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Ideal Soft Tissue Facial Profile in Iranian Males and Females: Clinical Implications

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Background: Proper pre-operative facial analysis that includes a thorough evaluation of both the bony and soft tissue anatomy is paramount to success in performing aesthetic surgery of the face. Ethnic variations in soft tissue profile add an important variable to pre-operative facial analysis. The aim of our study was to determine the role of ethnic variations in soft tissue facial profiles through profile analysis of Iranian male and female patients. Methods: Photographs of 100 Iranian males and 100 Iranian females (16 to 40 years old) were carried out. A review committee selected 10 male images and 10 female images, which they believed to be most ideal. The soft tissue profiles were then analyzed. A total of 21 measurements were analyzed and statistically compared with North American Caucasian males and females. Results: The upper lip projection and lower lip projection were significantly more prominent in Iranian males as compared with North American Caucasian males. In addition, Iranian males had longer face as compared with North American Caucasian males along with a more drooping nasal tip. The frontonasal area is straighter and the lower face is longer in Iranian females compared with North American Caucasian in addition to more convex faces along with a shorter upper face. Conclusion: Significant differences in ideal soft tissue profiles exist between Iranian and Caucasian males. These differences should be recognized as they may play an important role in performing facial aesthetic and reconstructive procedures, particularly rhinoplasty, genioplasty, midface/facelifts, lip augmentation, and maxillofacial surgery.
Soft tissue landmarks on facial profile. Soft tissue glabella (G'): most prominent or anterior point in the mid sagittal plane of the forehead. 7 Soft tissue nasion (N'): The most concave point of the tissue overlying the area of the frontonasal suture. 7 Pupil (P): The most anterior point in the midsagittal plane of the lens of the eye. 7 Pronasale (Pn): The most prominent or anterior point on the midsagittal profile of the nose. 8 Subnasale (SN): A point located at the junction between the lower border of the nose and the beginning of the upper lip at the mid sagittal plane. 7 Soft tissue A-Point (A'): The deepest point on the upper lip determined by a line joining SN with the upper vermilion border. 7 Upper vermilion border (UV): The point at which the upper lip tissue merges with vermilion tissue. Upper lip anterior (ULA): The most anterior point of the upper lip vermilion tissue. 9 Lip commissure (LC): The most lateral point in the transverse plane of the lips. 10 Stomion (St): The median point of the oral embrasure when the lips are closed. 9 Lower lip anterior (LLA): The most anterior point of the lower lip vermilion tissue. 9 Lower vermilion border (LV): The point at which the lower lip tissue merges with vermilion tissue. Soft tissue B-point (B'): the point at the deepest concavity between the lower vermilion border and the soft tissue pogonion. 7 Soft tissue pogonion (Pg'): The most prominent or anterior point of the soft tissue chin in the midsagittal plane. 7 Soft tissue menton (Me'): The most inferior point on the soft tissue chin. 7
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179
Ma et al.
www.wjps.ir /Vol.7/No.2/May 2018
Ideal Soft Tissue Facial Prole in Iranian Males and
Females: Clinical Implications
Amir Ali Ma1, Reza Shahverdiani2, Parviz Ma2*
A BS TR AC T
BAC KGROUN D
Proper pre-operative facial analysis that includes a thorough
evaluation of both the bony and soft tissue anatomy is paramount
to success in performing aesthetic surgery of the face. Ethnic
variations in soft tissue prole add an important variable to pre-
operative facial analysis. The aim of our study was to determine
the role of ethnic variations in soft tissue facial proles through
prole analysis of Iranian male and female patients.
METHODS
Photographs of 100 Iranian males and 100 Iranian females (16
to 40 years old) were carried out. A review committee selected
10 male images and 10 female images, which they believed to be
most ideal. The soft tissue proles were then analyzed. A total of
21 measurements were analyzed and statistically compared with
North American Caucasian males and females.
RESULTS
The upper lip projection and lower lip projection were signicantly
more prominent in Iranian males as compared with North
American Caucasian males. In addition, Iranian males had longer
face as compared with North American Caucasian males along
with a more drooping nasal tip. The frontonasal area is straighter
and the lower face is longer in Iranian females compared with
North American Caucasian in addition to more convex faces
along with a shorter upper face.
CONCLUSION
Signicant differences in ideal soft tissue proles exist between
Iranian and Caucasian males. These differences should be recognized
as they may play an important role in performing facial aesthetic
and reconstructive procedures, particularly rhinoplasty, genioplasty,
midface/facelifts, lip augmentation, and maxillofacial surgery.
KEY WORDS
Soft tissue; Facial prole; Caucasian; Aesthetic surgery
Please cite this paper as:
Ma AA, Shahverdiani R, Ma P. Ideal Soft Tissue Facial Prole in
Iranian Males and Females: Clinical Implications. World J Plast Surg
2018;7(2):17 9 -185.
INTRODUCTION
1. Clinical Research and Development
Center, Shahid Beheshti Universit y of
Medical Sciences, Tehran, Iran
2. Department of Plastic Surgery, Shah id
Beheshti University of Medical Science,
Tehran, Iran
*Corresponding Author:
Parviz Ma, MD, FACS;
Department of Plastic Surgery,
15th Khordad Hospital,
Shahid Beheshti University of Medical
Sciences,
South Aban Ave, Karim Khan Zand
Blvd, Tehran, Iran
Tel: +9 8-21- 889 02155
Fax: +98 -21-88909193
E-mail:
parvizma@yahoo.com
Received: May 11, 2017
Revised: March 20, 2018
Accepted: April 2, 2018
Original Article
Although the underlying skeleton denes the shape and size of
the face, the overlying soft tissue is as important as the skeleton
180 Soft tissue facial prole in Iranians
www.wjps.ir /Vol.7/No.2/May 2018
in facial appearance.1 Ideal facial proles have
been studied in medicine and art by Ricketts.2
Attention has also been given to details about
the morphological and proportional upper,
middle, and lower thirds of the face.3-6 The
frontonasal angle, columellar-lip angle, lip-
chin relationship, nose-chin-lip relationships,6
projection of the chin and maxilla in relation
to the facial plane have all been described as
important parameters when evaluating the face
for cosmetic procedures.3,5,6
In particular, rhinoplasty, genioplasty, and
lip augmentation procedures, require detailed
knowledge of the normative values of the specic
ethnic subgroup that is to be operated on. In
addition, the importance of proper, individual
pre-operative evaluation cannot be over-
emphasized. In order to properly treat congenital
or post-traumatic facial disgurements,
surgeons may benet from access to facial
prole databases for specic ethnic populations,
that are based on accurate anthropometric and
morphologic measurements.2 -19
Previously, a comparison of these databases
with the established norms of North American
Caucasians has offered a suitable way to select
a method for successful treatment.1 The purpose
of this study is to analyze and describe the ideal
aesthetic facial prole in Iranian males and
females. This prole analysis may assist plastic
surgeons who want to perform aesthetic and
reconstructive surgery on Iranian and Middle
Eastern faces and may help decrease the risk of
creating post-operative “racial incongruity”.
MATER IAL AND METHODS
This study was carried out on 200 photographs
of Iranian males (n=100) and females (n=100).
None of the study patients had noticeable facial
disgurements or trauma. The age of the subjects
ranged from 16 to 40 years and no signicant
differences were seen between male or female
age ranges. Each photograph was scanned, the
image was projected onto a computer monitor,
and computerized sketches were obtained based
on the photographs.
An independent review committee was
created that included the following: plastic
surgeon (n=12), sculptors (n=10), hair dressers
(n=12), artists (n=16) and randomly selected
individuals from the general population (n=15).
The review committee was compiled with the
premise that it would include those who are
considered experts on facial beauty, aesthetic
Fig. 1: Soft tissue landmarks on facial prole. Soft
tissue glabella (G’): most prominent or anterior
point in the mid sagittal plane of the forehead.7 Soft
tissue nasion (N’): The most concave point of the
tissue overlying the area of the frontonasal suture.7
Pupil (P): The most anterior point in the midsagittal
plane of the lens of the eye.7 Pronasale (Pn): The most
prominent or anterior point on the midsagittal prole
of the nose.8 Subnasale (SN): A point located at the
junction between the lower border of the nose and
the beginning of the upper lip at the mid sagittal
plane.7 Soft tissue A-Point (A’): The deepest point on
the upper lip determined by a line joining SN with
the upper vermilion border.7 Upper vermilion border
(UV): The point at which the upper lip tissue merges
with ver milion tissue. Upper lip anterior (ULA): The
most anterior point of the upper lip vermilion tissue.9
Lip commissure (LC): The most lateral point in the
tran sverse plane of the l ips.10 Stomion (St): The median
point of the oral embrasure when the lips are closed.9
Lower lip anterior (LLA): The most anterior point
of the lower lip vermilion tissue.9 Lower vermilion
border (LV): The point at which the lower lip tissue
merges with vermilion tissue. Soft tissue B-point
(B’): the point at the deepest concavity between the
lower vermilion border and the soft tissue pogonion.7
Soft tissue pogonion (Pg’): The most prominent or
anterior point of the soft tissue chin in the midsagittal
plane.7 Soft tissue menton (Me’): The most inferior
point on the soft tissue chin.7
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preference, and facial proportions. A selection
of the 20 most ideal computerized sketches (10
males and 10 females) was chosen and then
systematically analyzed using standardized
soft tissue prole measurements. The following
soft tissue landmarks were identiable on the
computerized sketches (Figure 1).
The soft tissue landmarks listed above were
measured with respect to each photographic-
derived sketch. Each prole was modied so that
the distance between the soft tissue nasion and
the subnasale (N’- Sn) was equivalent to 54 mm.
A total of 21 angular and linear measurements
were calculated (Figure 2 and 3). A standard
protractor and millimeter ruler were used for
all measurements. Angular measurements
were made to the nearest 0.5 degree and linear
measurements were taken to the nearest 0.5 mm
and the denitions for angular measurements on
soft tissue prole were as follows (Figure 2).
Frontonasal angle (FNA): Angle formed by
the intersection of lines drawn from soft tissue
glabella to nasion and from nasion tangent with
the superior surface of the nose.7 Nasal tip angle
(NTA): Angle formed by the inter section of a
line passing from nasion tangent to the superior
surface of the nasal tip and a line passing along
the greatest tangent of columella.8 Nasal base
Fig. 2: Angular measurements on soft tissue prole: a- FNA, NTA and NLA; b- ILA and LMA; c- LLP and ULP;
d- NBA; e- TFA. 1. Frontonasal angle (FNA).7 Nasal tip angle (NTA).8 Nasal ba se angle (N BA).8 Nasolabial angle
(NL A).8 Inter labial angle (ILA).6 Labiomental angle (LMA).8 Total facial angle (TFA).9 Upper Lip projection
(U LP).6 Lower lip projection (LLP).6
182 Soft tissue facial prole in Iranians
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angle (NBA): Angle formed by the inter section
of a line passing along the greatest tangent of
columella and a line passing from soft tissue
nasion to soft tissue pogonion.8 Nasolabial angle
(NLA): Angle formed by the intersection of
lines drawn from SN to the greatest tangent of
the columella of the nose and from SN to the
most anterior point on the upper lip.8 Inter labial
angle (ILA): Angle formed by the inter section
of lines drawn from A’ to UVB and from LVB
to the B’ point.6
Labiomental angle (LMA): Angle formed
by the intersection of lines drawn from LVB to
B’ and from B’ to Pg. Total facial angle (TFA):
Angle formed by the intersection of lines drawn
from soft tissue glabella to SN and from SN
to soft tissue pogonion.9 Upper Lip projection
(ULP): Angle formed by the intersection of lines
from Pg’ to nasion and from nasion to ULA.6
Lower lip projection (LLP): Angle formed by the
intersection of lines from nasion to Pg’ and from
nasion to LLA.6
The denitions for linear measurements were
as follows (Figure 3): Upper lip anterior (ULA)
to prole root vertical line (PRV) (pogonion to
glabella);2 Lo w e r l i p ant er i o r ( L LA) to PRV. UL A
to Stei n e r (S) li n e (pogon i o n to colu mella);11 LLA
to S-line; ULA to esthetic (E)-plane (pogonion
to pronasale);12 LLA to E-plane; Upper lip length
(UL): SN to St; Lower lip length (LL): St to B’;
Chin length (C): B’ to Me’; Upper facial height
(UF): P to Sn; Middle facial height (MF): Sn to
St; Lower facial height (LF): St to Me’.
Each angular and linear category was
measured ve times by the investigator, and was
blindly repeated by the co-investigator. All of the
measurements were averaged for a mean of each
category, which was then used as the value for
the study. Statistical analysis was performed on
each variable including the least, greatest, mean,
and standard deviation data-points. Student
unpaired t-test analysis was used to compare
these results from those of comparative studies in
the literature. The level of statistical signicance
was set at p-value equal to 0.05. The results of
our study were compared with the results of the
Farkas
17
and Sutter and Turley
18
study on North
American Caucasian males and females and
unpaired students t-test were used to determine
the differences between all of the groups.
Fig. 3: Linear measurement on soft tissue prole. a- Reference lines for measuring linear measurements: PRV
line, S-line and E-line; b- facial heights according to PRV line. Upper lip anterior (ULA) to prole root vertical
line (PRV) (pogonion to glabella);2 Lower lip anterior (LLA) to PRV. ULA to Steiner (S) line (pogonion to
colu mella);11 LLA to S-line; ULA to esthetic (E)-plane (pogonion to pronasale);12 LLA to E-plane; Upper lip
length (UL): SN to St; Lower lip length (LL): St to B’; Chin length (C): B’ to Me’; Upper facial height (UF): P to
Sn; Middle facial height (MF): Sn to St; Lower facial height (LF): St to Me’.
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RESULTS
The mean, ranges, and standards deviations for
all measurements are reported in Table 1 for
males and Table 2 for females. In Iranian males,
the NLA, ILA, and TFA all measured less than
North American Caucasians (p<0.05). On the
other hand, Iranian males ULP, LLP, ULA-E,
LLA-E, ULA-S, LLA-S, ULA-PRV, and LLA-
PRV all measured greater than North American
Table 1: Results in Iranian males and comparison to Caucasian males.
Variable MIN MAX MEAN SD p value
FNA 114 152 140.8±3.20 10.27 >0.05
NTA 60 94 75.6±3.39 11.52 >0.05
NBA 92 120 106.8±3.05 9.35 >0.05
NLA 80 118 97.7±3.23 10.46 <0.05
ILA 100 136 121.8±3.39 11.53 <0.05
LMA 118 144 132±3.05 9.36 >0.05
TFA 158 172 165±4.42 4.42 <0.05
ULP 511 7.3±1.37 1.88 <0.05
LLP 364.1±0.93 0.87 <0.05
ULA-E 2 7 4.4±1.19 1.42 <0.05
LLA-E 06 2.9±1.36 1.85 <0.05
ULA-S 0 4 1.4±1.12 1.26 <0.05
LLA-S -2 3 0.8±1.32 1.75 <0.05
ULA-PRV 6 11 8.9±1.28 1.66 <0.05
LLA-PRV 296±1.50 2.26 <0.05
UL 19 30 23.1±1.72 2.99 <0.05
LL 14 21 18.3±1.45 2.11 <0.05
C 25 39 32.5±2.10 4.45 <0.05
UF 44 52 46.9±1.50 2.28 <0.05
MF 19 30 23.1±1.41 1.99 <0.05
LF 42 57 50.8±2.21 4.91 <0.05
Table 2: Results in Iranian females and comparison to Caucasian females.
Variable MIN MAX MEAN SD p value
FNA 144 154 149.1±1.92 3.69 <0.05
NTA 62 91 74.1±3.1 10.2 >0.05
NBA 93 124 106.5±3.43 11.6 *
NLA 93 131 110.4±3.53 12.5 >0.05
ILA 98 144 123±3.75 14.1 >0.05
LMA 118 149 133.8±3.02 9.13 >0.05
TFA 151 170 161±2.24 5.03 <0.05
ULP 4 10 6.9±1.42 2.02 >0.05
LLP 0 7 3.8±1.46 2.14 >0.05
ULA-E -8 -1 -4.3±1.58 2.5 >0.05
LLA-E -8 2 -3.35±1.64 2.69 >0.05
ULA-S -5 1 -1.8±1.41 2 >0.05
LLA-S -6 3-1.6±1.56 2.46 >0.05
ULA-PRV 4 13 9.3±1.63 2.67 >0.05
LLA-PRV 0 10 6.05±1.64 2.71 >0.05
UL 19 23 20.9±1.13 1.29 >0.05
LL 12 23 16±1.90 3.62 >0.05
C 23 32 27.5±1.69 2.88 >0.05
UF 36 46 41.1±1.64 2.72 <0.05
MF 19 23 20.9±1.13 1.29 <0.05
LF 39 49 44.1±1.81 3.28 <0.05
*NBA value for Caucasian females was not available
184 Soft tissue facial prole in Iranians
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Caucasians (p<0.05).
Iranian males UL, LL, and C are less and UF,
MF and LF are greater than North American
Caucasians (p<0.05). Other measurements
including FNA, NTA, NBA, and LMA had no
signicant difference from the North American
Caucasians ( p>0.05). Iranian females, FNA,
MF, and LF are greater than North American
Caucasians, while TFA ands UF are less
prominent than North American Caucasians
(p<0.05). Other measurements including NTA,
NLA, ILA, LMA, ULP, LLP, ULA-E, LLA-E,
ULA-S, LLA-S, ULA-PRV, LLA-PRV, UL, LL,
and C had no signicant difference from the
North American Caucasians ( p>0.05).
DISCUSSION
Understanding ethnic variations in facial
skeletal and soft tissue morphology is important
in performing proper pre-operative facial
analysis and in formulating the aesthetic goals in
particular ethnic subgroups. While studies have
been carried out that demonstrate similar cross-
cultural aesthetic preference among various
ethnic groups, recognition of the morphological
differences that exist between various ethnic
groups plays an important role in the aesthetic
evaluation and treatment.11,12
In the current study, the linear and angular
facial measurements between Iranian and North
American Caucasian males and females were
carefully delineated. The upper lip projection
and lower lip projection was signicantly more
prominent in Iranian males as compared with
North American Caucasian males, because ULP,
LLP, LLA-E, ULA-E, ULA-S, LLA-S, ULA-
PRV, and LLA-PRV were greater in Iranian males.
Therefore, Iranian males have lips that are fuller
and more projected as compared with North
American Caucasian males. This may be important
in evaluating soft tissue distribution in the face and
lips, which may dictate the degree to which lip
augmentation or lifting should be carried out.
11,12
UF, MF, LF were greater in Iranian males
than North American Caucasian males, which
indicated that Iranian males have longer face
as compared with North American Caucasian
males, which is important in planning
orthognathic procedures and in balancing the
facial thirds, especially with regard to vertical
maxillary/mandibular osseous advancements
and set-backs.13 -17 NLA was greater in North
American Caucasian males as compared with
Iranian males suggesting that Iranian males
have a more drooping nasal tip compared with
North American Caucasian males.
The morphology of the nose in Middle
Easterners is a whole topic unto itself. However,
a plunging nasal tip (often hyperdynamic
due to depressor septi nasi muscle activity),
once corrected produces a dramatic change
in nasofacial balance. This will often require
depressor septi nasi muscle transaction/
transposition.20 Being sensitive to the prevailing
nasal morphology in ethnic subgroups such as
Iranians will help direct the surgeon to what is
most in need of change.
TFA was greater in North American
Caucasian males as compared with Iranian males,
and therefore, Iranians males demonstrate more
inclination in their general facial prole and have
more convexity in their faces than North Amer ican
Caucasian. This is important with regards to malar
augmentation and evaluating both pre-operatively
and intra-operatively, the magnitude of change in
facial soft tissue redirstribution/augmentation that
is required, without creating racial incongruity.
Other measurements including FNA, NTA,
NBA, and LMA showed no signicant difference
between Iranian males and North American
Caucasian males.
The frontonasal area is straighter and the
lower face is longer in Iranian females based on
a greater. FNA, MF and LF in Iranian females
compared with North American Caucasian
females while the TFA and UF were greater in
North American Caucasian females as compared
with Iranian females indicating that Iranian
females have more convex faces and the upper
face is shorter. Therefore, it may be important to
be especially sensitive to facial modications in
the vertical direction.
For instance, an osseous genioplasty that
increase vertical mandibular height should be
very conservative so that a discrepancy between
the upper, middle, and lower facial heights is
not exaggerated post-operatively. Other linear
and angular measurements in females did not
show signicant difference between our study
and North American Caucasian females. In
summary, the facial prole in Iranian females
was more similar to North American Caucasian
females than the facial prole of Iranian males as
compared to North American Caucasian males.
We believe that plastic surgeons must know the
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Ma et al.
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standards of beauty and the prole of the ideal
facial soft tissue of specic ethnic subgroups.
This familiarity will help guide the surgeon
in pre-operative planning and intra-operative
assessment of dynamic (“on-table”) changes that
occur, so that racial incongruity is not produced. It
is important, however, to stress that the treatment
plan should always be dictated by individual
assessment.6,15- 20 Ethnic morphological studies
such as the current paper serve as merely a guide
as to the normative values of a particular ethnic
population. The current study may assist the
plastic surgeon for better performance of facial
aesthetic and reconstructive surgery on Iranian
and Middle Eastern patients.
CONFLICT OF INTEREST
The authors declare no conict of interest.
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... In addition to orthodontic treatments, normal ethnic standards are also used in treatments in other fields, including nose and chin surgery, cosmetic lip injections, and other plastic surgeries (7). Commonly used standards are the result of cephalometric studies on the Caucasian race. ...
... Commonly used standards are the result of cephalometric studies on the Caucasian race. Recent studies conducted on different races such as Turkish, Arabic, Iranian, Bulgarian, Japanese, Chinese, Brazilian, Indian, and Pakistani have proved that there are significant differences in cephalometric norms between different ethnicities (1,(7)(8)(9)(10)(11)(12). These studies depict the importance of having cephalometric norms specific to each population more than ever. ...
... Studies have also shown that cephalometric features vary between genders and different age groups (14)(15)(16). Studies conducted on Iranian people in recent years have reported significant differences between Iranians and Caucasians (6,7,(17)(18)(19). However, in previous studies, the number of samples has been quite low (6,18) or studies have been limited to either soft or hard tissue examination and have not studied hard tissue along with soft tissue (15,17,20). ...
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... 16 variation. 17,18 This ultimately has clinical implications and should be considered not only for facial aesthetics, surgical and reconstructive procedures but, crucially, for orthodontic treatment planning. ...
... Perceptions of facial profile and dental aesthetic variations between patients and clinicians has been extensively researched. A study of 892 subjects (16)(17)(18)(19)(20)(21)(22)(23)(24) year-olds) by Yin et al, conducted in China, found that young adults perceived their facial profiles to be significantly more straight and dental appearances more attractive than orthodontists. 19 They also found a significant proportion of young female adults preferred a mildly convex facial profile (Class II skeletal pattern). ...
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The nature of beauty is one of the most imperishable and controversial themes in Western philosophy, and is a fundamental issue in philosophical aesthetics. Beauty has classically been counted among the ultimate values, with goodness, truth and justice. It is a primary theme among ancient Greek, Hellenistic and Medieval philosophers. The origins of clinical facial aesthetic analysis stem from the theoretical musings and introspection of pioneering artists and sculptors, stretching back to antiquity. The application of such analyses in clinical practice has been modified in accordance with changing cultural perceptions. Nonetheless, the work of the great artists and sculptors of past ages remains inherent in our ability to diagnose variations in facial appearance accurately. CPD/Clinical Relevance: Understanding the philosophical, artistic and clinical basis of facial harmony is essential to diagnose and treat dental patients in general, and orthodontic patients in particular.
... The findings revealed that the forehead length of Iranian women is significantly greater than that of American women. Additionally, the lower part of the face in Iranian women was observed to be taller compared to American women, aligning closely with the results of our study [19]. Similarly, we observed that the length of the forehead was significantly greater at higher ages. ...
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Introduction Anthropology is the scientific exploration of the human body morphology. The present study aims to establish the anthropometric norms among young Persian ethnic women and compare them with golden proportion, a mathematical formula in facial esthetics. Methods This cross‐sectional study was performed on Persian women between July 2020 and January 2021. Persian women were randomly selected based on the inclusion criteria of the study. Two standard photos were taken of each participant in profile and frontal angle, and then the anthropometric ratios were extracted and compared in different groups. Results Two hundred twenty‐five Persian women aged 20–50 years with an average age of 32.4 ± 7.09 were included. The golden ratio in Fars ethnicity was 1.79 ± 0.24. Forehead height I significantly increased with age (p value = 0.03). Philtrum length also showed a significant age‐related increase (p value = 0.001). Lower and upper lip heights increased with age (p value = 0.002). Our results revealed statistically significant differences in the mean labial fissure width among the three age groups (p value = 0.009). Lower vermilion height significantly decreased with increasing age (p value = 0.028). The mentolabial and nasal dorsum angles exhibited significant differences among the age groups (p value = 0.002). Furthermore, the jaw and chin angles were notably lower in the younger age groups (p value = 0.047 and 0.001, respectively). When comparing different ethnicities, the Turk ethnicity stood out as having a significantly higher chin angle. Conclusion In conclusion, the present study challenges the universality of the golden ratio, with Persian females demonstrating a closer adherence to a ratio of 1.75 and recommending a modified golden ratio for Middle Eastern. Our findings also highlight the importance of considering age‐related changes in cosmetic interventions, particularly lip and forehead dimensions.
... 34 The small amount of literature describing the anthropometry of people of Middle Eastern descent is focused on specific geographic regions and includes studies describing Iranian, Lebanese, Saudi Arabian, Egyptian, and Emirati anthropometry. [35][36][37][38][39][40][41][42] Understanding these variations is part of a wellrounded baseline knowledge, and personalized assessment for each patient is needed. Facial shape, convexity, and proportions are highly variable among Middle Easterners, and perceptions of these features can be shaped by the high degree of ethnic diversity exhibited by people with Middle Eastern heritage. ...
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Background Though in facial plastic surgery, the ideal nasal characteristics are defined by average European-American facial features known as neoclassical cannons, many ethnicities do not perceive these characteristics as suitable. Methods To investigate the preferences for nasofrontal angle, nasolabial angle, dorsal height, alar width, and nasal tip projection, manipulated pictures of one male and one female model were shown to 203 volunteer patients from a tertiary university hospital's facial plastic clinic. Results The most aesthetically preferred nasofrontal angles were 137.64 ± 4.20 degrees for males and 133.55 ± 4.53 degrees for females. Acute nasofrontal angles were more desirable in participants aged 25 to 44. The most preferred nasolabial angles were 107.56 ± 5.20 degrees and 98.92 ± 4.88 degrees, respectively. Volunteers aged 19 to 24 preferred more acute male nasolabial angles. A straight dorsum was the most desirable in both genders (0.03 ± 0.78 and 0.26 ± 0.75 mm, respectively). The ideal male and female alar widths were –0.51 ± 2.26 and –1.09 ± 2.18 mm, respectively. More 45- to 64-year-old volunteers preferred alar widths equal to intercanthal distance. The ideal female and male tip projections were 0.57 ± 0.01 and 0.56 ± 0.01, respectively. Conclusion Results indicate that the general Iranian patients prefer thinner female noses with wider nasofrontal angles for both genders. However, the ideal nasolabial angles, dorsal heights, and tip projections were consistent with the neoclassical cannons. Besides ethnic differences, the trend of nasal beauty is also affected by gender, age, and prior history of aesthetic surgery.
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A proportional analysis of the facial soft tissue profile in natural head position involving 11 indices(ratios), was applied to 80 Caucasian, and 80 Chinese male and female 12-year-old children in Hong Kong. The analysis is based on the true horizontal and the porion vertical, and has the advantage that its foundation lies on a more stable (less growth affected) region of the head compared to profile soft tissue landmarks. Measurements were made on cephalograms recorded in natural head position. Male subjects were larger than the females for most of the horizontal measurements, but for both population samples the vertical measurements displayed virtually no significant intersex differences at 12 years. No very significant intersex differences were found for the proportional indices. Ethnic differences were mainly found with the horizontal measurements. Relative to the porion vertical the Caucasian children were more protrusive over soft tissue nasion, nose tip, and sulcus labialis superior, whilst the Chinese displayed more protrusion over the lower lip and sulcus labialis inferior. Ethnic proportional differences relative to nasion were combined with a shorter porion-nasion distance in the Chinese as compared with the Caucasian children. The sella-nasion line was found to be more forwards-upwards inclined in Chinese than Caucasian children. It was concluded that a proportional soft tissue profile analysis, based on natural head position, is a useful method for the comparison of ethnic population groups. This study amplified ethnic differences previously reported by Cooke (1986) and Cooke and Wei (1989).
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This article expresses the view that the unexcelled beauty of the normal human face may be an end product of evolution. All of the values explained in this article, including the concept of divine proportion, can assist remarkably in the determination of dysplasia and in explaining to the patient where the faults lie. The author contends that the use of divine proportion in conjunction with the principles of maxillofacial surgery will lëad to greater success for all concerned.