
vertical fifths with each fifth being equal to one eye width. This
technique is also helpful at determining the appropriate width of
several individual subunits and will be discussed more later. Also
transverse distances at bitemporal and bigonial lines should be
equal and approximately ten percent shorter than the bizygomatic
line drawn through the malar eminences.
A midsagittal line is
drawn and the symmetry of the various subunits (ears, eyes,
eyebrows, nose, and mouth) is compared. This is also a good time
to assess the overall facial shape which should be roughly oval.1
Prior to evaluating
the patient's profile, it is important to assure appropriate head
position. This has traditionally been accomplished by placing the
Frankfort horizontal line parallel to the floor. The Frankfort
horizontal line is drawn between the superior aspect of the
external auditory canal (or through the tragion) and the
infraorbital rim. A second technique to obtain the patient's
natural horizontal head position is to have them fix their eyes on
a point at eye level.
Vertical height - Again, facial
height is divided into thirds as in step 1, and the equality of
the thirds reassessed. The vertical placement of landmarks is also
determined in this step. As stated above, the lower third can be
further divided into thirds with the stomion separating the upper
and mid thirds and the pogonion lying in the center of the lower
Step 5. Midface
projection - To assess the midface position relative to the
upper face, a second line is drawn from the nasion to the
subnasale. This line should form an angle of 85 to 92 degrees when
compared to the Frankfort horizontal line and is termed the zero
meridian.2,3 If this line is excessively anterior, the midface is
described as anteface, and if posteriorly, a retroface profile is
Step 6. Lower
face position - The position of the
lower third of the face compared to the upper third is then
established, again with the zero meridian providing the reference.
A line is drawn from the subnasale to the pogonion. This line
should lie at a ten degree posterior angle from the zero meridian.
If the pogonion is placed significantly anteriorly, it is said to
be protruding and if posteriorly, retruding.
Nose-Lips-Chin Position - At this
point the relationship of the nose, lips and chin to each other is
evaluated using Rickett's E (esthetic) line.4 This line is drawn
from the nasal tip to the pogonion. The lips should lie just
posterior to this line with the upper lip approximately twice as
far from the line as the lower lip. If this is the case, no
further evaluation of these structures is indicated at this time.
If not, one of the three structures is malpositioned. Since the
pogonion was evaluated in step 4 and 6, only the lips and nasal
projection are further evaluated at this time. A quick assessment
of nasal projection is provided using Goode's ratio which compares
a line form the alar groove to the tip to a second line from the
nasion to the tip. The ratio of the former to the later should be
approximately 0.55 to 0.6.2 The anterior-posterior position of the
lips is quickly evaluated by the Holdaway H (harmony) line. This
line starts at the ideal pogonion and is drawn ten degrees
anterior to a line from the pogonion to the glabella. The lips are
appropriately positioned if they approximate this line.2,5
Step 8. Evaluation Of
The exam now focuses
on a more detailed evaluation of the specific facial subunits
including the forehead, eyes and eye brows, nose, mouth, chin,
neck and ears.
Although the forehead is rarely altered
surgically, it is important to evaluate because of its
relationship to other parts of the face. Additionally, certain
aspects of the forehead may dictate the surgical approach as in
the case of a receding hair line or the presence or absence of
deep forehead creases. In regards to the normal contour of the
forehead, men tend to have more prominent glabellar and
supraorbital rim regions with women having a smoother transition
into the midface.
eyebrows - Again the eyebrows differ
between sexes with the ideal male brow placed at the supraorbital
rim and fairly flat. The female brow rest slightly superior to the
rim and has a more prominent arch located at the level of the
lateral limbus. The brow should start medially at a vertical line
that passes through the alar groove and medial canthus, and
continue laterally to end along an oblique line from the nasal ala
through the lateral canthus at roughly the same height as the
medial brow.6,7 Careful exam to rule out brow ptosis is extremely
important if blepharoplasty is being considered. The intercanthal
distance is usually 30 to 35 mm and can readily be evaluated when
the frontal view is divided into vertical fifths with this
distance equal to one eye width.1 Both upper and lower lids should
be carefully examined both visually and manually to determine
their shape and elasticity. The upper lid margin should have its
highest point at the junction of its middle and medial thirds and
the lower lids lowest point should be between the middle and
lateral thirds. The upper lid should cover 2 to 3 millimeters of
superior iris and the lower lid margin usually approximates the
inferior iris.1 An eye doctor, such as an ophthalmologist, can provide further information about measurement of the eye areas. These measurements are often used for fitting glasses. These surgeons also typically offer elective procedures, such as Intracor eye surgery or cataract eye surgery, to help patients eliminate their dependence on glasses.
Lagophthalmos may be
identified by having the patient look down while tilting the head
backward.8 The superior palpebral lid crease identifies the
attachment of the levator aponeurosis into the orbicularis muscle
and should be located approximately 8 mm from the eyelash line.9
The presence and location of fat pseudoherniation should be
determined and an inferiorly displaced lacrimal gland noted if
present. Horizontal laxity of the lower lid can be tested by
pulling the lid away from the globe and then releasing it. In the
normal lid, it should snap back. If it returns slowly or not at
all, significant laxity exist and may alter the surgical plan.
Also the strength of the orbicularis muscle should be checked by
having the patient close their eyes tightly while the examiner
attempts to open them manually.
In addition to the initial evaluation
presented above, the nose should be evaluated for dorsal
deformities and appropriate width on frontal view. Again, dividing
the face into vertical fifths helps quickly determine whether an
acceptable lower nasal width is present. The alar- alar distance
should be equal to one eye width (one fifth) in Caucasians with
wider noses acceptable in Asian and African-Americans. This
distance may also be evaluated by determining the length of the
nose from nasion to tip, with the width being approximately 70% of
the length. On profile view nasal projection, rotation and length
as well as the nasofrontal, nasofacial and nasolabial angles are
more closely evaluated. The nasofrontal angle is formed at the
nasion by lines that extend from this point to the glabella and to
the nasal tip. This angle should ideally be 120 to 135 degrees.
The position of the vertex of this angle (nasion) is also
important because moving it up or down will lengthen or shorten
the nose, respectively. Its usual position is at the level of the
superior limbus of the eye. Nasal tip projection is often
difficult to determine and many techniques have been advanced.
Goode's ratio of 0.55-0.6:1comparing projection to nasal length
has been presented above. Another method involves the nasofacial
angle which is formed by a line along the nasal dorsum
intersecting a line from the glabella to the pogonion. The ideal
nasofacial angle is 36 degrees. Nasal length, height and
projection may also be examined simultaneously by creating a right
triangle between the alar groove, the tip defining point and the
nasion. The projection, height and length should create sides with
a ratio of 3:4:5 respectively.
Finally, an easy but
often inaccurate method of determining projection compares it to
the length of the upper lip from subnasale to vermilion border
with the two being roughly equal. The fault with this technique
lies in the variability of the upper lip length. Tip rotation is
assessed by evaluation of the nasolabial angle which is formed by
lines along the columella and upper lip that intersect at the
subnasale. The ideal nasolabial angle for women is 100 to 120
degrees and men between 90 and 105 degrees. Also on lateral view,
the alar and lobular lengths should be equal and there should be
between 2 and 4 mm of columellar show. On basal view, the nose
should have the shape of an equilateral triangle and the columella
should be approximately twice as long as the lobule. The lobule
should be 75% as wide as the alar base and the nostrils should be
roughly pear shaped.
Lips - The
relative position of the lips as compared to the nose and chin
have been discussed. It must be remembered that these structures
as well as the patient's dentition will affect the appearance of
the lips. Other considerations include the width of the lips, the
interlabial gap and the degree of incisor show with smiling. The
oral commissures should be located along vertical lines drawn from
the medial limbus of the iris. Also, the lower lip should be
slightly fuller than the upper lip. When relaxed and with teeth in
occlusion, the lips should approximate one another with an
interlabial gap of 3 mm being the upper limit of acceptable. When
smiling, there should be no gingival show and no more than two
thirds of the maxillary incisors exposed.
Chin and neck
- The relative position of the chin
has been determined in the initial evaluation and further
evaluation is aimed mainly at the shape of the chin and its
relation to the neck. The mentolabial sulcus depth is assessed by
creating a line from the lower vermilion border to the pogonion.
The sulcus should lie approximately 4 mm behind this line. In
regards to the neck, Dedo developed a classification system based
on the depth of the abnormality proceeding from superficial, skin
and fat, to deep, muscle (platysma) and bone (chin or hyoid).
Class I is the youthful, normal neck. Class II and III represent
early abnormalities of skin and fat accumulation respectively.
When platysmal abnormalities such as banding are identified, Class
IV is defined, and the loss of an appropriate mentocervical angle
because of a posteriorly positioned chin is labeled Class V.
Finally Class VI results from an inferiorly placed hyoid bone.
This final class is particularly important to identify because
very little can be done surgically to correct this abnormality.10
Lastly, the appropriateness of the neck length can be determined
by comparing the distance from menton to suprasternal notch, to
the head height measured from menton to vertex, with the head
being approximately twice as tall as the neck.
Ear - The
auricular length should be slightly less than twice its width and
the long axis should be inclined approximately 20 degrees
posteriorly. The external auditory canal should be located at a
level roughly halfway between the lateral canthus and the nasal
base. The superior aspect of the ear should be at the level of the
lateral brow and the inferior aspect at the level of the nasal
base. The auriculocephalic angle should measure approximately 20
to 30 degrees.11 Specific landmarks of the ear including the
helix, antihelix, scaphoid fossa, tragus, and lobule should be
evaluated for obvious deformity. The thickness and flexibility of
the cartilage should also be estimated.
occlusion - As mentioned above, the
patient's dentition may play a significant role in overall
cosmesis. Although an in depth discussion is beyond the scope of
this presentation, the dentition should be evaluated and
correction considered if abnormalities are present that could
cause aesthetic problems. Briefly, normal occlusion is present
when the mesiobuccal cusp of the maxillary first molar occludes
the buccal groove of the mandibular first molar. This is termed
Type I occlusion. Type II occlusion occurs when the mandibular
teeth occlude in a more posterior position and Type III occlusion
is when they are more anteriorly located". Dental occlusion could be the result of TMJ (or TMD). See your dentist if you have TMJ symptoms.
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(Updated on 09/22/10)
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