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Facial Analysis
Key Points
- 1.
Symmetry and proportion are important to facial harmony. The individual subunits must balance each other to achieve an aesthetically pleasing result.
- 2.
Ideal relationships have been established based on the relationship of soft tissue landmarks to each other. However, variations exist for different ethnicities.
- 3.
When analyzing the nose, it is important to evaluate its relationship to the rest of the face in addition to its individual characteristics.
- 4.
Photography and imaging software enhance physician-patient communication, surgical planning, and resident education.
Pearls
- 1.
The Frankfort horizontal line allows for standardization in photographs and is the cornerstone for facial analysis.
- 2.
Nasal rotation refers to movement of the tip along an arc from the Frankfort horizontal line.
- 3.
Nasal projection refers to how far the tip projects from the face.
Questions
1
What are the important soft tissue reference points of the face with regards to facial analysis?
Trichion: anterior hairline at the midline
Glabella (G): most anterior point of the forehead on profile view
Nasion (N): point of deepest depression at the root of the nose on profile view
Nasal tip (T): most anterior point of nose on profile view
Columellar point (Cm): most anterior point of the columella on profile view
Subnasale (Sn): point where the nasal columella merges with the upper lip
Labrale superioris (LS): vermillion border of the upper lip
Labrale inferioris (LI): vermillion border of the lower lip
Pogonion (Pg): most anterior point of the chin on profile view
Menton (Me): lowest point of the chin
Cervical point (C): innermost point between the submental area and the neck
Fig. 60.1 illustrates these reference points.
2
What is the Frankfort horizontal plane?
A line drawn from the superior aspect of the external auditory canal to the inferior aspect of the infraorbital rim on a lateral view ( Fig. 60.2 ). In photographs, it is approximated by a line drawn from the superior tragus to the lower eyelid-cheek skin junction. This allows standardization for patient positioning in photographs, as well as for facial analysis.
3
What is the facial plane?
A line drawn from the glabella to the pogonion. The facial plane should intersect the Frankfort horizontal plane at an angle of 80 to 95 degrees.
4
What is the zero meridian of Gonzales-Ulloa?
A line perpendicular to the Frankfort horizontal line that goes through the nasion. The pogonion should be within 5 millimeters of this line.
5
What are some important angles used for facial analysis?
Nasofrontal angle ( Fig. 60.3A ): intercept of G to N line with N to T line
Nasofacial angle ( Fig. 60.3B ): intercept of G to Pg line with N to T line
Nasolabial angle ( Fig. 60.3C ): intercept of Cm to Sn line with Sn to LS line
Nasomental angle ( Fig. 60.3D ): intercept of N to T line with T to Pg line
Mentocervical angle ( Fig. 60.3E ): intercept of G to Pg line with Me to C line
6
What is the aesthetic triangle of Powell and Humphreys?
This system incorporates the nasofrontal, nasofacial, nasomental, and mentocervical angles to relate all of the major components of the face in the evaluation of facial harmony ( Fig. 60.4 ). The nasomental angle is considered the most important measurement because it is dependent upon nasal projection and chin position and shows the interdependence of individual facial features.
7
What are ideal measurements of the angles mentioned above?
Nasofrontal angle: 115–130 degrees
Nasofacial angle: 36–40 degrees
Nasolabial angle: 90–95 degrees in males and 95–110 degrees in females
Nasomental angle: 120–132 degrees
Mentocervical angle: 80–95 degrees
8
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