The ideal male jaw angle eAn Internet survey
Maurice Y. Mommaerts
European Face Centre, Universitair Ziekenhuis, Brussels, Belgium
Paper received 30 October 2015
Accepted 23 December 2015
Available online 21 January 2016
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
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
deviation from) a line extending from the lateral canthus to the alare, ascending ramus slope 65
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.
©2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights
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.
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: email@example.com.
Contents lists available at ScienceDirect
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1010-5182/©2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
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.
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
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
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.
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
copyright-free pictures that were readily available on the Internet
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
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
at 12 years of
age and 120
in the elderly. Using Indian dry skulls, Upadhyay
et al. (2012) measured an average jaw angle of 129
) 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
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
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
for edentulous patients and 123.9
for those with teeth.
Similarly, Ohm and Silness (1999) found that the mean gonial angle
degrees for edentulous patients and 127
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.
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
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.
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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 15downward 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
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