Facial Aesthetics. Concepts and Clinical Diagnosis

Reviews of the First Edition xvi

Preface to Second Edition xviii

Preface to the First Edition xx

Acknowledgements xxii

Part I Concepts

Chapter 1 Facial Beauty
with Hengameh B. Naini 3

Definition of beauty and aesthetics 3

Is beauty ‘in the eye of the beholder’? 5

The enigma of facial beauty 6

Beauty and facial beauty: historical and philosophical perspectives 11

Facial Beauty: Scientific perspectives 17

Importance of facial beauty 22

Striving for form 23

References 24

Chapter 2 Facial Proportions: Classical Canons to Modern Craniofacial Anthropometry 26

Introduction 26

Ancient Egypt 26

Ancient Greece 27

Ancient Rome 34

The Renaissance 36

The Enlightenment and neoclassicism 51

Twentieth century 53

The golden proportion 55

Conclusion 61

References 61

Chapter 3 Facial Expression: Influence and Significance 63

Introduction 63

Importance of facial expressions 63

History of research into facial expressions 64

References 70

Chapter 4 Psychological Ramifications of Facial Deformities 72

Introduction 72

Health and psychosocial well-being 72

Self-image 73

The effect of the response of others on those with facial deformities 74

To treat or not to treat? The controversial debate 75

Body dysmorphic disorder: the delusion of deformity 76

Managing facial deformity in a neurotic-dysmorphic patient 81

Conclusion 82

References 82

Further reading 83

Part II Clinical Diagnosis

Section 1 Patient Interview and Clinical Diagnostic Records 87

Introduction to Section 1 87

Diagnosis 87

Chapter 5 Patient Interview and Consultation 89

Introduction 89

Presenting complaint 89

History of presenting complaint 90

Psychosocial history 91

Medical history 93

Danger signals and the ‘problem’ patient 93

Concluding remarks 93

References 94

Chapter 6 Clinical Diagnostic Records, Natural Head Position and Craniofacial Anthropometry 95

Introduction 95

Radiographs 95

Clinical photographs 97

Clinical videography 97

Study models 97

Serial height measurement 98

Three-dimensional hard and soft tissue imaging 98

The Frankfort Craniometric Agreement and the Frankfort Plane 99

The unreliability of anatomical reference planes 101

Natural head position: the key to diagnosis 102

Choice of horizontal and vertical reference planes 103

Orientation of the patient in natural head position 104

Equipment for digital photography and data storage 105

Patient consent forms 105

Background and lighting 105

Facial views 106

Intraoral views 107

Anthropometric craniofacial surface landmarks 108

References 112

Chapter 7 Cephalometry and Cephalometric Analysis 113

Introduction 113

Cephalometric landmarks and planes of reference 114

Landmarks, lines, planes and volumes 114

Cephalometric planes of reference 119

Posteroanterior cephalometric radiography 122

Cephalometric analysis and geometric principles 125

Description of dentofacial deformities 125

Sagittal skeletal relationships 127

Sagittal dentoalveolar relationships 137

Vertical skeletal relationships 142

Vertical dentoalveolar relationships 148

Transverse skeletal relationships 149

References 149

Section 2 Facial Aesthetic Analysis: Facial Type, Proportions and Symmetry 151

Introduction to Section 2 151

The diagnostic process – clinical evaluation 152

Clinical evaluation – the sequence 154

References 155

Chapter 8 Facial Type 157

Introduction 157

The fictional conception of the ‘normal’ 157

Proportion indices 157

Head type 159

Cephalic index 159

Head circumference 160

Facial type: frontal view (norma frontalis) 160

Facial shape 160

Facial index 161

Facial type: profile view (norma lateralis) 162

Facial divergence 162

Sagittal facial profile contour 164

Parasagittal facial profile contour 167

Facial curves and curvilinear relationships 171

Curvilinear relationships – frontal and profile views 172

Angularity of facial contour lines 172

Facial profile curves and ‘S-shaped’ curvilinear considerations 172

Contour defects 173

Sexual variation: the main differences between male and female faces 174

‘Ethnic’ variation: considerations in facial aesthetic evaluation 175

Historical background 175

Considerations in facial aesthetic evaluation 175

Clinical implications 176

Facial ageing 178

Current understanding, controversies and future research 179

Recognizing the visible effects of ageing 181

References 182

Chapter 9 Facial Proposition 184

Introduction 184

Craniofacial height to standing height proportion 185

Vertical Facial Proportions 190

Transverse facial proportions 194

Concluding remarks 198

References 198

Chapter 10 Facial Symmetry and Asymmetry 199

Introduction 199

Relationship between symmetry and proportion 199

Balance and harmony: a note on terminology 200

Aetiology and classification of facial asymmetry 200

Clinical evaluation 201

Dynamic clinical evaluation 206

Dental midlines 209

Radiographic/cephalometric evaluation 210

Three-dimensional imaging evaluation 214

Craniofacial growth and treatment timing 218

References 222

Section 3 Facial Aesthetic Analysis: Regional Analysis 223

Introduction to Section 3 223

The modified subunit principle 223

Relativity and the five facial prominences 224

References 225

Upper Facial Analysis 226

Chapter 11 The Forehead 227

Introduction and Terminology 227

Anatomy 227

Clinical evaluation 228

References 232

Chapter 12 The Orbital Region 233

Introduction 233

Terminology 234

Anatomy 234

Clinical evaluation 236

References 240

Midfacial Analysis 242

Chapter 13 The Ears 243

Introduction 243

Terminology 243

Anatomy 243

Clinical evaluation 244

References 248

Chapter 14 The Nose 249

Introduction 249

Terminology 251

Anatomy 252

Nasal type, topography and the subunit principle 254

Clinical evaluation 257

Normative values for nasal dimensions 271

Nasal function 272

References 272

Chapter 15 The Malar Region 274

Introduction 274

Terminology 274

Anatomy 275

Clinical evaluation 275

Principles in planning the correction of malar deficiency 280

References 282

Chapter 16 The Maxilla and Midface 283

Introduction 283

Terminology 283

Anatomy 286

Clinical evaluation 288

Maxillary deficiency 297

Maxillary excess 301

Maxillary asymmetry 305

References 306

Lower Facial Analysis 307

Introduction 307

Chapter 17 The Lips 308

Introduction 308

Anatomy 308

Terminology 310

Clinical evaluation 310

References 326

Chapter 18 Mentolabial (Labiomental) Fold 328

Introduction 328

Mentolabial fold (sulcus) depth 328

Mentolabial angle 328

Attractiveness research 331

Vertical position of the mentolabial fold 331

Mentolabial fold morphology 331

References 334

Chapter 19 The Mandible 335

Terminology 335

Anatomy, morphology and size 335

Sagittal and vertical relationships 339

Mandibular deficiency 339

Mandibular excess 342

Transverse relationships 346

Mandibular asymmetries 347

References 352

Chapter 20 The Chin 353

Introduction 353

Anatomy 353

Terminology 354

Classification of chin deformities 359

Clinical evaluation 362

Sagittal evaluation and chin projection 362

Sagittal position of hard tissue (skeletal) pogonion 367

Indirect morphological influences on sagittal chin projection 369

Soft tissue chin pad 370

Mentolabial fold and chin pad morphology 370

Dynamic chin pad evaluation 370

Mentalis muscle – anatomy, activity and significance 371

Vertical chin height 374

Transverse chin width 374

References 375

Chapter 21 Submental-Cervical Region 377

Introduction 377

Anatomy 377

Terminology 377

Aetiology 378

Clinical evaluation 379

Relative submental projection and aesthetics 391

References 391

Section 4 Smile and Dentogingival Aesthetic Analysis 393

Introduction to Section 4 393

Chapter 22 Dental-Occlusal Relationships: Terminology, Description and Classification 395

Introduction 395

Terminology 395

Dental occlusion 397

Classification of dental-occlusal relationships 400

The term ‘Class’ and classification 404

The aetiology of malocclusion 406

Oral health 409

Occlusal function 410

References 410

Chapter 23 Smile Aesthetics
with Daljit S. Gill 412

Introduction 412

Clinical evaluation 413

Lip aesthetics 413

Lip lines 413

Upper lip–maxillary incisor relationship 414

Incisor exposure and phonetic analysis 418

Incisor exposure in oblique lateral view 419

Incisor exposure and anterior occlusal guidance 419

Smile symmetry 420

Dynamic upper lip curvature 420

Orientation of the transverse occlusal plane 420

Orientation of the sagittal occlusal plane 421

Smile curvature (smile arc) 421

Dental midlines 425

Buccal corridors (negative space) 425

Smile aesthetics in profile view 427

References 431

Chapter 24 Dentogingival Aesthetics
with Daljit S. Gill 432

Introduction 432

Anatomy 432

Clinical evaluation 434

Tooth shape 434

Tooth size 436

Tooth proportions 438

Tooth symmetry 439

Arch form 440

Maxillary incisor axial angulations 441

Gradation (front-to-back progression) 441

Gingival aesthetics 442

Contacts, connectors and embrasures 445

Tooth colour 446

References 448

Index 450

The definitive reference on facial aesthetic analysis for aesthetic and reconstructive surgery and aesthetic dentistry

Facial Aesthetics: Concepts and Clinical Diagnosis is a unique resource for facial aesthetic surgery and dentistry. Providing a comprehensive guide to both the art and science of facial aesthetics, the book incorporates all aspects relevant to the work of the clinician involved in the management of facial deformities. Revised and expanded with extensive additions, the second edition is structured over 24 easy-to-follow chapters with numerous illustrations and diagrams.

Part I of Facial Aesthetics covers the historical evidence for facial aesthetics canons and concepts in depth. It incorporates all aspects relevant to the work of the clinician, including the philosophical and scientific theories of facial beauty, facial attractiveness research, facial proportions, facial expression, and the psychological ramifications of facial deformities. Part II of the book goes on to examine clinical evaluation and diagnosis in considerable detail under four sections, from the initial consultation interview and acquisition of diagnostic records, complete clinical examination and analysis of the craniofacial complex, in-depth analysis of each individual facial region, and the comprising craniodentoskeletal and soft tissue units and subunits, using a top-down approach, and finally focusing on smile and dentogingival aesthetic evaluation.

Written by a highly qualified practitioner and researcher in the field, Facial Aesthetics also provides:

• Examines facial aesthetics in a clinical context
• Step-by-step aesthetic analysis of each facial region
• Detailed descriptions of the systematic clinical evaluation of the facial soft tissues and craniodentoskeletal complex
• In-depth analysis of 2D and 3D clinical diagnostic records
• An evidence-based approach, from antiquity to contemporary scientific evidence, to the guidelines employed in planning the correction of facial deformities
• Treatment planning from first principles highlighted

Facial Aesthetics is a comprehensive, practical reference and essential guide for practitioners with interest in refining their understanding and appreciation of the human face and applying practical protocols to their clinical diagnosis and treatment planning. It is essential reading for facial aesthetic surgeons and aesthetic dentists, orthodontists, oral and maxillofacial surgeons, as well as plastic and reconstructive surgeons.

Farhad B. Naini is Consultant Orthodontist, Director of Research and Clinical Lead for Maxillofacial Surgery and Specialist Dentistry at Kingston Hospital NHS Foundation Trust, and Consultant Orthodontist in The Gillies Unit, Queen Mary’s Hospital, King’s College Hospital NHS Foundation Trust, London, UK. He is Honorary Professor at Kingston University London, UK.