IJO • VOL. 15 • NO. 1 • SPRING 2004 9

Feature

Abstract

T here is a universal standard for facial beauty regard-less of race, age, sex and other variables. Beautifulfaces have ideal facial proportion. Ideal proportion

is directly related to divine proportion, and that proportionis 1 to 1.618. All living organisms, including humans, aregenetically encoded to develop to this proportion becausethere are extreme esthetic and physiologic benefits. The vastmajority of us are not perfectly proportioned because ofenvironmental factors.

Establishment of a universal standard for facial beautywill significantly simplify the diagnosis and treatment offacial disharmonies and abnormalities. More important,treating to this standard will maximize facial esthetics, TMJhealth, psychologic and physiologic health, fertility, andquality of life.

IntroductionThis is a follow up of my facial beauty article published

in 1996.1 Many concepts presented in this paper may con-tradict certain mainstream thinking. Some may even becontroversial. These concepts are based on the author’s 20years of clinical observation and experience as well as find-ings from other researchers and clinicians. Wherever possi-ble, these concepts are supported by references; however,some concepts are so new that there are no studies or refer-ences currently available. It is not the intent of the author tocreate controversy. Hopefully this paper will cause many toseek out the truth, to reassess past concepts, and to critical-ly assess new concepts for the ultimate benefit of ourpatients. In time, the truth will become self-evident.

The following are concepts establishing the existence ofa universal standard for facial beauty based on the divineproportion and its biologic significance:1. There is a universal standard for facial beauty regard-

less of race, age, sex and other variables.2. Universal standard is based on divine proportion, and

divine proportion is universal and synonymous withbeauty.

3. All living organisms including humans are geneticallyencoded to develop and conform to the divine proportion.

4. Facial and body disproportions/abnormalities are due toenvironmental factors and significantly less to genetics.

5. Divinely proportioned faces and bodies are estheticallypleasing, healthy, fertile, and physiologically vigorous

6. The following biologic equation holds true for allhumans regardless of race, age, sex and other variables:

Divine proportion=facial beauty=TMJ health=psychologic health=physiologic harmony=fertility=

total health and wellness=Quality of Life©

Divine ProportionMore and more information is coming to light as to the

existence and the significance of the divine proportion. It isall encompassing and it affects living and non-living enti-ties. All living organisms are biologically engineered to con-form to this proportion. Man made items and structuresappear to be directed to conform to the divine proportion.Even more amazing, non-living, dynamic, entities conformto the divine proportion. Dynamic is defined as moving andis the opposite of static. Ripples of water, ocean waves, andtornadoes are few examples of dynamic, non-living entities.Note that divine proportion, golden proportion and Phi aresynonymous terms. The symbol 0I represents Phi, and Phiequals 1.618.

With his permission, Figure 1 shows a few examplesfrom Dr. Eddy Levin’s website, www.goldenmeangauge.co.uk,to show that divine proportion is everywhere. He uses a 3-pronged golden gauge to illustrate divine proportion. Theshorter distance of the end prong to the middle prong is 1,and the longer distance of the end prong to the middle prongis 1.618. Divine proportion is seen in art, architecture, fash-ion, birds, insects, and flowers, just to name a few.

There are possibly billions of examples of divine pro-portion within the human body. With his permission,Figure 2 shows a few examples from Mr. Gary Meisner’swebsite, www.goldennumber.net.

In Figure 2, the distance from longest fingertip to the wristis 1, and the distance from the wrist to the elbow is 1.618. Inthe bones of the finger, going from left to right, each succeed-ing finger bone is 1.618, the length of the previous finger bone.In the heartbeat, the EKG shows three peaks. The distance

Facial Beauty — Establishing a Universal Standard

This article has been peer reviewed.

By Yosh Jefferson, DMD

10 IJO • VOL. 15 • NO. 1 • SPRING 2004

from the first peak to thesecond peak is 1; the dis-tance from the second peakto the third peak is 1.618.

Non-living, dynamic,entities conform to thedivine proportion like thespiral of a galaxy as seenin Figure 2. The spiral ofa galaxy is based on theFibonacci numericalseries1,2,3,5,8,13,21, etc.Each number is derived byadding the two numberspreceding it. The spiral isconstructed by attaching a1-unit square to another 1-unit square, then attachinga 2-unit square, then a 3-unit square and so on andso forth. See Figure 3.Quarter-circle arcs aredrawn starting with the 1-unit square and connect-ing opposite corners ofthe squares (using thesides as the radii of thearcs) in such a way thatthe arcs connect sequen-tially. What develops is abeautiful spiral known asequiangular spiral or loga-rithmic spiral and can befound in plants and ani-mals such as seashells.2

As shown from thefew examples given, divineproportion is everywhereand all encompassing.Even the credit cards con-form to this proportion.There are many excellentbooks on this topic.3-5 Theintent here is to illustrate itsexistence and significance.Levin, in his 1978 article,6

explained its history andmathematics. More impor-tant to our profession, heexplains how this propor-tion relates to estheticallypleasing dentition andsmile. Mack7,8 discusses theimportance of treating the

Fig. 2 Divine proportion in the human body and even the galaxy.

Fig. 1 shows how the proportion 1 to 1.618 is everywhere in our lives.

IJO • VOL. 15 • NO. 1 • SPRING 2004 11

dentition to the face based on the divine proportion. Hewarns of potential problems in facial esthetics when onlymounted casts are used for diagnosis. He states that the lower1/3 of the face significantly influences facial appearance. Asproof, he sites the public’s preoccupation with fullness of thelips and the importance of a pleasing smile.

No major concepts are without contrary opinions.Preston9 disagreed with the relevance of divine proportionas did Moss et al10 who found that professional models didnot all conform to the divine proportion.

Divine proportion of the human body There is no greater example of illustrating divine pro-

portion of the human body than Leonardo DaVinci’s draw-ing, Human Figure in a circle, Illustrating Proportions,1485-90. See Figure 4.

Fig. 3 Series of connecting boxes based on the Fibonacci numerical series.Equiangular spiral based on the divine proportion.

Fig. 4 Human Figure in a circle, illustrating proportion.

Fig. 5 Divine proportion of the human face

Transverse proportion

External proportion

Vertical proportion

12 IJO • VOL. 15 • NO. 1 • SPRING 2004

Figure 4 illustrates the human body in perfect propor-tion. If the distance from the top of the head to the umbili-cus is 1, then the distance from the umbilicus to the toe is1.618. Also, if the distance from the right shoulder to thetip of the left finger is one, then the total height of thehuman body (head to toe) in an ideally proportioned adulthuman body is 1.618. These are just a few of possibly bil-lions of examples that could be found in the human body.Divinely proportioned individuals are attractive and tend tobe strong, physiologically healthy, and fertile. It would beinteresting to study the proportions of Olympic athletescompared to the general population.

More relevant to the dental profession as well as themedical profession (such as plastic surgeons) is the divineproportions of the human face.

The adult human face must also conform to the divineproportion in order for it to be beautiful and biologically

efficient. Figure 5 shows some of the vertical relationshipsof the face. For example, if the distance from LN (lateralside of the nose) to ME (soft tissue menton) is 1, then thedistance from LN to TRI (Trichion-beginning of foreheadwrinkling when one lifts the eyebrow) is 1.618. Also, if thedistance from CH (Cheilion-corner of the mouth) to ME is1, then the distance from LC (lateral canthus of the eyes) toCH is 1.618.

Figure 5 shows a few transverse relationships of theface that must conform to the divine proportion. For exam-ple, if the distance between LN is 1, then the distancebetween CH is 1.618. The distance between LC is (1.618),2

and the distance between the temporal soft tissues of thelevel of the eyebrow is (1.618)3 or 4.236.

Figure 5 shows that the external dimension of the adulthead must also conform to the divine proportion. Ideally, ifthe distance from LCHK (lateral border of the cheeks) is 1,then the distance from TH (top of the head) to ME (soft tissuementon) should be 1.618. Figure 6 shows the reality of thetheory just proposed. It shows faces of two beautiful womenwhose external configuration is divinely proportioned.

As seen in Figure 7, if the face from TH to ME isgreater than 1.618, the faces will be dolichofacial and have atendency toward long face syndrome. If the distance fromTH to ME is less than 1.618, the faces will be brachyfacialand have a tendency toward a short face syndrome. Both willhave esthetic problems as well as greater chance for medicalproblems. For instance,patients with long face syn-drome tend to have a greaterincidence of upper airwayobstruction and mouthbreathing. Patients with shortface syndrome tend to have agreater incidence of craniofa-cial pain and migraineheadaches. If TH to ME isequal to 1.618, the faces willbe mesofacial and will be ide-ally proportioned. These faces will be esthetically pleasingand will have significantly less incidence of medical prob-lems. In the frontal view, the universal standard for beauty isthe mesofacial face.

There is also a universal standard for facial beauty inthe profile view. Figure 8 illustrates 6 different types of pro-files A through F. Profile A is a long face with a retrognath-ic mandible; profile B is a short face with a retrognathicmandible; profile C is a short face with a prognathicmandible; and profile D is a long face with a prognathicmandible. Profile E is a normal vertical with a flat profile,and profile F is fuller profile and is universally accepted asbeing the most beautiful. The profile most universallyaccepted as being beautiful is a fuller profile. This was truein 1970 when Peck and Peck12 did their research. They stat-Fig. 8 Various types of facial profile. Only one is considered the most beautiful.

Fig. 9 Divine proportion of the facialprofile. Courtesy of Gary Meisner.

Fig. 6 Two beautiful faces showing divine proportion of external configura-tion. Second photograph by Francesca Sorrenti. Permission to use photo-graph by Mademoiselle Magazine.

Fig. 7 Three different types of faces, long, short, and ideal.

IJO • VOL. 15 • NO. 1 • SPRING 2004 13

ed, “...one interesting tendency was apparent from the data.The sample means almost always favored a fuller, moreprotrusive dento-facial pattern than our cephalometric stan-dards would have liked to present.” This finding was alsosupported by Auger and Turley13 in 1999 and Nguyen andTurley14 in 1998.

It must be emphasized that no one segment of thehuman population has a monopoly on any of the variousprofiles shown. The classically beautiful profile F can befound in every sex, age, and race. My clinical observationshave shown that there are multitude of medical problemsassociated with disharmonious profiles A through E, andsignificantly less medical problems associated with the beau-tiful profile F. Beautiful profile is determined by divine pro-portion. See Figure 9.

Often, many orthodontic practitioners feel that facialbeauty is racially and culturally influenced.15-22 However,many current studies have shown the universality of facialbeauty. For instance, there is a high degree of agreementamong examiners when assessing facial attractiveness fromphotographs.23-25 A number of recent cross-culturalresearchers have shown that the bases for judging facialattractiveness were consistent across cultural lines.26-33 They

showed that racially and ethnically diverse faces possess simi-lar facial features that were deemed desirable and attractiveregardless of the racial and cultural background of the per-ceiver. This cannot be better illustrated than in Figure 10. Atfirst glance, you will observe four beautiful women of variousraces with ideal facial proportions. In actuality, all four facesare of the same person (the face on the lower right) withmakeup and wig. We must stop looking at superficial differ-ences such as skin color and hair texture, and start looking atsimilarities that make us one race—the human race.

There is much debate as to the importance of establish-ing different standards to different races. It is true that eachrace has certain characteristics. It is also true that differentfamily members of the same race have different characteris-tics. These differences should be considered “variations.”When considering all of human biology, physiology, andgenetics, these differences are so insignificant that theyshould be considered normal. On the other hand, facialdisharmonies such as long face syndrome, short face syn-drome, skeletal II’s and III’s, facial asymmetries, and othercraniofacial disharmonies have esthetic and physiologicproblems; they should be considered abnormal and they allshould be diagnosed and treated if necessary.

Relationship between beauty and healthRicketts34 discusses in great detail the importance of the

divine proportion to beauty and its biologic significance. Hestates that the appreciation of beauty in humans functions atthe limbic level. In other words, individuals of all ages areattracted to beauty; it is a primeval attraction that has itsbasis in survival. He also states that organisms, includinghumans that conform to the divine proportion, are not onlybeautiful, but also biologically healthy. He states, “Biologistsand morphologists speak of this in terms of ‘laws.’ There isthe first the ‘law’ of conservation of energy—maximum per-formance with minimum effort. Second, they refer to the‘law of conservation of tissue’—minimum amount of mate-rial to be employed to perform the needed task. A thirdlaw...is a combination of the first two. It is an arrangement toprovide profound efficiency. Efficiency is required for indi-vidual survival.” My own clinical observations have shownthat beautiful faces have less medical problems such as cran-iofacial pain and headaches than faces that are disharmo-nious and unattractive. As faces deviate further away fromthe divine proportion, there tends to be greater incidence ofmedical problems in number and magnitude.

The position of underlying bone has a direct effect onthe health of TM joints and physiologic harmony. As statedearlier, patients who are dolichofacial (long face syndrome)tend to have upper airway obstructions.35-37 Patients who arebrachyfacial (short face syndrome) tend to have myofascialpain and temporomandibular disorder.38-40 Both problemsare associated with a multitude of other medical problemsincluding irritability, lowering of the immune system, lack

Fig. 10 Beautiful faces of different races. Illustration from New WomanMagazine. Makeup by Paddy Crofton, Photograph Courtesy by Todd Eberle,photographer.

14 IJO • VOL. 15 • NO. 1 • SPRING 2004

of delta phase sleep, etc. These observations support thevarious biologic laws discussed earlier, such as conservationof energy and conservation of tissue.

Many researchers including Thornhill and Gangestad41

and others42-43 discuss the importance of bilateral symmetryto physical beauty, health, and sexual attraction in humansand animals. Most interestingly, Rikowski and Grammer44

found direct correlation to human body odor, symmetry andattractiveness. This study supports the possibility of humanpheromones in sexual attraction. In light of this, it must beemphasized that bilateral symmetry is a small part or subsetof divine proportion. If an individual is not bilaterally sym-metrical, then that individual is not divinely proportioned.

A perfectly symmetrical face does not always correlateto a beautiful face; however, a divinely proportioned facewill always be beautiful.

Some practitioners use the term “neuromuscular” posi-tion in describing ideal mandibular position. To the vastmajority of health practitioners, this term is not well under-stood. It also places too much emphasis on the nervous andthe muscular system. In order to maximize health, everyaspect of the human body should be in ideal position. Thisincludes, but is not limited to, nervous, muscular, circulato-ry, endocrine, respiratory, digestive, immune, reproductive,skeletal, cerebral-spinal, joints, sutures, ligaments, etc.Additionally, all the organs, including the brain, must bepositioned and confined to ideal space in order to functionmaximally and efficiently. In order to accommodate allthese biologic and physiologic factors, a more appropriateterm is ideal “physiologic” position.

Impact of environment to facial abnormalities

There is much debate as to whether facial abnormali-ties are caused by genetics or environmental factors. Manydoctors and researchers believe that abnormalities such aslong faces, short faces, skeletal II’s and III’s, small, narrowpalates, and others are strictly due to genetics while othersbelieve it is environmental. Perhaps both are right and theymay be due to both genetics and environmental factors.However, we as healthcare practitioners must make a firmdecision as to which of the two factors predominate.

It is my contention, based on clinical observation aswell as other research literatures, that facial “variations” aregenetically induced. Facial “abnormalities” are environ-mentally induced with possibly a small genetic component.Studies by respected researchers bear this out. Linder-Aronson and Woodside45 studied frontal and lateral headfilms of 22 out of 120 males who had excessive lower verti-cal height. They noted that the mean size of the airwaythrough the nose and/or nasopharynx was narrower thanthe control group. In essence, individuals with long facesyndrome had upper airway obstruction and tended to bemouth breathers. They implied that some facial features

previously thought to be genetic in origin may also be influ-enced by environmental factors. Linder-Aronson46 alsonoted monozygotic twins in which only the twin with nasalobstruction developed long face syndrome.

Respiratory characteristics can influence facial growthpattern. Studies by Linder-Aronson,47 Subtelny,48 Ricketts,49

Quinn,50 Principato et al51 and Cheng et al,52 and others haveimplicated nasal airway obstruction and mouth breathing asthe likely cause of long face syndrome. Zettergren-Wijk etal53 studied the effects of surgical removal of swollen tonsilsin children, mean age 5.7 years, on dentition and facial mor-phology. They found normalization of facial disharmonyafter surgery, but most of the changes occurred in the firstyear after surgical removal of tonsils and/or adenoids.

Marks54 blames modern diet for creating much of theallergic problems in humans. He states that cow’s milk in theneonatal period may sensitize the nasal mucous membraneto persistent edema and consequent nasal airway obstruction.Taylor55 describes this nasal vasomotor reaction in greaterdetail. Human and animal studies have shown that whenforced to breathe orally rather than nasally, vastly differentmyofunctional habits and jaw position are necessary toaccommodate this different method of breathing.49, 56-59 It isthought that nasal airway obstruction leads to mouth breath-ing, lowered tongue posture, decreased swallowing pattern,supereruption of posterior teeth, and open mandibular posi-tion.60 If this abnormal breathing function continues duringactive growth, then narrowing of the maxillary dental archmay occur as well as increased lower facial height.61

Inductive reasoning clearly points to environmental fac-tors as the major cause of facial abnormalities. Why werethere almost no dental malocclusion and facial abnormali-ties in primitive societies and an abundance of these prob-lems in modern society? Price62 made it his life’s workstudying the nutritional problems of modern diet. Aroundthe world, he evaluated local villages that maintained theirnatural diet with comparable villages that consumed mod-ern food, and the differencein physical development andhealth were staggering.Those villages that main-tained natural diet hadbroader faces, broader dentalarches, with significantly lessdental caries and periodon-tal disease than those thatate modern diet. There werealso significant differences inthe body types. Those thatate natural diet had stronger,broader bodies than thosethat ate modern diet.

Practitioners whobelieve that facial abnormal-

Fig 11. Frontal beauty mask based onthe divine proportion. Beauty maskis copyrighted by Stephen Marquardt.

IJO • VOL. 15 • NO. 1 • SPRING 2004 15

ities are genetic in origin feel that the size of the jaws can-not be changed. They tend to treat crowded dentitions byextracting bicuspids. Those who believe that abnormalitiesare caused by environmental factors tend to treat crowdeddentitions by expanding the dental arches. Many argue thatdoctors who expand arches are violating the genetic make-up of their patients and that these treatments will relapse. Ithas been shown by Little et al63, 64 that first premolar extrac-tion treatments also have a high relapse rate. After 10 years,70 per cent of premolar extraction cases relapsed; after 20years, 90 per cent relapsed. Expansion cases also have prob-lems with relapse as shown from studies by Schwarze.65 This

is a dilemma for orthodontic practitioners. However, proper dietand alleviation of upper airway obstruction may be the keyto preventing facial abnormalities in young children andproviding stability after orthodontic therapy.

Divine proportion: soft tissue analysisMarquardt developed a soft tissue analysis based on the

divine proportion.66 He has a lateral (repose) and a frontalbeauty mask based on the divine proportion, more specifi-

Fig. 12 Beauty mask analysis on an average face and significantly unattrac-tive face. Illustration, courtesy of Stephen Marquardt.

Beautiul Caucasian woman

Beautiul Asian woman

Beautiul Black woman

Timeless beauty of Nefertiti

© www.ryanstoney.com

© www.ryanstoney.com

© www.ryanstoney.com

Fig. 13 (right column) Faces that conform to beauty mask are beautifulregardlless of race, age, sex, era, and other variables. There is a male ver-sion of beauty mask for males.

16 IJO • VOL. 15 • NO. 1 • SPRING 2004

cally the golden decagon. Figure 11 only shows the frontalbeauty mask. He goes into greater detail on his website:www.beautyanalysis.com.

The mask can be superimposed over properly posi-tioned and properly sized facial photographs to assessesthetic problems. If the face falls in line close to the beauty

mask, then the face will be esthetically pleasing. The facewill become more and more unattractive as the facial shapeand structures move away from the divine proportion. SeeFigure 12. In this illustration, the beauty mask shows thatthe face on the top is not too far off from the divine propor-tion and is average in attractiveness. On the other hand, thebeauty mask shows the face on the bottom is significantlyoff and is very unattractive.

Marquardt believes that facial beauty is universal. If theadult face conforms to the beauty mask, then that face willbe beautiful regardless of sex and race. See Figure 13.There are three faces of different races, Caucasian, Asian,and Black. All are beautiful and all conform closely to thedivine proportion. Beauty is also timeless as can be seen inthe lower right in figure 13. Nefertiti (around 1350 B.C.)was famed throughout the ancient world for her outstand-ing beauty. She conforms to the divine proportion as shownby the beauty mask. It is interesting to note that Dr.Marquardt, who is on the west coast, has been studyingfacial beauty for 30 years. This author, who is on the eastcoast, has been studying the same for 20 years. Both inde-pendently came to the same conclusion that there is a uni-versal standard for facial beauty.

Divine proportion: hard tissue analysisAn excellent hard tissue analysis for evaluating lateral

profiles is the Jefferson Analysis.© It was known earlier asModified Sassouni Analysis© or Skeletal Archial Analysis.©

Previously published articles clearly explain its tracing tech-nique, diagnosis, and skeletal classification system. 1, 67, 68

The Jefferson Analysis treats patients to beautiful faces,healthy TM joints, and physiologic health. It is based onthe divine proportion since in almost every instance facesare made more beautiful when treated to this analysis.Credit should be given to Dr. Vikan Sassouni sinceJefferson analysis is a modified, simplified, and muchabbreviated version of the Sassouni Archial Analysis.69, 70

Figure 14 shows a female face with nearly ideal facialproportion and profile. She was 21-year 3-months when thisphoto was taken and her case was reported in 1993.71 Thecephalometric tracing of this individual uses the Jeffersonanalysis. This analysis assesses the antero-posterior position ofthe maxilla and the mandible and assesses lower facial verti-cal height. The diagnostic interpretation is visual and simple.

In an ideal face in both children and adults, the anteri-or tip of the maxilla, anterior-nasal spine (ANS), and ante-rior portion of the mandible, pogonion (P), should be with-in 2 mm of the anterior arc. Assessment of lower facial ver-tical height is simple. In an adult face 18 years old andolder, menton (M) should be within 2 mm of the age 18vertical arc. At age 4, menton should be within 2 mm ofthe age 4 vertical arc. From age 4 to age 18, menton growsdownward at a rate of 3/4 mm (.75 mm) per year. Theanalysis shows that this individual’s maxilla and mandibleFig. 15 Jefferson Skeletal Classification System©

Fig. 14 Female face nearly ideal. Jefferson analysis showing ideal skeletalposition.

IJO • VOL. 15 • NO. 1 • SPRING 2004 17

are almost perfectly positioned, both antero-posterioralyand vertically. It is extremely rare to find individuals withsuch nearly perfect alignment. As expected, she had nosymptoms of TMD or craniofacial pain.

Jefferson Skeletal Classification© should be used in con-junction with the Jefferson analysis.1, 67, 68 The classificationsystem proposed by this author is simple, easy to under-stand, and practical. See Figure 15.

There are 9 skeletal types: I, IIA, IIB, IIC, IIIA, IIIB,IIIC, BR and BP. Each has an upper and a lower arrowpointing to an arc. The upper arrow represents the maxillaand the lower arrow represents the mandible. The tip of theupper arrow represents ANS; the tip of the lower arrowrepresents P. The arc in front of the arrows represents ante-rior arc. Skeletal I shows the tips of both arrows touchingthe anterior arc. This means that the maxilla and themandible are both in ideal A-P position. The individual inFigure 14 and her ceph analysis shows her to be Skeletal I.

The rest of the skeletal types represent skeletal prob-lems. For example, Skeletal IIA represents the maxilla

being prognathic and the mandible in ideal A-P position.Skeletal IIB represents the maxilla in ideal A-P position andthe mandible being retrognathic. Skeletal IIC is combina-tion problem. It represents the maxilla being prognathicand the mandible being retrognathic. Skeletal III’s are justthe reverse of Skeletal II’s. BR (bi-skeletal retrognathic) rep-resents both maxilla and mandible being retrognathic.Finally, BP (bi-skeletal prognathic) represents both maxillaand mandible being prognathic. Along with the skeletalclassification, the lower facial vertical height (short, normal,or long) must be noted.

The following cases show how the Jefferson analysisand classification are used.

Case 1 in Figure 16 shows a face with facial disharmo-ny. Her ceph analysis shows normal maxillary A-P posi-tion; however, her mandible is prognathic. Her lower facialvertical is short by approximately 19mm. Her classificationis Skeletal IIIB, short.

Note, this is a pseudo Skeletal III. If her vertical wascorrected, her mandible would rotate clockwise and pogo-

Fig. 16 Case 1 showing facial-skeletal abnormality, Skeletal IIIB, Short. Fig. 17 Case 2 showing facial-skeletal abnormality, Skeletal IIIB, Long.

18 IJO • VOL. 15 • NO. 1 • SPRING 2004

nion would rotate back to possibly a more normal A-P posi-tion. Prior to treatment, this patient had severe craniofacialpain and other medical problems.

Case 2 in Figure 17 shows a disharmonious face. Theceph analysis shows a nearly normal maxillary A-P posi-tion; however, the mandible is prognathic. Additionally, thepatient is 16y-7m years old and her menton has grown ver-tically downward past the age 18 vertical arc. Her classifica-tion is Skeletal IIIB, long. She had severe upper airwayobstruction and severe maxillary and mandibular arch con-striction.

Case 3 in Figure 18 shows a disharmonious face. Herceph shows the maxilla as being retrognathic and the

mandible as being prognathic. This is a combination prob-lem. Additionally, she is 13y-1m years old, and her mentonhas not even developed to the age 4 vertical arc. Her classi-fication is IIIC, short. Prior to treatment, she had severecraniofacial pain, headaches, and other medical problems.

Practical application of JeffersonAnalysis—case presentation

The following patient in Figures 19, 20 and 21 was treat-ed with the aid of Jefferson analysis to assess her skeletalproblems. See Figure 19. As can be seen from the patient’sfacial photographs, her lower jaw appears to be somewhatretrognathic. The Jefferson analysis shows that the maxilla is

Fig. 18 Case 3 showing facial-skeletal abnormality, Skeletal IIIC, Short.

Fig. 19 Female, Age 12-12m, pretreatment.

IJO • VOL. 15 • NO. 1 • SPRING 2004 19

slightly retrognathic and the mandible is retrognathic. Herlower facial vertical is normal. Her classification is SkeletalBR, normal. Her intraoral photograph shows significantcrowding as well as blocked out upper left canine. She hadsymptoms of TMD and associated physiologic stress.

The patient was treated with an upper Schwarz toexpand the upper arch and straight wire fixed appliance.

Her post treatment photos and ceph, Figure 20, showsimprovements both dentally and facially. Jefferson analysisshows that the maxilla and mandible are now both in idealA-P position, and her lower facial height is slightly short.Her post treatment classification is Skeletal I, short tenden-cy. By moving the mandible forward, her TMD symptomswere alleviated.

Fig. 20 Female Age 13y-10m, post treatment

Fig. 21 Female age 15y-10m, 2 years post treatment

Figure 21 shows the patient’s photographs exactly twoyears post treatment. There is good evidence that thispatient’s self-confidence and feeling of self worth hasimproved dramatically after the orthodontic and orthopedictreatment. Treating to the divine proportion has improvedher facial esthetics, TMJ health, physiologic and psycholog-ic health, her total health and wellness, and quality of life.

As previously stated, Mack cautions against just treatingthe dentition.7,8 Esthetics is not just about mounted casts orabout perfect alignment of teeth but more importantly abouttheir position in relation to the total face. Frindel studied theimportance of a well-positioned smile in a balanced positionon the face based on the divine proportion. He correlates thisposition to a young-looking smile throughout life.72 A divinelyproportioned face is timeless and ageless. Conversely, a facesignificantly divergent from the divine proportion appearsolder and will age more quickly over time. Facial disharmonyis associated with a multitude of medical problems. This,added to the physiologic stress, can deteriorate the humanbody and face and accelerate the aging process.

ConclusionDue to recent advances in science and technology, espe-

cially in the area of functional orthopedic therapy, the dentalprofession is able to treat beyond the confines of the oral cav-ity. Former Surgeon General, David Satcher, in his reportstates, “Oral health means much more than healthy teeth. Itmeans being free of chronic oral-facial pain conditions, oraland pharyngeal (throat) cancers, oral soft tissue lesions, birthdefects such as cleft lip and palate, and scores of other dis-eases and disorders that affect the oral, dental, and craniofa-cial tissues, collectively known as the craniofacial complex.”This report also states that “the importance of the face as thebearer of identity, character, intelligence, and beauty is uni-versal.”73

In the introduction of this paper, six concepts were pre-sented with references wherever possible. These six con-cepts form the bases for establishing a universal standardfor facial beauty. A single standard for beauty regardless ofrace, age, sex and other variables will simplify diagnosisand treatment. Implicit in this discussion is the followingunderstanding. It is not enough to just move the soft tissuessuperficially to make the face appear beautiful. It is tanta-mount that the facial-skeletal structures be properly alignedand to allow the soft tissues to conform to the hard tissue.In so doing, not only are the faces made more beautiful butthe individuals will also be made healthier.

This paper explains how beauty and health are inti-mately related. Additionally, there are emotional and psy-chological issues that come with unattractive facial features.

During their formative years, young children suffer themost. Many with unattractive facial features, may also haveassociated medical problems, and possible learning disabili-ties. We in the dental profession can harmonize and nor-

malize their face and health. In so doing, we are able tooffer these children a life that they may not otherwiseachieve: an equal opportunity for health, happiness, andsuccess. We weld tremendous power within our fingertipsto intervene professionally and to change the lives of thesechildren in a very positive way. This is a supreme giftbestowed upon us—a gift that we should use wisely andresponsibly.

References1. Jefferson Y. Skeletal types: Key to unraveling the mystery of

facial beauty and its biologic significance. JGO 1996; 7(2): 7-25.2. Garland TH. Fascinating Fibonaccis: Mystery and magic in num-

bers. Dale Seymour Publications, 1987.3. Huntley HE. The Proportion: A study in mathematical beauty.

Dover Publications, 1970.4. Ghyka M. The Geometry of art and life. Dover Publications 1946.5. Hambridge J. The elements of dynamic symmetry. Dover

Publications; 1968.6. Levin IL. Dental esthetics and the golden proportion. J

Prosthet Dent 1978; 40(3): 244-252.7. Mack MR. Perspective of facial esthetics in dental treatment

planning. J of Pros Dent 1996; 75(2): 169-76.8. Mack MR. Vertical dimension: a dynamic concept based on

facial form and oropharyngeal function. J Prosthet Dent 1991;66(4): 478-85.

9. Preston JD. The golden proportion revisited. J Esthet Dent

1993; 5:247-251.10. Moss JP, Linney AD, & Lowey MN. The use of three-dimen-

sional techniques in facial esthetics. Semin Orthod 1995 June;1(2)94-104.

12. Peck H & Peck S. A concept of facial esthetics. Angle Ortho1970; 40(4): 284-317.

13. Auger TA & Turley PK. The female soft tissue profile as pre-sented in fashion magazine during the 1900’s: a photographicanalysis. Int J Adult Orthod Orthognath Surgery 1999; 14(1): 7-18.

14. Nguyen DD & Turley PK. Changes in the Caucasian malefacial profile as depicted fashion magazines during the twenti-eth century. AJODO 1998; 114(2): 208-17.

15. Lusterman EA. The esthetics of the occidental face: A studyof dentofacial morphology based upon anthropologic criteria.AJODO 1963; 49(11):826-50.

16. Satravah S & Schiegel KD. The significance of the integu-mentary profile. AJODO 1987; 92(5): 422-6.

17. Park I, Bowman D & Klapper LA. A cephalometric study ofKorean adults. AJODO 1989; 96(1): 54-9.

18. Love RJ, Murray JM & Mamandras AH. Facial growth inmales 16 to 20 ears of age. AJODO 1990; 97(3): 200-6.

19. Bishara SE, Abdella EM & Hoppens BJ. Cephalometric com-parisons of dentofacial parameters between Egyptian andNorth American adolescents. AJDO 1990; 97(5): 413-21.

20. Ben-Bassat Y, Dinte A, Brin I & Koyoumdjisky-Kaye .Cephalometric pattern of Jewish East European adolescentwith clinically acceptable occlusion. AJODO 1992; 102(5):443-8.

21. D’Aloisio D & Pangrazio-Kulbersh V. A comparative andcorrelational study of the cranial base in North AmericanBlacks. AJODO 1992; 102(5): 449-455.

22. Swierenga D, Oesterle LJ & Messersmith ML. Cephalometricvalues for adult Mexican-Americans. AJODO 1994; 106(2):146-55.

23. Iliffe A. A study of preferences in feminine beauty. Br J of

Psychology 1960; 51: 267-73.

20 IJO • VOL. 15 • NO. 1 • SPRING 2004

IJO • VOL. 15 • NO. 1 • SPRING 2004 21

24. Udry R. Structural correlates of feminine beauty preferencesin Britain and the U.S.: A comparison. Sociology and Social

Research 1965; 49: 330-42.25. Patzer G. The physical attractiveness phenomena. Plenum

1985; New York.26. Bernstein IH, Lin T & McClellan P. Cross-vs. within-racial

judgments of attractiveness. Percep& Psychophys 1982; 32: 495-503.

27. Cunningham MR: Measuring the physical in physical attrac-tiveness. Quasi experiments on sociobiology of female facialbeauty. J of Soc and Personality Psych 1986; 50: 925-35.

28. Johnson RW, Dannenbring GL, Anderson NR & Villa RE.How different cultural and geographic groups perceived theattractiveness of active and inactive feminists. J of Social Psych

1983; 119: 111-17.29. Maret SM. Attractiveness ratings of photographs of Blacks

by Cruzans and Americans. J of Psych 1983; 115: 113-16.30. Maret SM & Harling GA. Cross cultural perceptions of phys-

ical attractiveness: Ratings of photos of Whites by Cruzansand Americans. Percep Motor Skills 1985; 60: 163-6.

31. Richardson SA, Goodman N, Hastorf AH & Dornbusch SM.Cutltural uniformity in reaction to physical disabilities. Am

Soc Review 1961; 26: 241-7.32. Thakerar JN & Iwawaki S. Cross-cultural comparisons in

interpersonal attraction of females toward males. J of Soc

Psych 1979; 108: 121-2.33. Weisfield GE, Weisfield CC & Callaghan JW. Peer and self

perception in Hopi and Afro-American third and sixthgraders. Ethos 1984; 12: 64-83.

34. Ricketts RM. The biologic significance of the divine propor-tion and Fibonacci series. AJO 1982; 81(5): 351-370.

35. Timms DJ & Trenouth MJ. A quantified comparison of cran-iofacial form with nasal respiratory function. AJODO 1988;94: 216-22.

36. Weimert T. On airway obstruction in orthodontic practice.JCO 1986; XX(2): 96-104.

37. Champagne M. Upper airway compromise (UAC) and thelong face syndrome. JGO 1991; 2(3): 18-25.

38. Zarb GA & Speck JE. The treatment of temporomandibularjoint dysfunction: A retrospective study. J Prosthet Dent 1977;38: 420.

39. Van Sickels JE & Ivey DW. Myofacial pain dysfunction: Amanifestation of the short-face syndrome. J Prosthet Dent

1979; 42(5): 547-50.40. Abadi BJ & Okeson JP. Alteration of vertical dimension in

the treatment of Cranio-mandibular Disorders. J of

Craniomand Pract 1982-83; 1: 55-9.41. Thornhill R & Gangestad S. Human facial beauty: average-

ness, symmetry and parasite resistance. Human Nature 1993;4: 237-69.

42. Rhodes G, Yoshikawa S, Clark A, Lee K, McKay R, &Akamatsu S. Attractiveness of facial averageness and symme-try in non-western cultures: in search of biologically basedstandards of beauty. Perception 2001; 30(5): 611-25.

43. Simposon JA, Gangestad SW, Christensen PN & Leck K.Fluctuating asymmetry, sociosexuality, and intrasexual com-petitive tactics. J Pers Soc Psychol 1999 Jan; 76(1): 159-72.

44. Rikowski A & Grammer K. Human body odour, symmetryand attractiveness. Proc R Soc Lond B Biol Sci 1999 May &; 266(1422): 869-74.

45. Linder-Aronson S & Woodside DG. The channelization ofupper and lower anterior face heights compared to populationstandards in males between 6 to 20 years. Eur J Ortho 1979; 1:25-40.

46. Linder-Aronson S. Nasorespiratory function and craniofacialgrowth in McNamara, JA (editor): monograph no. 9, Craniofacial

Growth Series, Ann Arbor, Center for Human Growth andDevelopment, University of Michigan 1979; 121-47.

47. Linder-Aronson S. Effects of adenoidectomy on the dentitionand facial skeletal over a period of 5 years. In Transact of theThird Internat Ortho Congress, St. Louis. CV Mosby Co1975; 85-100.

48. Subtelny JD. The significance of adenoid tissues in orthodon-tics. Angle Ortho 1954; 24: 59-69.

49. Ricketts RM. Respiratory obstruction syndrome. In Forumon the tonsil and adenoid problems in orthodontics. AJO

1968; 54: 495-514.50. Quinn GW. Airway interferences and its effect upon the

growth and development of the face, jaws, dentition and asso-ciated parts. NC Dent J 1978; 60: 26-31.

51. Principato JJ, Kerrigan JP & Wolf P. Pediatric NasalResistance and lower anterior vertical face height. Presentedat the American Academy of Otol Rhinol Laringol-Head andNeck Surgery, Sept 1984.

52. Cheng M-C, Enlow DH, Papsidero M, Broadbent Jr BH,Oyen O & Sabat M. Developmental effects of impairedbreathing in the face of a growing child. Angle Ortho 1988; 58:309-20.

53. Zettergren-Wijk L, Linder-Aronson S, Nordlander B, ÅgrenK & Svanorg E. Longitudinal effect on facial growth aftertonsillectomy in children with obstructive sleep apnea. WJO

2002; 3(1): 67-72.54. Marks MG. Allergy in relation to orofacial dental deformities

in children: a review. J Allergy 1965; 36: 293-302.55. Taylor M. The nasal vasomotor reaction. Otolaryngol Clin

North Am; 6(3): 645-54.56. Harvold EP. The role of function in the etiology and treat-

ment of malocclusion. AJO 1968; 54: 883-98.57. Harvold EP, Chierici G & Vargervik K. Experiments on the

development of dental malocclusions. AJO 1972 (61) 38-44.58. Paul JL & Nanda RS. Effect of mouth breathing on dental

occlusion. Angle Ortho 1973; 43: 201-6.59. Ackerman RI & Klapper K. Tongue position and open-bite:

the key roles of growth and the nasopharyngeal airway. J of

Dent for Child Sept-Oct 1981; 339-45.60. Hawkins AC. Mouth breathing as the cause of malocclusion

and other facial abnormalities. Tex Dent J 1965; 83: 10-15.61. Brodie AG. Muscular factors in the diagnosis and treatment

of malocclusion. Angle Ortho 1953; 23: 71-7.62. Price WA. Nutrition and physical degeneration. Keats

Publishing, Inc. 1997 6th Edition; New Canaan, Ct. Orderthrough Price-Pottenger Nutrition Foundation, 800-366-3748.

63. Little RM, Wallen TR & Reidel RA. Stability and relapse ofmandibular anterior alignment—first premolar extractioncases treated by traditional edgewise orthodontics. AJODO

1981; 80(4): 349-65.64. Little RM, Riedel RA & Artun J. An evaluation of changes

in mandibular anterior alignment from 10 to 20 years postretention. AJODO 1988; 93(5): 424-8.

65. Schwarze CW: Expansion and relapse in long follow-upstudy. Trans Euro Ortho Soc 1972; 263-74.

66. Marquardt SR. Dr. Stephen R. Marquardt on the GoldenDecagon and human facial beauty. JCO 2002; XXXVI(6):339-347.

67. Jefferson Y. Skeletal classification system for describing max-illary and mandibular A-P relationship using a modifiedSassouni Analysis. JGO 1990; 1(1): 5-11.

68. Jefferson Y. Skeletal classification of maxillary and mandibu-lar malpositions. Funct Orthod 1996; 13(5): 21-4.

22 IJO • VOL. 15 • NO. 1 • SPRING 2004

69. Sassouni V. A roentgenographic cephalometric analysis ofcephalofacial dental relationships. AJO 1955; 41: 735-764.

70. Sassouni V. Diagnosis and treatment planning via roetgeno-graphic cephalometry. AJO 1958; 44: 433-463.

71. Jefferson Y. Facial esthetics—presentation of an ideal face.JGO 1993; 4(1): 18-23.

72. Frindel F. Pour un meilleur positionnement du sourire. Revue

d’Orthopédie Dento Faciale 2001; 35(4): 473-97.73. “Oral health in America: A report of the Surgeon General,

2000.” Available at: http://www.nidr.nih.gov.

“Facial Beauty — Establishing a Universal Standard”Copyright Yosh Jefferson 2003

Dr. Yosh Jefferson, a general dentist, has

limited his practice to orthodontics, TMD

therapy, and major oral rehabilitation cases.

Currently he is IAO president, a member of

AGD, the New Jersey Dental Association

Legislation Committee, and chair of the

International Ortho-TMD Consortium. He

was awarded MAGD, FACD, FICD and

FADI, and he is an IAO Board Diplomate

and Senior Instructor. He has been published

and has lectured nationally and internation-

ally and is regarded as an expert on facial beauty and its biologic

significance. His website is:

www.facialbeauty.org. He can be reached at 1-609-261-1199.

Yosh Jefferson, DMD