ArticlePDF Available

The ideal male jaw angle - An Internet survey

January 2016
Journal of Cranio-Maxillofacial Surgery 44(4)

DOI:10.1016/j.jcms.2015.12.012

Authors:

University Hospital Brussels

Background: The ideal male jaw angle has not been established. With the advent of additive manufacturing, precise customized shaping is a reality. This study aimed to define the ideal masculine mandibular angle as an aid for 3-dimensional (3D) design. Methods: An Internet survey was conducted using black/white photographs of celebrities and non-celebrities. Preferences regarding gonial angle (profile and frontal views), intergonial width and vertical jaw angle position (face frontal view), and angle curvature and definition in oblique views were obtained using simplified, unbalanced Likert scales. Constructs were defined for planning 3D implant designs. Results: The preferred jaw angle had these characteristics: 130° in face profile view, intergonial width similar to facial width, vertical position in frontal view at the oral commissure or at least not below the lower lip, jawline slope in the face frontal view nearly parallel to (with a maximum 15° downward deviation from) a line extending from the lateral canthus to the alare, ascending ramus slope 65°-75° to the Frankfort horizontal, and curvature in the oblique view visible from earlobe to chin and not pointy. Conclusions: Photogrammetric analysis of panel preferences lead to constructs with values useful for the design of 3D printed jaw angles.

Constructs used in the study. a. Construct showing the intergonial width vs interzygomatic width. b. Construct showing the angle between the lower mandibular border and a line connecting the lateral canthus with the ipsilateral alare. c. Construct showing the level of bigonial plane in relation to the lips. d. Construct A shows the angle between the posterior border of the mandible and the Frankfort horizontal plane. Construct B shows the gonial angle, between the posterior and lower borders of the mandible. e. Relationship between the slope of the posterior border of the mandible and the slope of the forehead. f. Pointiness of the jaw angle, whether judged using the radius of a circle segment or the distance between the posterior end of the lower straight mandibular border contour and the lower end of the straight posterior border contour.

…

Question 1 e " Not considering the chin or cheek shadows, which is most appealing for a male model? " This question was used to sensitize the study participants. Shown are the percentage of respondents who considered the pictures to be the most appealing.

…

Question 2 e " A hypoplastic angle produces a concealed jaw (1 & 2). A jaw angle can be concealed by fat, sagging skin, and/or a beard, and this is not aesthetically pleasing. Do you agree? " This was also used as a sensitizing question. Overall, 74% of those who answered the question indicated that a concealed angle was not aesthetically pleasing.

…

Answers to question 3 regarding the aesthetics of bigonial width compared to bizygomatic width in the face frontal view: " Compared to the total facial width at the malar level, how do you score the lower jaw width at the jaw angle level? "

…

Answers to question 4 regarding the inclination of the lower border in the face frontal view: "Is the inclination of the lower border in the face front view too steep, neutral, or too flat?"

…

Figures - uploaded by Maurice Y Mommaerts

Content may be subject to copyright.

Content uploaded by Maurice Y Mommaerts

Content may be subject to copyright.

The ideal male jaw angle eAn Internet survey

Maurice Y. Mommaerts

European Face Centre, Universitair Ziekenhuis, Brussels, Belgium

article info

Article history:

Paper received 30 October 2015

Accepted 23 December 2015

Available online 21 January 2016

Keywords:

Jaw

Mandible

Aesthetics

Male

Data collection

abstract

Background: The ideal male jaw angle has not been established. With the advent of additive

manufacturing, precise customized shaping is a reality. This study aimed to deﬁne the ideal masculine

mandibular angle as an aid for 3-dimensional (3D) design.

Methods: An Internet survey was conducted using black/white photographs of celebrities and non-

celebrities. Preferences regarding gonial angle (proﬁle and frontal views), intergonial width and verti-

cal jaw angle position (face frontal view), and angle curvature and deﬁnition in oblique views were

obtained using simpliﬁed, unbalanced Likert scales. Constructs were deﬁned for planning 3D implant

designs.

Results: The preferred jaw angle had these characteristics: 130



in face proﬁle view, intergonial width

similar to facial width, vertical position in frontal view at the oral commissure or at least not below the

lower lip, jawline slope in the face frontal view nearly parallel to (with a maximum 15



downward

deviation from) a line extending from the lateral canthus to the alare, ascending ramus slope 65



e75



the Frankfort horizontal, and curvature in the oblique view visible from earlobe to chin and not pointy.

Conclusions: Photogrammetric analysis of panel preferences lead to constructs with values useful for the

design of 3D printed jaw angles.

reserved.

1. Introduction

Batides and Zide wrote in 2014,“Esthetically, a fuller,

augmented gonial angle portrays a look of masculinity, and a

‘stronger’jaw is often desired.”To underscore their statement, the

authors referred to articles published at least 12 years earlier

(Whitaker, 1989; Aiache, 1992). Indeed, no reports regarding the

aesthetic appraisal of the male jaw angle have been publishedsince

1994 (Ousterhout,1991; Whitaker, 1991; Taylor and Teenier, 1994).

The sparse articles published more recently regarding jaw angle

augmentation have emphasised implant shape (Terino, 1994;

Ramirez, 2000) and surgical complications (Semergidis et al.,

1996; Thomas and Yaremchuk, 2009).

The emergence of 3-dimensional (3D) printing based on

computed tomography (CT) and cone-beam CT segmentation al-

lows the design of patient-speciﬁc implants, but speciﬁcations

regarding the ideal jaw shape are clearly lacking. As noted by

Adrien Aiache in 1992, no cephalometric standards are available, so

surgeons must depend on the “ideal concept.”The ideal concept

according to Aiache (1992) is a jaw angle “well below the ear …,

long and low in proﬁle and less than 105



when measuring the

slope of the lower border and the ascending process. In front view,

the bigonial distance should be as wide as the bitemporal distance

…usually less than or equal to 10% less than the bizygomatic dis-

tance …”These guidelines are rather vague for use with contem-

porary computer-aided designs, which have a precision of 0.1 mm.

The aim of this study was to determine speciﬁcations that can

assist in designing ideal jaw angle patient-speciﬁc implants for

men. We performed a contemporary appraisal of the aesthetically

ideal male jaw angle and created constructs for use when guiding

the planning of implants.

2. Methods

An Internet survey was established at www.netq.nl to reach a

database of 770 consenting people. The database was based on the

author's professional and personal list of contacts. Study partici-

pants were recruited by email with a request to assist in completing

a survey regarding facial contours and deﬁnition. The survey was

*European Face Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit

Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium. Tel.: þ32 02 477 60 12.

E-mail address: maurice.mommaerts@uzbrussel.be.

Contents lists available at ScienceDirect

Journal of Cranio-Maxillo-Facial Surgery

journal homepage: www.jcmfs.com

http://dx.doi.org/10.1016/j.jcms.2015.12.012

Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391

available online during the entire month of May 2015. After

informed consent was obtained, the survey began with questions

about the participants' age, sex, and occupation (facial surgeon or

non-facial surgeon). These personal data remained anonymous.

In addition to the participants' personal data, the survey con-

tained nine questions, each based on a set of facial pictures. All

pictures used in the survey were non-copyrighted images obtained

from the Internet. They were modiﬁed (mainly cropped and con-

verted to black and white), and the eyes were covered when

necessary to reduce the likelihood of confounding relationships

between other facial features than aimed for. Many of the pictures

were images of celebrities, as they were the most readily available

pictures that demonstrated features appropriate for this study. The

pictures of celebrities were interspersed with pictures of non-

celebrities. The celebrities were Ben Afﬂeck, Brad Pitt, Colin

O'Donoghue, Colton Haynes, Dean Winchester, Hrithik Roshan,

Jensen Ackles, Liam Hemsworth, Matthew Bomer, Michael Fass-

binder, Richard Armitage, Tahmoh Penikett, and Tom Hiddleston.

Some individuals were included in more than one question (using

the same or another image) to distract the study participants.

Two initial questions were asked to sensitize the participants to

subsequent questions focussing on the mandible (questions 1 and

2). Further questions were posed to retrieve information about the

ideal intergonial width (question 3), ideal inclination of the jawline

in the face frontal view (question 4) and face proﬁle view (question

6), ideal vertical position of the gonial angle in the face frontal view

(question 5), relationship between the inclination of the forehead

and inclination of the posterior border of the mandible (question 7),

opinion regarding the angle and posterior border of the jaw when

the forehead is taken into account (question 8), and shape of the

mandible angle in the face oblique view (question 91aef). The re-

sponses for questions 3 to 8 were rated on a 3-item Likert scale,

Fig. 1. Constructs used in the study. a. Construct showing the intergonial width vs interzygomatic width. b. Construct showing the angle between the lower mandibular border and

a line connecting the lateral canthus with the ipsilateral alare. c. Construct showing the level of bigonial plane in relation to the lips. d. Construct A shows the angle between the

posterior border of the mandible and the Frankfort horizontal plane. Construct B shows the gonial angle, between the posterior and lower borders of the mandible. e. Relationship

between the slope of the posterior border of the mandible and the slope of the forehead. f. Pointiness of the jaw angle, whether judged using the radius of a circle segment or the

distance between the posterior end of the lower straight mandibular border contour and the lower end of the straight posterior border contour.

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391382

with items tailored toward the speciﬁc question (e.g., for question

3, the items were “too wide,”“good,”or “too narrow”).

Constructs were created to be used during 3D print planning of

patient-speciﬁc implants. The constructs are displayed in Fig. 1aef.

Ideal aesthetics for the male jaw were deﬁned by transposing the

survey results onto the constructs. Based on qualitative apprecia-

tion assessments and quantitative measurements with Image J, a

public domain, Java-based image processing program developed at

the United States National Institutes of Health, we developed a set

of guidelines for the ideal male jaw.

3. Results

A total of 770 persons were inclined to participate in the study.

Of these, 124 (16%) startedthe survey,115 continued it (82 males,33

females), and 81 (11%; 82 males, 33 females) completed the survey.

Fig. 2. Question 1 e“Not considering the chin or cheek shadows, which is most appealing for a male model?”This question was used to sensitize the study participants. Shown are

the percentage of respondents who considered the pictures to be the most appealing.

Fig. 3. Question 2 e“A hypoplastic angle produces a concealed jaw (1 &2). A jaw angle can be concealed by fat, sagging skin, and/or a beard, and this is not aesthetically pleasing.

Do you agree?”This was also used as a sensitizing question. Overall, 74% of those who answered the question indicated that a concealed angle was not aesthetically pleasing.

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391 383

For those who completed the survey, the mean completion time

was 11 min 15 s and the mean number of sessions was 1.3. Nearly

half of the respondents who completed the survey were facial

surgeons (48%). Overall, 29% of respondents who completed the

survey were younger than 40 years of age and 61% were between 40

and 60 years old.

Question 1, regarding which image was most appealing, was

answered by 114 study participants: 52% chose picture #1 and 36%

chose #5 (Fig. 2). A total of 108 responses were obtained for

question 2 regarding a concealed jaw angle, 74% of which indicated

that a concealed angle was not aesthetically pleasing (Fig. 3). Re-

sponses to question 3, comparing the intergonial width to the

Fig. 4. Answers to question 3 regarding the aesthetics of bigonial width compared to bizygomatic width in the face frontal view: “Compared to the total facial width at the malar

level, how do you score the lower jaw width at the jaw angle level?”

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391384

interzygomatic width, were obtained in 103 respondents, as shown

in Fig. 4. Question 4, about the ideal inclination of the jawline in the

face frontal view, was answered by 94 people, the results of which

are displayed in Fig. 5. The vertical position of the jaw angle in the

face frontal view (question 5) was assessed by 93 study

participants; these results are shown in Fig. 6. The inclination of the

lower jaw border in the face proﬁle view (question 6) was

answered by 89 participants (Fig. 7). Question 7, comparing the

slope of the posterior border and the slope of the forehead, was

answered by 84 people; their responses are shown in Fig. 7a and b.

Fig. 5. Answers to question 4 regarding the inclination of the lower border in the face frontal view: “Is the inclination of the lower border in the face front view too steep, neutral, or

too ﬂat?”

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391 385

Fig. 6. Answers to question 5 regarding the ideal vertical position of the jaw angle in the face frontal view: “Is the vertical position of the jaw angle too high, good, or too low?”

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391386

Fig. 7. Answers to question 6 regarding the inclination of the lower border in the face proﬁle view: “Is the inclination of the lower border in the face proﬁle view too ﬂat, good, or

too steep?”

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391 387

Fig. 8. Answers to questions 7 and 8 regarding comparisons between the posterior border of the mandible and forehead in the face proﬁle view and opinions regarding the jaw

angle and posterior border when recognizing the forehead as a possible confounding factor: 7.) “Compared to the forehead slope, is the posterior border of the lower jaw steeper,

parallel, or ﬂatter?”; 8.) “Now that you appreciate the relationship with the forehead, can you again indicate your opinion regarding the angle and posterior border of the jaw? Is it

nice, neutral, or ugly when taking the forehead into account?”

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391388

This assessment prepared the participants for question 8, in which

the forehead was noted as being a confounder in the judgement of

the inclination of the posterior border of the jaw; question 8 was

answered by 82 respondents (Fig. 8). Question 9 regarding the

shape of the angle judged in the face oblique view was answered by

81 participants, the responses of which are shown in Fig. 9.

Fig. 10 shows the set of guidelines we developed for the ideal

aesthetics of a male jaw angle, based on transposing our panel

survey results to our series of constructs.

4. Discussion

Designing the ideal jaw is not an easy task. Determining

aesthetic appreciation is preferably performed using panel studies

and Likert or visual analogue scales (Mees et al., 2013). In this study,

we used an Internet survey approach to create a panel of in-

dividuals who assessed the aesthetic characteristics of the ideal jaw

angle. However, it was not possible to use an assessment scale that

separated the jaw angle from the overall facial features of the

models, nor was it possible to use a completely balanced scoring

system. Hence, we decided to use photographs of many individuals

and to ask the panel to score each variable on a symmetrical, yet

unbalanced 3-item Likert scale. The scale was simpliﬁed from 7 to 3

grades, so the survey could be ﬁnished within a reasonable time

(15 min). This was important because the attention and focus of

respondents were found to be relatively low during a test run of the

survey. The low response rate is to be linked with the difﬁculty of

the task, which proved to be mentally exhausting according to the

feedback we received. This may also be the reason for the

decreasing response during the answering procedure. We used

because clinical studio pictures tend to obliterate facial deﬁnitions,

and although standardized (Ettorre et al., 2006), they do not

necessarily provide appealing images with strong characteristics.

Most of the pictures used in the study were images of celebrities.

Although we tried to reduce the possibility that they would be

recognized, this was likely not always successful and it may have

been a source of bias. Gender, age, and occupation of the partici-

pants were other potential confounding factors that could not be

excluded.

Additive manufacturing from a 3D-computer aided design can

create patient-speciﬁc jaw implants of titanium, tantalum, and

ceramic (Büttner and Mommaerts, 2015). The shape of the implants

can be liberally chosen to provide augmentation in a lateral, dorsal,

and/or caudal direction. This freedom in design poses an artistic

challenge. When facial symmetry constitutes the main indication,

then mirroring the healthy or most pleasing side solves the issue of

shape. When the wish is to enhance gonial deﬁnition bilaterally,

then the surgeon is faced with the issue of the deﬁnition of an ideal

customized shape. A jaw angle is by deﬁnition the angle within the

jaw. Izard (1927) cited normal angles of 120



e130



at 12 years of

age and 120



e150



in the elderly. Using Indian dry skulls, Upadhyay

et al. (2012) measured an average jaw angle of 129



(standard de-

viation 7.6



) in a group of 17e35 years old, with no signiﬁcant

differences observed between males and females. This ﬁnding was

conﬁrmed by Raustia and Salonen (1997), Ceylan et al. (1998), and

Al-Faleh (2008). The literature norm seems to be far from Aiache's

(1992) ideal of less than 105



, with a long and low mandible in the

facial proﬁle view. The panel in our study also chose a less angu-

lated ideal shape in the face proﬁle view, which more closely

approached the normal values. Lateral projection, however, co-

incides with Aiache's (1992) statement. In the face frontal view, the

ideal jaw angle should approach the face width, from zygion to

zygion.

Fig. 9. Answers to question 9 regarding the shape of the jaw angle in the face oblique

view: “What do think of the shape of these angles enice, neutral, or ugly?”

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391 389

The vertical position of the jaw angles and the slope of the

mandibular borders in the face frontal view often pose a dilemma.

The slope of the mandibular plane is determined by both the ver-

tical position of the jaw angle and the height of the chin. Chin

height is determined by the growth pattern and whether the face is

long or short; it can also be surgically altered. Height reduction of

the bony chin does not change the vertical position of the gonial

angle. In the current study, we found that the ideal vertical position

of the jaw angle was at the level of the oral commissure or lower lip.

The ability to change chin height by reduction chin osteotomy and

alter gonial position by shaping a 3D printed implant permits

correction of a long face either without, or as an adjunct to, a

bimaxillary procedure.

The radius of the gonial curvature is still an enigma. While many

patients seeking enhancement prefer pointiness, the survey indi-

cated that a wide curvature is preferred. Qualitative judgement

indicated that the mandibular border should cast a shadow

extending from the earlobe to the chin. A clear distinction between

the face and neck, with no fat or sagging tissue obliterating the

retromandibular fovea or interrupting the mandibular border,

projects a youthful appearance.

One can ask why a strong jaw angle is preferred for the modern

man. It may be an indicator of youthfulness and, hence, strength in

general. When teeth are present, muscular activity associated with

mastication maintains a constant angle magnitude. With the loss of

teeth, bone at the muscular attachments resorbs, leading to an

increase in jaw angulation. Casey and Emrich (1988), using ortho-

pantomograms, found that the mean size of the gonial angle was

126.3



for edentulous patients and 123.9



for those with teeth.

Similarly, Ohm and Silness (1999) found that the mean gonial angle

was 131



degrees for edentulous patients and 127



degrees for

partially dentate adults, and the angles were similar for men and

women. Although all existing studies indicate that the normal

gonial angle does not differ between sexes, males wishing

mandibular accentuation generally prefer more extreme features.

The study results will form the basis for a prospective study in

our male patients receiving jaw angle implants. Especially the

already predicted skewness of the individually desired deviation to

the now proposed ideals will be intriguing.

5. Conclusion

Using an Internet-based survey to conduct a panel study, we

found clear indications of the preferred characteristics of a male

jaw angle. These included a 130



gonial angle, intergonial width

similar to the facial width, vertical position of the angle at the level

of the lips, slope of the jawline in the face frontal view nearly

parallel to (with a maximum 15



downward deviation from) a line

extending from the lateral canthus to the ipsilateral alare, slope of

the posterior mandibular border 65



e75



to the Frankfort hori-

zontal, and a wide diameter curvature of the gonial angle in the

oblique view. This information will be helpful in generating 3D

print designs for men desiring mandibular aesthetic surgery.

References

Aiache AE: Mandibular angle implants. Aesthetic Plast Surg 16: 349e354,

1992

Al-Faleh W: Changes in the mandibular angle in the dentuouls and edentulous

Saudi population. Egypt Dent J 54: 2367e2375,2008

Bastidas N, Zide BM: The treachery of mandibular angle augmentation. Ann Plast

Surg 64: 4e6,2014

Büttner M, Mommaerts MY: Contemporary aesthetic management strategies for

deﬁcient jaw angles. PMFA News 2(4): 2e4,2015

Casey DM, Emrich LJ: Changes in the mandibular angle in the edentulous state.

J Prosthet Dent 59: 373e380, 1988

Ceylan C, Yanikoglu N, Yilmaz A, Ceylan Y: Changes in the mandibular angle in the

dentulous and edentulous states. J Prosthet Dent 80: 680e684, 1998

Ettorre G1, Weber M, Schaaf H, Lowry JC, Mommaerts MY, Howaldt HP: Standards

for digital photography in cranio-maxillo-facial surgery epart I: basic views

and guidelines. J Craniomaxillofac Surg 34: 65e73,2006

Izard G: The gonio-mandibular angle in dento-facial orthopedia. Int J Orthodontia

13: 57 8e583, 1927

Mees S, Jim

enez Bellinga R, Mommaerts MY, De Pauw G: Preferences of AP position

of the straight Caucasian facial proﬁle. J Craniomaxillofac Surg 41: 755e763,

2013

Ohm E, Silness J: Size of the mandibular jaw angle related to age, tooth retention

and gender. J Oral Rehabil 26: 883e891, 1999

Ousterhout DK: Mandibular angle augmentation and reduction. Clin Plast Surg 18:

153e161, 1991

Fig. 10. Guidelines generated using the constructs, qualitative survey results, and quantitative measurements. A. The ideal intergonial width in men is very close to the inter-

zygomatic width, whereas the normal width is up to 10% less than the interzygomatic distance. B. The inclination of the jawline in the face frontal view is parallel to (with a

maximum 15downward deviation from) a line extending from the lateral canthus to the ipsilateral alare. C. The jaw angle should ideally be at the height of the oral commissure in

the frontal view or at least no lower than the lower lip border. D. The gonial angle (formed by the jawline and posterior mandibular border) preferably measures 130. E. The angle

between the posterior mandibular border and Frankfort horizontal preferably measures 65e75. F. The relationship between the slope of the forehead and slope of the posterior

border of the mandible is more indicative of the forehead than the jawline. G. The jaw angle should demarcate the face well from the neck, without being too pointy.

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391390

Ramirez OM: Mandibular matrix implant system: a method to restore skeletal

support to the lower face. Plast Reconstr Surg 106: 176e189,2000

Raustia AM, Salonen MA: Gonial angle and condylar and ramus height of the

mandible in complete denture wearers ea panoramic radiograph study. J Oral

Rehabil 24: 512e526, 1997

Semergidis TG, Migliore SA, Sotereanos GC: Alloplastic augmentation of the

mandibular angle. J Oral Maxillofac Surg 54: 1417e1423, 1996

Taylor CO, Teenier TJ: Evaluation and augmentation of the mandibular angle region.

Facial Plast Surg Clin North Am 3: 329, 1994

Terino EO: Unique mandibular implants, including lateral and posterior angle im-

plants. Facial Plast Surg Clin North Am 2: 311e328, 1994

Thomas M, Yaremchuk MJ: Masseter muscle reattachment after mandibular angle

surgery. Aesthet Surg J 29: 472e476,2009

Upadhyay RB, Upadhyay J, Agrawal P, Rao NN: Analysis of gonial angle in relation to

age, gender, and dentition status by radiological and anthropometric methods.

J Forensic Dent Sci 4: 29e33,2012

Whitaker LA: Aesthetic contouring of the facial support system. Clin Plast Surg 16:

815e823, 1989

Whitaker LA: Aesthetic augmentation of the posterior mandible. Plast Reconstr

Surg 87: 268e275, 1991

M.Y. Mommaerts / Journal of Cranio-Maxillo-Facial Surgery 44 (2016) 381e391 391

Assessing Preferences of Facial Appearance in Transgender and Gender Nonbinary Patients

Article

Full-text available

Nov 2023

We designed a survey to evaluate preferences of facial appearance in transgender male (TM), transgender female (TF) and gender nonbinary patients to better inform goals of facial gender affirming surgery (FGAS) in gender nonbinary patients. TM/TF and nonbinary patients > 18 years old were identified via retrospective chart review and distributed an anonymized survey via email from October 3 to December 31, 2022. To assess facial preferences, AI-generated and open-source portraits were edited to create five image sets with a range of features from masculine to feminine for the forehead, mandible/chin and hairline. Data were analyzed using Fisher’s exact tests and ANOVA in R-Studio. Survey response rate was 32% (180 patients identified via chart review, 58 respondents; TM = 5, TF = 39, nonbinary = 14). TM and TF patients as well as TF and nonbinary patients had significantly different preferences for all regions (p < 0.005; all series), while TM and nonbinary patients did not (p => 0.05; all series). TF patients consistently selected 4s with neutral or more feminine features. TM and nonbinary patients, however, demonstrated no consistent preference for either male or female features but rather a range of responses spanning extremes of both masculine and feminine options. When stratified by sex assigned at birth, nonbinary patients consistently identified preferences opposite to their assigned gender. Gender nonbinary and TM patients appear to have uniquely individual preferences regarding facial appearance that do not fit into classically masculine or feminine patterns/phenotypes. As a result, we recommend individualized preoperative planning for FGAS to achieve the optimal result in these patient populations. 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.

Enhancements in Clinical Practice in the Contemporary Landscape of Male Facial Attractiveness

Article

Full-text available

Sep 2024

The concept of gender has evolved significantly in recent decades, moving from a binary status to a multiplicity of gender types. In today’s world, the new reality of the concept of masculinity, as defined socially and historically, must be recognized and accepted by aesthetic medicine. Consequently, aesthetic doctors will have to adapt the views and treatment plans that they propose in their consultations to the ideals of beauty, as well as with the roles, behaviors, and attributes considered masculine within their society. Each facial feature suggests a personality characteristic that represents that individual. This expert opinion article aims to assess Caucasian male gender-related anatomical facial features and achieve an expert agreement on the association of specific features with the perception of attractiveness, masculinity, and personality traits in order to cover the wide range of current male representations, as well as to provide orientation for clinical practice improvement in the contemporary landscape of facial masculinization.

ARTIGO ORIGINAL Estudo tomográfico das variações do ângulo mandibular em diferentes tipos de deformidades faciais no âmbito da harmonização orofacial

Article

Full-text available

Jun 2024

Genu PR, Laureano Filho JR, Vasconcel-los RJH. Tomographic study of mandib-ular angle variations in different types of facial deformities in the context of orofa-cial harmonization. J Braz Coll Oral Ma-xillofac Surg. 2024 Jan-Mar;10(1):71-85. » Os autores declaram não ter interesses associativos, comerciais, de propriedade ou financeiros, que representem conflito de inte-resse, nos produtos e companhias descritos nesse artigo. O(s) paciente(s) que aparece(m) no presente artigo autorizou(aram) previamen-te a publicação de suas fotografias faciais e intrabucais, e/ou radiografias. RESUMO Objetivo: Avaliar a variação do ângulo mandibular nas deformidades dentofa-ciais, através da tomografia computadorizada. Métodos: Estudo retrospectivo, onde foram examinadas tomografias computadorizadas pré-operatórias de pa-cientes submetidos à cirurgia ortognática. A altura vertical do ângulo mandibu-lar, distância bizigomática, distância intergonial e ângulo mandibular foram ana-lisados com o software Dolphin Imaging & Management Solutions. Os dados foram submetidos à análise estatística por meio de ANOVA com teste post-hoc de Bonferroni. Resultados: Foram incluídos 43 pacientes divididos em quatro grupos, de acordo com a deformidade dentofacial. Os grupos Face Longa e Padrão III obtiveram valores mais próximos, assim como os pacientes Padrão II com os pacientes Face Curta. Os pacientes Face Curta tiveram a menor mé-dia padrão dos grupos, enquanto os pacientes Face Longa tiveram as maiores médias. Os pacientes Padrão III e Face Longa obtiveram médias semelhan-tes em ambos os lados. Pacientes Face Curta apresentaram menor média de altura vertical do ângulo mandibular, enquanto pacientes Face Longa apre-sentaram médias mais altas. Pacientes Face Longa apresentaram maior pro-porção facial, quando comparada à diferença entre distâncias bizigomáticas e distâncias intergoniais. Conclusões: Esse estudo possibilitou a compreen-são das métricas dos ângulos mandibulares nas deformidades dentofaciais, o que pode auxiliar na avaliação clínica e prevenir resultados indesejáveis. Palavras-chave: Mandíbula. Cirurgia plástica. Tomografia.

Short-Term Outcomes of High-Density Porous Polyethylene Orthoses for Chin and Gonial Angle Augmentation

Article

Oct 2024

Unlabelled: The high-density porous polyethylene implants are used in chin and gonial angle augmentation surgeries. These implants are valued for their biocompatibility and ease of integration with tissues, particularly in correcting retrognathia and mandibular hypoplasia. The research aimed to detail the epidemiological profile, feasibility, outcomes, and complications associated with these procedures. Methodology: This retrospective observational study evaluated 100 patients over 18 years. Data on age, sex, aesthetic complaints, surgery types, and postoperative complications were collected and analyzed using the two-proportion z-test and descriptive statistics in RStudio 4.3.3. All patients with neuropraxia underwent neurosensory evaluation. Results: The average age was 35.92 years for males and 33.71 years for females, with a male predominance (76%). Aesthetic complaints were prevalent in 72% of patients (p < 0.01). Chin surgery was performed on 56% of patients, jaw angle surgery on 17%, and both on 39%. Complications included one case of suture dehiscence, three wound infections, and four transient cases of paresthesia, all resolving within 30 days. Overall, patient satisfaction with outcomes was high. Conclusion: High-density porous polyethylene implants proved effective and safe in enhancing facial aesthetics and correcting mandibular deformities. Further research should focus on long-term outcomes to consolidate these findings. 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 .

Mandibular Gender Dimorphism: The Utility of Artificial Intelligence and Statistical Shape Modeling in Skeletal Facial Analysis

Article

Aug 2024

In gender-affirming surgery, facial skeletal dimorphism is an important topic for every craniofacial surgeon. Few cephalometric studies have assessed this topic; however, they fall short to provide skeletal contour insights that direct surgical planning. Herein, we propose statistical shape modeling (SSM) as a novel tool for investigating mandibular dimorphism for young white individuals. A single-center, retrospective study was performed using computed tomography (CT) scans of white individuals, aged 20 to 39 years old. AI-assisted, three-dimensional (3D) mandibles were reconstructed in Materialise Mimics v25.0. We used SSM to generate average 3D models for both genders. Relevant manual anthropometric measurements were taken for the SSMs and individual mandibles. Contour disparities were then represented using 3D overlays and heatmaps. Statistical analyses were performed using unpaired student t testing or Wilcoxon signed rank testing with 95% confidence interval as deemed appropriate by population-level normality assessment. Ninety-eight patients (53 females, 45 males) were included. Male mandibles showed greater bigonial width, intercondylar width, ramus height, and body length [p<0.005]. There was no statistically significant difference in the gonial angle measurements [p=0.62]. All relevant manual individual measurements demonstrated excellent concordance to their SSM counterparts. The 3D overlays of SSMs revealed squarer male chins with more lateral but less anterior projection than their female counterparts. Also, the female mandibles showed smoother transition at the gonial angle. SSM provides a novel tool to objectively evaluate volumetric and contour dimorphisms between genders. Moreover, this method can be automated, allowing for expedited comparisons between populations of interest compared to manual assessment. 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. Bullet points about the importance of this work: Advancing Anthropometric Assessment: Statistical shape modeling (SSM) offers a cutting-edge approach to visualizing gender-specific skeletal anatomic differences for aesthetic and gender-affirming facial surgery. Expediting Comparative Analysis: The workflow established in this paper streamlines the evaluative process, enabling rapid morphologic comparisons between populations. Patient-Centered Care: This study establishes a foundation for the development of SSMs in individualized operative planning.

Hyaluronic Acid Filler VYC-25L for Jawline Restoration Yields High Satisfaction, Improved Jawline Measurements, and Sustained Effectiveness Across Skin Types, Age, and Gender for up to 12 Months

Article

Aug 2024

Background A randomized study was previously reported to demonstrate the safety and efficacy of hyaluronic acid filler VYC-25L for restoring jawline definition. Objectives Evaluate patient-reported outcomes (PROs), objective changes in jawline profile, and safety and effectiveness measures by Fitzpatrick Skin Phototype (FST), gender, and age following VYC-25L treatment. Methods Adults were randomized to receive VYC-25L (n=157) or no treatment (control; n=49) for 6 months. PROs were assessed by FACE-Q Satisfaction with Lower Face and Jawline, FACE-Q Appraisal of Lines: Marionette, and participant satisfaction with treatment questionnaires. Changes in jawline profile linear depth and volume were calculated using 3D digital image analysis. Responder rates, PROs, and injection site responses (ISRs) were assessed by FST, gender, and age. Results At month 6, >70% of treated participants responded “somewhat/very satisfied” to FACE-Q Satisfaction with Lower Face and Jawline questions, and ≥78% of treated participants responded “satisfied/definitely satisfied” with treatment overall. For participants treated in the marionette lines, the FACE-Q Appraisal of Lines: Marionette questionnaire mean score improved by 32.6 (baseline to month 6). Mean change in linear depth in the prejowl sulcus in the treatment vs control groups was 4.6 mm vs 2.5 mm, respectively, and for jawline volume was 6.0 cc and -2.6 cc, respectively, (baseline to month 6). Subanalyses showed similar outcomes by FST, gender, and age except for a numerically higher ISR incidence in females vs males. Conclusions Treatment with VYC-25L to improve jawline definition yielded high patient satisfaction, objective improvements in jawline profile, and comparable effectiveness across various demographics.

Jawline Aesthetic Definition: Enhancement with Masseteric Augmentation Using Ultrasound-Guided Fat Transfer

Article

Full-text available

Mar 2024

Background The rejuvenation and restoration of a well-defined jawline contour are crucial for enhancing facial aesthetics in both men and women. Within the jawline aesthetic unit (mandibular angle), the masseter muscle plays a significant role, as it is responsible for mandibular masticatory movements. We propose a new approach using ultrasound-guided intramuscular fat transfer to enhance the mandibular angle and jawline. Methods The multicenter study included 20 patients from three countries (Peru, Brazil, and Mexico). After fat harvesting, the ultrasound-guided masseteric fat transfer was performed with a 1.5-mm Viaro cannula from an incision beneath the ear lobule. The fat was then injected intramuscularly into the masseter at each side of the mandibular angle. Results Masseter ultrasound-guided fat transfer was performed on 10 men and 10 women between 2021 and 2022. The patients had a mean age of 34.4 ± 6.39 years and a mean body mass index of 22.39 ± 2.59 kg per m ² . The mean injected volume was 5.83 mL and 5.58 mL on the right and left sides, respectively. Muscle thickness increased in patients immediately postsurgery, but decreased after 1 month. The muscle remained significantly thicker on each side than the presurgery measurements in patients regardless of gender (both P < 0.0001). Conclusions Ultrasound-guided intramuscular fat transfer is a safe and reproducible technique for enhancing the jawline contour at the mandibular angle. We believe that it could be a more durable solution than other procedures, although further evaluation of long-term results is necessary.

Gender Affirming Facial Surgery–Anatomy and Procedures for Facial Masculinization

Article

Mar 2024
Oral Maxillofac Surg Clin

Analysis of Sexual Dimorphic Features of the Jawline and Chin in White Celebrity Faces

Article

Jan 2024
J CRANIOFAC SURG

Background The jawline greatly influences facial shape and contributes to facial dimorphism. Analysis of lower facial shape and sexual dimorphic differences in contemporary attractive white faces can advance the goals of lower facial aesthetics and facial gender–affirming surgery (FGAS). Methods Full-face, front-view photos of 47 white female and 21 white male celebrities were included from a list generated using GQ magazine’s Highest Paid Models issue, People Magazine’s Beautiful issue (1991–2022), and celebrities featured on lifestyle websites. Facial landmarks were detected through a facial analysis program using Vision framework and MATLAB. After converting pixel distances to absolute distances, lower face measurements were compared between males and females. Results The mean lower facial height was 6.08 cm in females and 7.00 cm in males ( P value<0.001). The mean bigonial width was 11.21 cm in females and 12.30 cm in males ( P value<0.001). The ratio of facial height to lower facial height was 2.98 in females and 2.76 in males ( P value<0.001), signifying that symmetry in facial thirds is more prevalent in attractive female faces, while a longer lower face is more common in attractive male faces. The greatest differences in female and male facial contours were at gonial angles and chin. Conclusions Analysis of contemporary white celebrity faces demonstrated significantly wider and longer lower facial measurements in males. The overall contour of the female lower face was more tapered at the gonial angles and chin compared to males. These results are important when planning lower facial rejuvenation or FGAS, as lower face size and proportions influence perceived gender and attractiveness.

REMODELAÇÃO DO TERÇO INFERIOR DA FACE UTILIZANDO A TÉCNICA OVAL QAM - ADAPTADA: UM RELATO DE CASOREMODELING OF THE LOWER THIRD OF THE FACE USING THE QAM OVAL TECHNIQUE – ADAPTED: A CASE REPORT

Article

Dec 2023

A procura por procedimentos estéticos cresce progressivamente devido ao fato de que o sorriso e a face têm função importante na vida das pessoas e de elevar a autoestima do indivíduo. Com o objetivo de melhorar a sua qualidade de vida e confiança, pessoas procuram por procedimentos estéticos que visam aperfeiçoar a aparência, uma vez que a imagem é o cartão de visita do indivíduo. Uma opção de tratamento pouco invasivo e reversível a ser oferecido ao paciente que busca uma compensação estética é o preenchimento com ácido hialurônico (AH). Este presente relato clínico tem por objetivo descrever o preenchimento do terço inferior da face utilizando 4 seringas de ácido hialurônico – Restylane Lyft para compensar perfil convexo da paciente e realçar suas características faciais utilizando uma adaptação da técnica- oval QAM, sendo essa, uma técnica de preenchimento para mulheres jovens, sem flacidez e com boa cobertura tecidual. O resultado foi satisfatório, com alteração do contorno e do perfil facial, correção volumétrica e melhoria na harmonia facial.

Analysis of gonial angle in relation to age, gender, and dentition status by radiological and anthropometric methods

Article

Full-text available

Mar 2012

With development and function, the mandibular angle has shown changes in size and shape. A variation in mandibular angle with age, gender, and even the dental status has been observed, which is supported by radiographic and anthropometric studies. The aim of this study were to evaluate relationship between complete loss of teeth and changes in the gonial angle; the study further intends to evaluate any variation in gonial angle with age and gender. The study intends to assess the reliability and accuracy of age and gender determination using gonial angle as a parameter. A total of 185 subjects (91 males; 89 females) were included in the study and were divided into five groups on the basis of the chronological age. Physico-forensic anthropometry and lateral cephalometric methods were used to record the gonial angle. The present study shows a definite decrease in the gonial angle with advancing age, but the intergroup analysis does not follow a significant pattern. The study showed no correlation of gonial angle with gender. However, the study observed a 6° increase in gonial angle for edentulous subjects. Gonial angle has been used as an adjuvant forensic parameter, but its reliability is questionable, as the mandible does not follow one characteristic pattern. Gonial angle does show changes with dentition status, which may be attributed to physiologic function of the mandible. However, when evidence is scanty, it can be used to direct the investigation.

Masseter Muscle Reattachment After Mandibular Angle Surgery

Article

Full-text available

Nov 2009
Aesthetic Surg J

Altering the dimensions of the mandibular angle by alloplastic augmentation or skeletal reduction requires elevation of the insertion of the masseter muscle, including the pterygomasseteric sling. Disruption of the pterygomasseteric sling during exposure of the inferior border of the mandible can cause the masseter muscle to retract superiorly, resulting in a loss of soft tissue volume over the angle of the mandible and a skeletonized appearance. Subsequent contraction of the masseter elevates the disinserted edge of the muscle and not only increases the skeletonized area, but also exaggerates the deficiency by causing a soft tissue bulge above it. The authors describe the disinsertion of the masseter and the resulting deformity as a potential complication of mandibular angle surgery and review the technique for repair. The records of 60 patients (44 primary, 16 secondary) who presented for alloplastic mandible augmentation between 2003 and 2008 were reviewed. Nine patients presented with clinical signs of disruption of the pterygomasseteric sling after mandibular angle surgery. Five patients had clinical signs consistent with complete disruption. Two of these patients requested reconstruction. The other four had signs consistent with partial disruption. Through a Risdon approach, the masseter was successfully reinserted using drill holes placed at the inferior border of the mandible. Masseter disinsertion is a previously unreported sequelae after aesthetic surgery for the angle of the mandible. The resultant static and dynamic contour deformity can be corrected by reattaching the muscle to the inferior border of the mandible.

Evaluation and Augmentation of The Mandibular Angle Region

Article

Aug 1994
Facial Plast Surg Clin

Unique Mandibular Implants, Including Lateral and Posterior Angle Implants

Article

Aug 1994
Facial Plast Surg Clin

Edward O. Terino

Mandibular angle implants

Article

Jun 1993
PLAST RECONSTR SURG

Changes in the mandibular angle in the dentuouls and edentulous Saudi population

Article

Jan 2008
Egypt Dent J

Wafaa Al-Faleh

The goniomandibular angle in dentofacial orthopedia

Article

Jan 1927

G IZARD

Preferences of AP position of the straight Caucasian facial profile

Article

Feb 2013

Introduction: Several investigators have compared the perception of profile attractiveness between professional and non-professional people, different groups of clinicians, and different ethnic groups. Our aim was to study preferences for facial protrusion in the lateral view for a straight Class I profile and to study the influence of gender, age, sex preference, and profession. Material and methods: Portrait images of one male and one female model with a Class I occlusal relationship were warped into nine different antero-posterior positions. An internet site was established to reach as many people as possible, and a request was sent by email to participate in a scientific experiment. Finally, 1707 Caucasion assessors could be grouped. Results: The preferred male profile is the straight full ante profile. For a feminine facial profile, the straight average and the straight 2/3 ante profiles were perceived as the most attractive. Surgeons tended to give significantly higher scores to attractive (ante) profiles, which correlated strongly with scores of the orthodontists. Conclusion: Whenever possible with combined orthodontic/surgery treatment, straight ante profiles should be aimed for.

The Treachery of Mandibular Angle Augmentation

Article

Jan 2010
ANN PLAS SURG

Patients who present for alloplastic jaw angle augmentation have 2 potentially troublesome choices. The use of a silicone implant can mean unpredictable motion, and if the lower pterygomasseteric sling is breached during implant placement, the masseter insertion will ride up without anything to which to adhere. When the patient bites down, a bulge will be present.The porous alternative even has a ledge made to go under the gonial angle, which if not removed, guarantees violation of the pterygomasseteric sling and an implant that is longer than the muscle can cover. The inferior muscle insertion is disrupted and is left to ride up serendipitously.This article presents 5 instances of these issues in which one case required a revision via a modified Risdon approach to access the uncovered material which stuck out beyond the high riding masseter.The basic aim of this article is to advocate the need to maintain the pterygomasseteric sling, and describe the consequences of the failure to do so.

Mandibular angle implants

Article

Feb 1992

Adrien E. Aiache

A new type of implant designed to increase the angle of the mandible in three dimensions is described. Made of silicone and shaped like a saddle, this implant makes the technique of implantation relatively simple, and its versatility makes it a desirable addition to the tools for skeletal framework reconstruction of the face. The satisfaction rate has been high and the complications easy to manage. The surgical technique consists of an intraoral incision and the development of a subperiosteal pocket at the mandibular angle area, often performed under local anesthesia.