Preoperative Evaluation of the Aesthetic PatientNIEYUNFEIFacial AnalysisFacial Analysis Face: General (Shape)Facial Beauty“You cant define it, but you know it when it walks into the room” -Aaron Spelling Greek Polycleitus 450-420 B.C. first to quantify symmetries and proportions the CanonLeonardo Da Vinci (1452-1519)Durer (1471-1528)Joseph (1865-1934) father of rhinoplastyBroadbent (1894-1977) radiographic cephalometrics Ricketts -the golden proportion (1:1.618)Farkas -revised the classic cannon with hundreds of measurements on living subjectsDoryphorusFacial BeautyFew people, whether Caucasion or ethnic, fit the Neoclassical canon of fixed proportions and ratios (Farkas, Porter, Teck, Milgrim)Attractiveness consistent across cultural groups. (Cunningham, Thakerar, Buss, Perrett)Symmetry, “averageness” associated with beautyExtreme beauty seems to be associated with magnification or diminution of at least one feature (Perrett, Rhodes)“there is no excellent beauty that hath not some strangeness in the proportion” Francis BaconBeautyLife is easier when youre beautifulhigher grades (score equally on standardized tests)more often judged kind, decent and honestgiven more personal spacemore likely to marrymore likely to be promoted at work (rank in the armed forces)wait shorter amount of time for servicesbad behavior more likely to be forgivenless likely to be reported, caught, or punished for major or minor crimeeasier to procure help in times of needFacial Analysis - TermsTrichion- frontal hairlineGlabella- most prominent point of midsagittal foreheadRadix- root of noseNasion- depression at root of noseRhinion- junction of bony and cartilaginous nasal dorsumTip-defining point- anteriormost projection of nasal tipAlar crease- lateral aspect of nasal alaSubnasale- junction of columella and upper lip at base of noseStomion- where lips meetPogonion- most anterior aspect of chinMenton- lower border of contour of chinGnathion- point at junction of tangents to menton and pogonionCervical point- point at junction of tangents to menton and anterior border of neckFacial AnalysisFace: GeneralDivided in 1/3strichion to NFANFA to subnasalesubnasale to mentonFacial AnalysisFace: GeneralDivided in 1/3strichion to NFANFA to subnasalesubnasale to mentonFacial AnalysisVertical divisions1/5seach equal to one eye widthFacial AnalysisVertical divisions1/5seach equal to one eye widthLipsoral commissure at medial limbusNasal alalateral aspect at medial canthusFacial AnalysisLipsoral commissure at medial limbussmaller mouth preferred in Asia (Chinese)Nasal alalateral aspect at medial canthusmay be wider in Asian and African-American patientsFacial Analysis-The NoseNosenasofrontal angleapproximately 120 degreesnasolabial angle90-105 in men100-120 in womencolumnellar show2-4mmFacial Analysis-The NoseTip heightGoodes Ratio:(alar groove to tip) divided by (nasion to tip) = 0.55 - 0.60Baums Ratio:(nasion to tip) divided by (subnasale to tip) = 2.8Facial Analysis-The NoseNosenasofrontal angleapproximately 110 degreesnasolabial angle90-105 in men90 -110 in womenFacial Analysis-The NoseSubmental vertex view:equilateral trianglelateral ala at medial canthusmay be wider in asian, african nosesFacial Analysis-The NoseTip heightGoodes Ratio:(alar groove to tip) divided by (nasion to tip) = 0.55 - 0.60Baums Ratio:(nasion to tip) divided by (subnasale to tip) = 2.8Submental vertex view:equilateral trianglelateral ala at medial canthusmay be wider in asian, african nosesFacial AnalysisChin projectionBurstones AngleSN to pogonion to cervicomental angle is approximately 100 degreesVertical line from subnasale:3 mm for males5 mm for femalesFacial Analysis-The NoseChin projectionBurstones AngleSN to pogonion to cervicomental angle is approximately 100 degreesVertical line from subnasale:3 mm for males5 mm for femalesFacial Analysis-OcclusionOcclusionClass IClass IIClass IIIRetrognathia: poor chin projection plus Class II occlusionMicrognathia: poor projection Class IFacial Analysis - The NeckNeckDedo classificationhyoid positionskin positionfat accumulationmuscular positioncervicomental angle 90 to 110 degreesFacial Analysis - The NeckNeckDedo classificationhyoid positionskin positionfat accumulationmuscular positioncervicomental angle 90 to 110 degreesFacial Analysis: CheeksFacial Analysis-ForeheadBrow positionmales: at rimfemales slightly above rim, maximum lateral limbusEyeslateral hoodingFacial Analysis-ForeheadHairlineBrow positionmales: at rimfemales slightly above rim, maximum arch at lateral limbusFacial Analysis-EyesBrow PositionDermatochalasiaLid Fullness/Fat herniationLid crease position/symmetryLid laxityFacial Analysis : ScalpHairline: Norwood Classification (Class I to VII)The Facial Point of InterestForehead Eyebrows and EyesNasal Analysis