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

A new perspective: Quantitative description of the Cupid's peak aesthetics essence

OBJECTIVES

The Cupid's peak triangle theory was established to reveal the aesthetics essence of the Cupid's peak through golden ratio deviation to provide quantitative theoretical basis for lip plastic and cosmetic surgery.

MATERIALS AND METHODS

Model the Cupid's peak line on the lip bow ridge and construct expressions for Cupid's peak parameters and their associated triangle theory using the angle circle (AC) and radius circle (RC) of the Cupid's peak line. Calculate and establish functional relationships for Cupid's peak parameters and the concept of the Cupid's peak index (CPI) golden ratio deviation (GRD).

RESULTS

In the Cupid's peak triangle theory, important parameters describing Cupid's peak morphology include Cupid's peak angle (ACp), arc (RCp), the smooth connection point (SI) of the Cupid's peak arc and line, and the CPI. The parameters are interrelated in their functional relationships. ACp determines RCp, the SI point determines the proportion of the Cupid's peak arc to the line, and CPI determines GRD. Cupid's peak parameter ranges in the normal population are as follows: ACp is 109°-160°, RCp is 1.24-0.35 rad, CPI is 0.614-0.508, and GRD is 0.62%-17.85%.

CONCLUSIONS

The Cupid's peak triangle theory reveals the functional relationship between the Cupid's peak parameters and quantifies the aesthetics essence of lip shape.

CLINICAL RELEVANCE

The morphology of the Cupid's peak serves as a tangible manifestation of lip shape aesthetics. This study aims to elucidate the aesthetic essence and general principles of Cupid's peak morphology, offering a quantitative theoretical foundation for lip plastic and cosmetic surgery.

Ethnic Considerations When Planning Lip Augmentation

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

Is There An "Ideal Instagram Face" for Caucasian Female Influencers? A Cross-Sectional Observational Study of Facial Proportions in 100 Top Beauty Influencers

Background

In the digital arena, wherein younger generations predominantly spend their time, social media continues to determine what is considered beautiful. Social media, particularly Instagram (Meta, Menlo Park, CA), is becoming a prominent aspect of the plastic surgeon-patient relationship. Therefore, the beauty ideal escalates without any barriers and breaks. The majority of influencers look alike. This sets a new trend for a beauty ideal.

Objectives

In this study, the authors aimed to analyze the facial proportions of 100 top female beauty influencers, to evaluate them for identifying the "ideal Instagram face," and to determine whether there existed a deviation from the standard golden ratio.

Methods

The authors identified the top 100 beauty influencers, according to the latest rankings of November 2022. A detailed facial analysis has been conducted using the Fiji biomedical image analysis software. The primary outcome parameters included facial proportions such as lip ratio, Ricketts' line, and nasal dimensions. Secondary outcomes comprised BMI, age, and ethnicity. The results were collected and analyzed descriptively using graphs and statistics.

Results

Complete datasets were obtained from the top 100 female beauty influencers with a mean age of 31.3 ± 6.3 years (range, 24-38 years). The majority of influencers were Americans, followed by Germans and British. Based upon the mean of the aforementioned parameters, we could design the ideal Instagram face. There was no significant difference between the golden ratio and the new trend of the ideal Instagram face.

Conclusions

Despite the existence of varied ethnic population groups and nonstandard measurements, the ideal Instagram face represents today's ideal trending face. The ideal Instagram face is symmetrical, matching the golden ratios, with a small and neat nose, full and lush lips, high cheekbones, as also a sharp and chiseled jawline. Further studies on this topic, involving a greater number of influencers with standardized measurements, should be advocated to identify the ideal facial proportions. This will lead to improvements in invasive and noninvasive cosmetic treatments.

Level of Evidence 5 Diagnostic

Influence of ethnicity on aesthetic preferences for lip characteristics in Caucasian male and female faces

BACKGROUND

In an era where globalization and social media significantly reshape beauty standards, it is imperative to delve into the subjectivity of beauty and attractiveness. The lips, a key element in facial aesthetics, contribute significantly to the perception of attractiveness, and also have a profound impact on an individual's self-esteem.

OBJECTIVE

To analyze the influence of ethnicity on the aesthetic preferences for lip characteristics, among male and female faces.

MATERIALS AND METHODS

This study encompassed a sample of 231 study participants (153 women and 78 men) with an average age of 23.2 ± 2.8 years, representing ethnicities such as African, Caucasian, Middle Eastern, and South Asian. Participants were asked to rate a series of images showcasing various lip variants, providing insights into their aesthetic preferences.

RESULTS

Demographic analysis revealed gender and ethnic variations in aesthetic preferences for all the investigated lip parameters. Women were 2.42 times more likely than men to prefer no Cupid's indentation on a female model (p = 0.0019).

CONCLUSIONS

The study underscores the importance of understanding cultural influences on beauty standards and challenges the notion of a universal beauty ideal. The evolving role of social media trends, such as Cupid's bow indentation elimination, raises questions about the dynamic nature of aesthetic preferences among different ethnicities.

Comparison of the accuracy (trueness and precision) of virtual dentofacial patients digitized by three different methods based on 3D facial and dental images

STATEMENT OF PROBLEM

The accuracy of virtual dentofacial patients has been explored, but the accuracy of virtual patients established by using a straightforward and reliable method and the accuracy of different virtual patients are unclear.

PURPOSE

The purpose of this clinical study was to compare the accuracy of virtual dentofacial patients digitized by using registered-block impression, exposed anterior teeth, and cone beam computed tomography (CBCT) reconstruction methods based on 3-dimensional (3D) facial and dental images.

MATERIAL AND METHODS

From the 15 selected participants who needed CBCT scanning, 3 kinds of virtual dentofacial patients were established by using 3 registration methods based on digital dental casts: 3D facial images, CBCT data, and registered-block impression. Compared with actual measurement, 25 linear distances of all virtual dentofacial patients were selected and measured by using a software program, and 3 separate measurements were calculated by the same person. The 1-way analysis of variance (ANOVA) was used to compare the deviations among 3 kinds of virtual dentofacial patients (trueness) and the deviations within groups (precision). The 1-sample t test was used to compare the difference between the deviation and the ideal error of 0.00 (α=.05).

RESULTS

Compared with the actual measurement, the trueness of the average deviations for registered-block impression (1.02 ±1.24 mm) was better than that of exposed anterior teeth (2.35 ±1.71 mm) and CBCT reconstruction (2.86 ±1.61 mm). The precision of the average deviations for registered-block impression (1.29 ±1.43 mm) was better than that of exposed anterior teeth (2.00 ±1.72 mm) and CBCT reconstruction (2.12 ±1.94 mm). Significant differences in trueness and precision were found among the 3 groups of virtual dentofacial patients (P<.01). Significant differences among the deviations of all linear distances and the ideal error of 0.00 were observed for all groups of virtual dentofacial patients (P<.05).

CONCLUSIONS

The accuracy of registered-block impression was better than that of the exposed anterior teeth and CBCT reconstruction. The accuracy of exposed anterior teeth was lower than that of the other methods but could satisfy the requirements of clinical diagnostics and scientific methods. The accuracy of CBCT reconstruction was poor and could only be used for special situations that permitted low accuracy.

Enhancing Aesthetic Harmony: Comprehensive Anthropometric Lip Measurements in Youthful and Attractive Indonesian Adults for Precision Cosmetic Procedures

Lips are an important part of our perception of beauty, youthfulness and attractiveness. Aesthetic lips, as with the rest of the face, differs according to age, ethnicity and sex. The aim of this study was to evaluate the anthropometric measurements of the lips of young and attractive Indonesian adults. Photographs of faces were taken at an anterior neutral position for 100 participants; 47 men and 53 women volunteered to participate in this study. Seven landmarks were used in this study: stomion (st), sublabiale (sl), subnasale (sn), labiale superius (ls), labiale inferius (li), crista philtre (cp) and chelion (ch). Using these landmarks, lower lip height, upper lip height, philtrum length, upper vermillion height, lower vermillion height, cutaneous lower lip height, philtrum width and mouth width were measured. The results were analysed using independent t-test and Mann-Whitney test. Significant differences in lip size were observed between men and women in all the measurements st-sl (lower lip height), sn-st (upper lip height), sn-ls (philtrum length), li-sl (cutaneous lower lip height), sn-ls/ls-st (philtrum length and upper vermillion height) and ls-li/ch-ch (cutaneous lower lip height and mouth width) with a significance of p=0.003, p=0.007, p<0.001, p=0.05, p=0.005 and p=0.021, respectively. Male lip measurements of ch-ch (overall lip width) and ls-st/li-st (overall lower lip height) were significantly smaller than those of female lips. The lip ratios calculated in this study were congruent with aesthetic parameters reported in other populations. This study suggests that the same measurement standards cannot be used on different populations, but these ratios may offer a better framework for precision cosmetic procedures. We believe that the results obtained in this study on lip anthropometry will help in optimising the standard values that can be used for the Indonesian population aged 20 to 35 years.

Three-dimensional evaluation of mandibular width after mandibular asymmetric setback surgery using sagittal split ramus osteotomy

Objective

The study aimed to evaluate the changes in mandibular width after sagittal split ramus osteotomy (SSRO) in patients with mandibular asymmetric prognathism using cone-beam computed tomography (CBCT).

Methods

Seventy patients who underwent SSRO for mandibular setback surgery were included in two groups, symmetric (n = 35) and asymmetric (n = 35), which were divided according to the differences in their right and left setback amounts. The mandibular width was evaluated three-dimensionally using CBCT images taken immediately before surgery (T1), 3 days after surgery (T2), and 6 months after surgery (T3). Repeated measures analysis of variance was applied to verify the differences in mandibular width statistically.

Results

Both groups showed a significant increase in the mandibular width at T2, followed by a significant decrease at T3. No significant difference was observed between T1 and T3 in any of the measurements. No significant differences were found between the two groups (p > 0.05).

Conclusions

After mandibular asymmetric setback surgery using SSRO, the mandibular width increased immediately but returned to its original width 6 months after surgery.

Do the Most Attractive Faces of Patients With Class II Division 1 Malocclusion Differ From Those With the Least Attractive Faces in Terms of Angular and Proportional Measurements Assessed on Frontal and Lateral Photographs?

Background This study investigated the facial angles and proportions affecting facial aesthetics in patients with skeletal class II division 1 malocclusion between those labeled the most attractive and least attractive in each gender. Methodology The study sample included pretreatment extraoral photographs of 60 patients (30 males and 30 females) with skeletal class II division 1 malocclusion according to the ANB angle aged between 18 and 21 years. A panel of 240 laypersons (aged 20-25 years; the average age of 22.5 ± 0.37 years; 120 males and 120 females) scored the aesthetic evaluation of photographs using the visual analog scale (VAS). Two groups were created according to the mean aesthetic scores of each photograph, namely, the most attractive group with the highest aesthetic scores, and the least attractive group with the least aesthetic scores. A total of 12 patients in each group were selected. Subsequently, their angular and proportional measurements on the frontal and lateral photographs were calculated. Independent-sample t-tests were used to determine if there were significant differences in these measurements between the two groups. Results There was no significant difference in frontal variables between the most attractive and least attractive groups in each gender. The angle NPog-FH was significantly greater in the most attractive males than in the least attractive males, while there was no significant difference between the most attractive and least attractive females regarding any of the profile variables. Conclusions The most attractive females with class II division 1 were similar to the least attractive on evaluating the frontal and profile variables. In contrast, the most attractive males with class II division 1 malocclusion had more protrusion in the chin than the least attractive male patients, with no differences in other profile and frontal variables. These findings suggest considering the chin position during the diagnosis and treatment planning of class II division 1 malocclusion patients.

A CBCT Evaluation of Esthetic Preference Regarding the Perceived Facial Attractiveness of Young Korean Female Adults with a Normal Skeletal Pattern

The aim of this study was to determine the factors that affect esthetic preference regarding the perceived facial attractiveness of young Korean female adults with a normal skeletal pattern using cone-beam computed tomography (CBCT). After reorienting the CBCT images of 40 young Korean female adults, three-dimensional (3D) measurements were analyzed, and five 3D facial images were digitally constructed. A computer-based questionnaire was used to determine perceived facial attractiveness by scoring from 1 (very unattractive) to 10 (very attractive). Esthetic perception and the most influential facial view and component were examined and compared by orthodontists, general dentists, and laypeople to evaluate facial attractiveness. Compared to the unattractive group, the attractive group had significantly greater values for Pog-NB, L1SI-FH, U lip thickness, L lip-U lip, and Nasolabial angle, along with significantly lower values for U1SI-FH and Cant of U lip; the attractive group also had a more retruded U1MP (p < 0.01), L1MP (p < 0.01), U lip (p < 0.05), and L lip (p < 0.01) relative to N, as well as a more retruded U lip (p < 0.05) and L lip (p <0.001) relative to esthetic lines. Orthodontists and general dentists were more likely to consider the profile view. When evaluating facial attractiveness, orthodontists and laypeople more often focused on the lips and chin. When evaluating facial attractiveness, all evaluators showed a high esthetic preference for retroclination and retrusion of the incisors and lips, but there were some differences in how they perceived facial attractiveness. Therefore, the ultimate perception of facial attractiveness needs to be based on the esthetic perceptions of laypeople.

Rhinoplasty with Simultaneous Autologous Full-Face Fat Transfer for Asian Facial Contouring Balance: A Retrospective Study

BACKGROUND

The aesthetic facial contouring procedures have gained an increasing popularity in the Asian population. Nevertheless, currently, there are few specific literature assessments and studies on the outcomes of rhinoplasty combined with full-face fat graft contouring. To conduct an objective evaluation of the efficacy of Asian rhinoplasty combined with autologous facial fat transfer in terms of 3-dimensional measurement and patient-reported outcomes.

METHODS

Patients who underwent rhinoplasty combined with full-face fat transfer for facial contouring between January 2016 and July 2019 were recruited in the study. The preoperative and postoperative clinical variables and 3-dimensional measurement of patients were also collected. The satisfaction outcome of surgeons and patients was assessed.

RESULTS

Twenty patients completed rhinoplasty with full-face fat transfer. The average postoperative follow-up was 10.2 months (range 6-24 months). The nasal length, and the nasal protrusion rate were significantly increased (p < 0.05) after surgery, and the median number of nasolabial angles decreased from 106° to 101°, which was closer to the aesthetic standard of 90°-100°. The topographical projection images of whole face indicated that the volume of frontal, temporal, inner cheek and chin regions were increased obviously. All cases received satisfaction outcome based on surgeons' satisfaction scale, ROE scale, FACE-Q overall facial satisfaction scale, and FACE-Q Rhinoplasty scale. Additionally, no patients had intraoperative or postoperative complications.

CONCLUSIONS

Rhinoplasty combined with full-face fat transfer is a reliable and effective method of augmenting and contouring the facial convexity in the Asian populations.

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 .

Improved lip esthetics in patients with skeletal Class III malocclusion and facial asymmetry after isolated mandibular orthognathic surgery

INTRODUCTION

Asymmetry of the lips severely affects facial esthetics and is often one of the chief complaints of orthognathic patients, especially those with Class III malocclusion. The objectives of this study were to investigate the changes in lip symmetry in patients with mandibular prognathism and deviation and the relationships between jaw hard tissue and lip soft-tissue changes.

METHODS

Three-dimensional facial scan and cone-beam computed tomography scan data of 30 orthodontic-orthognathic patients treated with bilateral sagittal split ramus osteotomy were combined to conduct the research. Paired-sample t test and Pearson correlation coefficient were applied to compare the differences in the same variable before and after the orthognathic surgery and the potential correlations between the changes in hard and soft variables. To explore the important hard tissue variables influencing the lip soft-tissue changes, linear regression analysis was performed.

RESULTS

Although there was significant upper lip asymmetry presurgery, the upper lip asymmetry was corrected postsurgery. Surgical correction of the mandibular deviation was also accompanied by lengthening of the bilateral philtrum crests. Improvement in lip asymmetry and lengthening of the philtrum crests were primarily related to the transverse correction of the mandible rather than sagittal changes. The corresponding prediction formulas were established.

CONCLUSIONS

The isolated mandibular bilateral sagittal split ramus osteotomy surgery can substantially improve the upper and lower lip asymmetry in patients with mandibular prognathism and deviation, but one should be wary of the unesthetic effects associated with lengthening of the philtrum crests.

What Is the Perception of an Esthetic Lower Facial Third Profile in the Korean Layperson Population?

PURPOSE

The purpose of this study is to investigate whether there were differences in perception of facial profile esthetics at the upper lip, gnathic, and genial levels according to observer gender and age in the Korean layperson population.

METHODS

Ten male (M1 to M10) and 10 female (F1 to F10) silhouettes with differing facial profiles at the level of the upper lip, mandibular, and chin were created from a male and female facial profile deemed well-balanced and orthognathic by reviewer consensus. These silhouettes were presented to 288 participants who were asked to rank the 5 most attractive male and female profiles. The participants were composed of 144 males and 144 females divided into 4 age groups: group I (under 20 years), group II (20 to 39 years), group III (40 to 59 years), and group IV (over 60 years). The most preferred profile and observer scores were investigated and calculated. Descriptive analysis, χ² test, and analysis of variance were used for statistical analysis according to age and gender.

RESULTS

The most preferred male and female silhouettes were orthognathic profiles. There was no significant difference according to gender when rating male (P = .281) and female (P = .442) silhouettes. No statistically significant difference was observed even when analyzed according to age groups. Although the difference in observer scores among each ranking showed a statistical difference according to age groups, the overall rankings showed a similar pattern both in male and female silhouettes. In the same age group, no difference in rank scores according to gender was observed. Severe concave profiles were found to have the lowest rank.

CONCLUSIONS

An orthognathic profile was rated as the most desirable in the Korean layperson population, with few differences in perception of esthetic facial profile according to age and gender.

Lip Anthropometry of Healthy Turkish Young Adults

ABSTRACT

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

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Soft tissue facial changes among adult females during alignment stage of orthodontic treatment: a 3D geometric morphometric study

BACKGROUND

To investigate changes in facial morphology during the first six months of orthodontic treatment among adult females receiving orthodontic treatment.

METHODS

43 adult females receiving orthodontic treatment were randomly recruited. 3D facial images were taken at baseline (T0), three months (T1), and six months (T2) after treatment initiation. Spatially dense facial landmarks were digitized to allow for sufficient details in characterization of facial features. 3D geometric morphometrics and multivariate statistics were used to investigate changes in mean and variance of facial shape and facial form associated with treatment.

RESULTS

We observed statistically significant changes in facial shape across the three treatment stages (p = 0.0022). Pairwise comparisons suggested significant changes from T0 to T1 (p = 0.0045) and from T0 to T2 (p = 0.0072). Heatmap visualization indicated that the buccal and temporal region were invaginated while the labial region became protruded with treatment. The magnitude of shape change was 0.009, 0.004, and 0.010 from T0 to T1, T1 to T2, and T0 to T2, respectively, in unit of Procrustes distance. The average magnitude of change per-landmark was 1.32 mm, 0.21 mm, and 1.34 mm, respectively. Changes in mean facial form were not statistically significant (p = 0.1143). No changes in variance of facial shape were observed across treatment stages (p > 0.05).

CONCLUSION

Rate of facial changes was twice as fast during the first three months as that during fourth to sixth month. Buccal and temporal region became invaginated while labial region became protruded with treatment.

[Comparison of the registration methods for the three-dimensional facial scans applied to the design of full-arch implant supported restoration]

OBJECTIVE

To compare the registration accuracy of three-dimensional (3D) facial scans for the design of full-arch implant supported restoration by five methods and to explore the suitable registration method.

METHODS

According to the criteria, ten patients with maxillary edentulous jaw or end-stage dentition requiring implant supported restorations were enrolled in this study. A special rim with individual feature marks reflected appropriate occlusal relationship and esthetic characteristics was made for each patient. Both 3D facial scan data of natural laughter and with opener traction to expose the teeth or occlusal rim of each patient were acquired by facial scan and input to the digital analysis software Geomagic Qualify 2012. The dataset was superimposed by five different methods: seven facial anatomical landmark points alignment, facial immobile area alignment (forehead and nasal area), facial anatomical landmark points and immobile area combining alignment, facial feature points alignment, facial and intraoral feature points alignment with the same local coordinate system. The three-dimensional deviation of the same selected area was calculated, the smaller the deviation, the higher the registration accuracy. The 3D deviation was compared among the three registration methods of facial anatomical landmark points, facial immobile area alignment and the combination of the above two methods. Friedman test was performed to analyze the difference among the three methods (α=0.05). The effect of the aid of the facial and intraoral feature points were evaluated. Paired t test were performed to analyze the difference (P<0.05).

RESULTS

The average three-dimensional deviation of the selected area after alignment with the facial anatomical landmarks was (1.501 2±0.406 1) mm, significantly larger than that of the facial immobile area best-fit alignment [(0.629 1±0.150 6) mm] and the combination of the two methods[(0.629 1±0.150 6) mm] (P < 0.001). The aid of the facial feature points could significantly reduce the deviation (t=1.001 3, P < 0.001). There was no significant statistical difference in the remaining groups.

CONCLUSION

The forehead area of the 3D facial scan can be exposed as much as possible. The establishment of facial characteristic landmark points and the use of the invariant area alignment can improve the accuracy of registration. It should be clinically feasible to apply three-dimensional facial scan to the design of full-arch implant supported restoration with the registration of the immobile area on the face especially the forehead area.

[Comparison of the registration methods for the three-dimensional facial scans applied to the design of full-arch implant supported restoration]

OBJECTIVE

To compare the registration accuracy of three-dimensional (3D) facial scans for the design of full-arch implant supported restoration by five methods and to explore the suitable registration method.

METHODS

According to the criteria, ten patients with maxillary edentulous jaw or end-stage dentition requiring implant supported restorations were enrolled in this study. A special rim with individual feature marks reflected appropriate occlusal relationship and esthetic characteristics was made for each patient. Both 3D facial scan data of natural laughter and with opener traction to expose the teeth or occlusal rim of each patient were acquired by facial scan and input to the digital analysis software Geomagic Qualify 2012. The dataset was superimposed by five different methods: seven facial anatomical landmark points alignment, facial immobile area alignment (forehead and nasal area), facial anatomical landmark points and immobile area combining alignment, facial feature points alignment, facial and intraoral feature points alignment with the same local coordinate system. The three-dimensional deviation of the same selected area was calculated, the smaller the deviation, the higher the registration accuracy. The 3D deviation was compared among the three registration methods of facial anatomical landmark points, facial immobile area alignment and the combination of the above two methods. Friedman test was performed to analyze the difference among the three methods (α=0.05). The effect of the aid of the facial and intraoral feature points were evaluated. Paired t test were performed to analyze the difference (P<0.05).

RESULTS

The average three-dimensional deviation of the selected area after alignment with the facial anatomical landmarks was (1.501 2±0.406 1) mm, significantly larger than that of the facial immobile area best-fit alignment [(0.629 1±0.150 6) mm] and the combination of the two methods[(0.629 1±0.150 6) mm] (P < 0.001). The aid of the facial feature points could significantly reduce the deviation (t=1.001 3, P < 0.001). There was no significant statistical difference in the remaining groups.

CONCLUSION

The forehead area of the 3D facial scan can be exposed as much as possible. The establishment of facial characteristic landmark points and the use of the invariant area alignment can improve the accuracy of registration. It should be clinically feasible to apply three-dimensional facial scan to the design of full-arch implant supported restoration with the registration of the immobile area on the face especially the forehead area.

Adjunctive surgery after total arch distalization to optimize esthetics

This case report presents surgically assisted orthodontic treatment for an adult patient due to labial exostosis, prominent malar, and unesthetic chin. Her treatment was total arch distalization with modified C-palatal plate for maxillary arch and miniscrews for mandibular arch. In addition, she was treated with alveoloplasty, malarplasty, and genioplasty to improve the consistency of her profile. The total treatment duration was 28 months.

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.

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

Objective

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

Methods

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

Results

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

Conclusions

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

Lip Morphology and Aesthetics: Study Review and Prospects in Plastic Surgery

The lip profile plays an important role in the perception of facial aesthetics; lip morphology and aesthetics research is receiving increasing attention. The advancement of research tools such as three-dimensional imaging technology has led to the clarification of lip morphologic and aesthetic characteristics. After studies of lip characteristics according to gender, ethnicity and age provided basic data, studies on lip aesthetics have been conducted by scholars worldwide. These studies could provide a basic theory to support diagnosis and treatment options, as well as the basis for evaluative criteria for precise treatment and technical improvements. According to the conclusions of the above studies, new ideas for cosmetic surgery design, including lip, perioral and labial-facial relationships, have been discovered.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 .

Reconstruction of nasal supratip defect using vertical alar groove tissue

Background: Several local flaps have been introduced for the reconstruction of small-to-medium-sized nasal supratip defects.Objective: To evaluate the outcome of reconstructing supratip defects using tangential advancement flaps from the vertical alar groove tissue.Methods and materials: Medical records of 20 patients who underwent supratip reconstruction using this flap between January 2012 and July 2018 were retrospectively analyzed. The postoperative photographs were assessed by three dermatologists using a four-scale investigator's global assessment.Results: The male-to-female ratio was 9:11, with a mean age of 72.6 years (range, 56-89 years). In all 20 cases, defects were caused by a wide local excision of non-melanoma skin cancer on the nose. The mean diameter of the defects was 1.20 cm (ranging from 0.5 to 1.9 cm). The mean follow-up period was 14.0 months (ranging from 0.5 to 48 months). Excellent or good surgical outcome was reported in 95% of patients.Conclusions: Creating a tangential advancement flap using the vertical alar groove tissue is a simple, single-stage procedure with excellent surgical outcome. It may be useful in the reconstruction of supratip defects with a diameter of less than 2 cm.

What Is the Most Beautiful Facial Proportion in the 21st Century? Comparative Study among Miss Universe, Miss Universe Thailand, Neoclassical Canons, and Facial Golden Ratios

BACKGROUND

An ideal facial proportion has been attempted since the ancient times. However, modern facial proportions of the most beautiful women in the 21st century are unavailable and have never been determined.

METHODS

A retrospective review of the photographs of Miss Universe Thailand and Miss Universe from 2001 to 2015 was conducted. All photographs were searched from Internet websites. Twenty-six dominant points were identified. Comparisons of the facial proportion among Miss Universe Thailand, Miss Universe, neoclassical canons, and facial golden ratios were performed.

RESULTS

Sixteen Miss Universe Thailand and 16 Miss Universe were included. Nine points of facial proportions were found to be statistically significant between Miss Universe Thailand and neoclassical canons. Miss Universe Thailand showed wider nasofrontal angle, thinner lower-upper lip height ratio, and less chin projection. Ten points of facial proportions were found to be statistically significant between Miss Universe and neoclassical canons. Miss Universe showed wider nasofrontal and nasofacial angle, more nasal tip projection, and thinner lower-upper lip height ratio. Seven points of facial analysis were found to be statistically significant between Miss Universe Thailand and Miss Universe groups. Of the 16 facial golden ratios, 12 demonstrated statistical significance in both the Miss Universe Thailand and Miss Universe groups.

CONCLUSIONS

Modern facial proportions of beauty are different from the past. Photogrammetic analysis demonstrated longer forehead, thinner lower-upper lip height proportion, wider interala-medial canthus width proportion, and wider nasofrontal angle compared with previous references. Furthermore, facial golden ratios were statistically significantly invalid in modern facial proportions of beauty.

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 .