Facial Aesthetics

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.

• Reviews of the First Edition xviPreface to Second Edition xviiiPreface to the First Edition xxAcknowledgements xxiiPart I ConceptsChapter 1 Facial Beautywith Hengameh B. Naini 3Definition of beauty and aesthetics 3Is beauty ‘in the eye of the beholder’? 5The enigma of facial beauty 6Beauty and facial beauty: historical and philosophical perspectives 11Facial Beauty: Scientific perspectives 17Importance of facial beauty 22Striving for form 23References 24Chapter 2 Facial Proportions: Classical Canons to Modern Craniofacial Anthropometry 26Introduction 26Ancient Egypt 26Ancient Greece 27Ancient Rome 34The Renaissance 36The Enlightenment and neoclassicism 51Twentieth century 53The golden proportion 55Conclusion 61References 61Chapter 3 Facial Expression: Influence and Significance 63Introduction 63Importance of facial expressions 63History of research into facial expressions 64References 70Chapter 4 Psychological Ramifications of Facial Deformities 72Introduction 72Health and psychosocial well-being 72Self-image 73The effect of the response of others on those with facial deformities 74To treat or not to treat? The controversial debate 75Body dysmorphic disorder: the delusion of deformity 76Managing facial deformity in a neurotic-dysmorphic patient 81Conclusion 82References 82Further reading 83Part II Clinical DiagnosisSection 1 Patient Interview and Clinical Diagnostic Records 87Introduction to Section 1 87Diagnosis 87Chapter 5 Patient Interview and Consultation 89Introduction 89Presenting complaint 89History of presenting complaint 90Psychosocial history 91Medical history 93Danger signals and the ‘problem’ patient 93Concluding remarks 93References 94Chapter 6 Clinical Diagnostic Records, Natural Head Position and Craniofacial Anthropometry 95Introduction 95Radiographs 95Clinical photographs 97Clinical videography 97Study models 97Serial height measurement 98Three-dimensional hard and soft tissue imaging 98The Frankfort Craniometric Agreement and the Frankfort Plane 99The unreliability of anatomical reference planes 101Natural head position: the key to diagnosis 102Choice of horizontal and vertical reference planes 103Orientation of the patient in natural head position 104Equipment for digital photography and data storage 105Patient consent forms 105Background and lighting 105Facial views 106Intraoral views 107Anthropometric craniofacial surface landmarks 108References 112Chapter 7 Cephalometry and Cephalometric Analysis 113Introduction 113Cephalometric landmarks and planes of reference 114Landmarks, lines, planes and volumes 114Cephalometric planes of reference 119Posteroanterior cephalometric radiography 122Cephalometric analysis and geometric principles 125Description of dentofacial deformities 125Sagittal skeletal relationships 127Sagittal dentoalveolar relationships 137Vertical skeletal relationships 142Vertical dentoalveolar relationships 148Transverse skeletal relationships 149References 149Section 2 Facial Aesthetic Analysis: Facial Type, Proportions and Symmetry 151Introduction to Section 2 151The diagnostic process – clinical evaluation 152Clinical evaluation – the sequence 154References 155Chapter 8 Facial Type 157Introduction 157The fictional conception of the ‘normal’ 157Proportion indices 157Head type 159Cephalic index 159Head circumference 160Facial type: frontal view (norma frontalis) 160Facial shape 160Facial index 161Facial type: profile view (norma lateralis) 162Facial divergence 162Sagittal facial profile contour 164Parasagittal facial profile contour 167Facial curves and curvilinear relationships 171Curvilinear relationships – frontal and profile views 172Angularity of facial contour lines 172Facial profile curves and ‘S-shaped’ curvilinear considerations 172Contour defects 173Sexual variation: the main differences between male and female faces 174‘Ethnic’ variation: considerations in facial aesthetic evaluation 175Historical background 175Considerations in facial aesthetic evaluation 175Clinical implications 176Facial ageing 178Current understanding, controversies and future research 179Recognizing the visible effects of ageing 181References 182Chapter 9 Facial Proposition 184Introduction 184Craniofacial height to standing height proportion 185Vertical Facial Proportions 190Transverse facial proportions 194Concluding remarks 198References 198Chapter 10 Facial Symmetry and Asymmetry 199Introduction 199Relationship between symmetry and proportion 199Balance and harmony: a note on terminology 200Aetiology and classification of facial asymmetry 200Clinical evaluation 201Dynamic clinical evaluation 206Dental midlines 209Radiographic/cephalometric evaluation 210Three-dimensional imaging evaluation 214Craniofacial growth and treatment timing 218References 222Section 3 Facial Aesthetic Analysis: Regional Analysis 223Introduction to Section 3 223The modified subunit principle 223Relativity and the five facial prominences 224References 225Upper Facial Analysis 226Chapter 11 The Forehead 227Introduction and Terminology 227Anatomy 227Clinical evaluation 228References 232Chapter 12 The Orbital Region 233Introduction 233Terminology 234Anatomy 234Clinical evaluation 236References 240Midfacial Analysis 242Chapter 13 The Ears 243Introduction 243Terminology 243Anatomy 243Clinical evaluation 244References 248Chapter 14 The Nose 249Introduction 249Terminology 251Anatomy 252Nasal type, topography and the subunit principle 254Clinical evaluation 257Normative values for nasal dimensions 271Nasal function 272References 272Chapter 15 The Malar Region 274Introduction 274Terminology 274Anatomy 275Clinical evaluation 275Principles in planning the correction of malar deficiency 280References 282Chapter 16 The Maxilla and Midface 283Introduction 283Terminology 283Anatomy 286Clinical evaluation 288Maxillary deficiency 297Maxillary excess 301Maxillary asymmetry 305References 306Lower Facial Analysis 307Introduction 307Chapter 17 The Lips 308Introduction 308Anatomy 308Terminology 310Clinical evaluation 310References 326Chapter 18 Mentolabial (Labiomental) Fold 328Introduction 328Mentolabial fold (sulcus) depth 328Mentolabial angle 328Attractiveness research 331Vertical position of the mentolabial fold 331Mentolabial fold morphology 331References 334Chapter 19 The Mandible 335Terminology 335Anatomy, morphology and size 335Sagittal and vertical relationships 339Mandibular deficiency 339Mandibular excess 342Transverse relationships 346Mandibular asymmetries 347References 352Chapter 20 The Chin 353Introduction 353Anatomy 353Terminology 354Classification of chin deformities 359Clinical evaluation 362Sagittal evaluation and chin projection 362Sagittal position of hard tissue (skeletal) pogonion 367Indirect morphological influences on sagittal chin projection 369Soft tissue chin pad 370Mentolabial fold and chin pad morphology 370Dynamic chin pad evaluation 370Mentalis muscle – anatomy, activity and significance 371Vertical chin height 374Transverse chin width 374References 375Chapter 21 Submental-Cervical Region 377Introduction 377Anatomy 377Terminology 377Aetiology 378Clinical evaluation 379Relative submental projection and aesthetics 391References 391Section 4 Smile and Dentogingival Aesthetic Analysis 393Introduction to Section 4 393Chapter 22 Dental-Occlusal Relationships: Terminology, Description and Classification 395Introduction 395Terminology 395Dental occlusion 397Classification of dental-occlusal relationships 400The term ‘Class’ and classification 404The aetiology of malocclusion 406Oral health 409Occlusal function 410References 410Chapter 23 Smile Aestheticswith Daljit S. Gill 412Introduction 412Clinical evaluation 413Lip aesthetics 413Lip lines 413Upper lip–maxillary incisor relationship 414Incisor exposure and phonetic analysis 418Incisor exposure in oblique lateral view 419Incisor exposure and anterior occlusal guidance 419Smile symmetry 420Dynamic upper lip curvature 420Orientation of the transverse occlusal plane 420Orientation of the sagittal occlusal plane 421Smile curvature (smile arc) 421Dental midlines 425Buccal corridors (negative space) 425Smile aesthetics in profile view 427References 431Chapter 24 Dentogingival Aestheticswith Daljit S. Gill 432Introduction 432Anatomy 432Clinical evaluation 434Tooth shape 434Tooth size 436Tooth proportions 438Tooth symmetry 439Arch form 440Maxillary incisor axial angulations 441Gradation (front-to-back progression) 441Gingival aesthetics 442Contacts, connectors and embrasures 445Tooth colour 446References 448Index 450