aesthetic analysis of the face

8/12/2019 Aesthetic Analysis of the Face

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Soft tissue facial analysis


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Introduction

One of the primary goals of orthodontics is to

attain & preserve optimal facial attractiveness To achieve this orthodontist needs to carry out a

thorough facial examination so that orthodontic

correction of the malocclusion doesnt adverselyaffect facial traits

Bite correction doesnt always lead to

maintenance of facial harmony (contrary to

Angles beliefs)


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Introduction

Relying on cephalometric analyses can lead to

problems in terms of overall aesthetics Measurements are often made around the

cranial base. Since the position of nasion is

variable these measurements should be takenas a rough guide

Soft tissue appearance is only partly dependent

on underlying hard tissue. To predict soft tissue

response to hard tissue changes is difficult.


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Soft tissue predictability decreases as you

go down face Proffit values for soft tissue responses

Copy page 39 & 40 (deformities manual)good summary of soft tissue responses

following orthognathic surgery


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Outline

What is attractive

Important soft tissue measurements

Looking from the side Looking from the front

Arnette material if time. ?Dolphin planning


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What is attractive

For centuries, artists and physicians have

tried to quantify the ideal proportion of theface.

This concept of quantification is appealingto orthodontists because they want

guidelines for aesthetics


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What is attractive

Subjective.Beauty is altogether in the

eye of the beholder (Margaret Hungerford1878)

Listen to patients concerns It is a great error to try and put everyone in

the same aesthetic framework and an

even greater error to do this from hard

tissue relationships alone


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What is attractive

Love of averageness. We tend to plan

patients so that they become average.(Edler 2001)

Keating (1985) constructed Identi-kitcomposite portraits of male and female

faces, altering sizes of each component,

eyes, lips etc


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What is attractive: Keatings

findings

Female raters selectedmens faces that had

dominant, mature

features such as largejaws, small eyes, thin

lips


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What is attractive

Males preferred non-

dominant or neo-nataltype, large foreheads,

large wide set eyes,

small nose & chin & fulllips. Simulate nurturing

or caring instinct


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What is attractive

Most attractive females

had additionally some

mature features such as

prominent cheekbones

The combination of

mature with neonate

features may signal that

the female is at anoptimum age for mating


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What is attractive

Normal values are used to define

acceptable facial traits and to establish arange of values within which lies

acceptability

Norms should only be used as a guide.

They vary according to ethnicity of the

patient


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Facial Diagnosis


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Diagnosing skeletal pattern

All 3 planes considered:

1. AP2. Vertical

3. Transverse

Assess with patient in NHP and CR with lipsrelaxed


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Diagnosis

Start by looking at patient from side

Assess a-p relationship of jaws

Estimate FMPA

Look at nose, lips & chin

Then look at patient from front

Assess vertical dimension Look at nose, lips and chin

Look for asymmetries


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Posture important; NHP or photographic

position


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Zero meridian

Soft tissue perpendicularfrom Frankfurt plane

through soft tissue

nasion

Chin point should lie

near this line

Subnasale should be

approx 8mm infront of

this line


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Lip protrusion: Ricketts E Plane

Soft tissue pogonion to tip

of nose

-2 +/- 3mm. Upper lip

slightly further back thanlower lip. Ortho range = -5

to +1mm

?patient with large nose

+/- chin.

Consider growth


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Lip protrusion: Steiners S-line

This line extends from

chin to the middle of an

S formed by the lowerborder of the nose

Lips should lie approx

on this line


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AP: Nasolabial angle

NLA

The angle formed by the intersection of a line

originating at Subnasale tangent to the lowerborder of the nose and a line from Subnasale to

Labrale Superious

Approx 94-110


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NLA

Useful in evaluating AP position of the

maxilla Obtuse/increased angles generally

indicate retrusive maxilla. If lips slantbackwards, there is almost certainly

maxillary retrusion

Increased angles can be due to turned up

nose.


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NLA

This angle is greatly

affected byorthodontics

NLA increases by

1.6 for every mm ofupper incisor

retraction (Lo &

Hunter 1982)


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Nasal projection


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Upper lip curvature


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Anterior cheek convexity


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AP: Labiomental fold

The depth is measured at

right angles to Li Pg line=4mm (2-6)

A deep labio-mental fold canindicate strong muscle

activity

Lower incisors may be

retroclined. It is typically seen

in II/II malocclusions


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Labio-mental fold

Diagnosing hyperactive

mentalis function is

important in terms ofstability

In this case, the patient

has increased vertical

proportions but strong

mentalis activity iscausing retroclination of

the LLS


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Throat angle

Mean 93-107

Length = 56

56mm


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Reference plane: Sn

Origin of reference plane must be near the lower

1/3

rd

structures The point must not be affected with position or

size structure changes that take place in almost

all the traditional reference planes. Sn is therefore a useful reference plane. The

vertical should be dropped perpendicular to

THL. Canut, Epker, Arnette


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Sn reference line

118

103 62

60

6

-11

136

24

4

47

74

4

27

52

10

-9

-27

-32

-21

-15

17

-3

-5

-5-16

-27

-12-24

-32

22

151

5

-23

11

11

410

-6

29

19

7

-5

20

-8

46

-2

109

66

64

92

25

5

13

Mx1 to Mx Molar:

Md1 to Md Molar:

Md1 to Soft Pog:

32

32

42

96197

0


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Frontal view

Face can be divided

into 1/3rds

Proportions important


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Proportions

important not

actual

measurements

Normal range for

lower face

height to totalface height

ratio(measured

from glabella to

menton) is 53-56% (Epker)


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Studies differ, OK to quote these values


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High mid face

Shape of forehead

Symmetry eyebrows Inter pupillary width (63mm)

Outer canthal distance (98mm) Inner canthal distance (35mm)


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Mid face

Cheekbone symmetry/prominence

Symmetry of nose Alar base width (35mm)

See Arnette chart

L f


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Lower face

Look closely at lower face, very important inorthodontic & surgical planning

Lower face height (LFH) is measured fromSubnasale (Sn) to soft tissue Menton (Me)

71.9 +/- 6 M

65.5 +/- 4.5 F

L f h i h b di id d i 1/3 d


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Lower face height can be divided into 1/3rds

L f


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Lower face

Measure lip lengths

Upper lip height 19-22mm Lower lip height 42-48mm

19-22

42-48


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L f


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Lower face

Also measure:

Upper incisor show

at rest (2-5mm)

smiling 8mm crown to 2mm gingivae. F>M

Inter-labial gap 2-5mm

Lip competence. Gentle contact without strain

T h i i h


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Too much incisor show

VME

Short upper lip Everted upper lip

Hypermobile lip

(smiling)

Incompetent lips


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Incompetent lips

VME

Increased overjet Short/everted upper lip

Transverse


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Facial 5ths

Inter canthal width =alar base width

Look for asymmetries Vertical canting of

occlusal plane

Asymmetry


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Asymmetry

To check for maxillary

cant, use spatula

Can also measure to

pupil/lower eyelid

Vertical:transverse ratio


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Vertical:transverse ratio

Watch ratio


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Watch ratio


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Summary


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Summary

We need to acknowledge 2 things

1. Aesthetic considerations are paramountin planning appropriate orthodontic

treatment

2. Rigid rules cannot be applied to the

process

Summary


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Summary

First look at patient from side. Take

horizontal & vertical measurements.Measure naso-labial angle, lip protrusion,

depth of labio-mental fold, throat angle

and throat length, cheek bone prominence

Summary


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Summary

Then look at patient from front. Measurevertical dimension by looking at facial1/3rds

Take a closer look at LFH, measure upper

and lower lip lengthMeasure Incisor display at rest and onsmiling

Measure inter-labial gap and assesscompetency of lips

Summary


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Summary

All details

must be

accurately

recorded


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Cases


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Cases


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3 TC


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3. TC

Initialappearance


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Pre-op & post op


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SS

Start


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Movements?


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R.M.

Severe


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crowdingMandibular

retrognathia


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Start Ceph: 06/07/2000


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SNA = 78

SNB = 71.5

ANB = 6.5

UiMxP = 120/93.9

Li MnP = 96.5

MxMn = 23.5


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SNA = 77.4SNB = 71

ANB = 6.4

UiMx = 118

LiMn = 93

MxMn = 23.7


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SNA = 78SNB = 76

ANB = 2

UiMx = 116

LiMn = 93

MxMn = 23.9


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Pre-op Post-op


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With correct diagnosis and planning

& and a little help from our surgical friends


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aesthetic analysis of the face

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