Preface xv Dedication xvii Acknowledgements xviii Part I Concepts Chapter 1 Facial Beauty 3 Definition of beauty and aesthetics 3 Is beauty ''in the eye of the beholder''? 4 The enigma of facial beauty: Why is one face seen as beautiful and another as unattractive? What guides and validates our judgement? 5 ''Ideal'' proportions 6 Symmetry 6 Averageness 6 Facial neoteny 7 Sexual dimorphism (secondary sexual characteristics) 7 Heredity 7 Cultural influences on the perception of facial beauty 7 Facial beauty: historical and philosophical perspectives 9 Facial beauty: scientific perspectives 13 Importance of facial beauty 14 Self- image and negative self-perception 15 Outsiders'' perceptions 16 Severity of deformity 16 References 16 Chapter 2 Facial Proportions: Classical Canons to Modern Craniofacial Anthropometry 18 Introduction 18 Ancient Egypt 18 Ancient Greece 19 The Archaic Period 19 The Classical Period 21 The Roman conquest of Greece 25 Ancient Rome 26 The Renaissance 27 Leon Battista Alberti 28 Leonardo da Vinci 29 Albrecht Dürer 36 The Enlightenment and neoclassicism 38 Neoclassical canons of proportion 38 Craniometry 39 Twentieth century 41 Modern craniofacial anthropometry 41 Leslie Farkas - the father of modern craniofacial anthropometry 42 The golden proportion 43 The ongoing problem with research into the golden proportion 44 Conclusion 44 References 44 Chapter 3 Facial Expression: Influence and Significance 45 Introduction 45 Importance of facial expressions 45 History of research into facial expressions 46 The work of Duchenne 47 The work of Darwin 47 The work of Ekman 49 The debate: Are facial expressions of emotion universal or culture-specific? 50 References 52 Chapter 4 Psychological Ramifications of Facial Deformities 54 Introduction 54 Health and psychosocial well-being 54 Self-image 55 The effect of the response of others on those with facial deformities 56 Teasing and bullying 56 To treat or not to treat? The controversial debate 57 Body dysmorphic disorder: the delusion of deformity 57 Body dysmorphic disorder 58 Conclusion 60 References 61 Part II Clinical Diagnosis Section 1 Patient Interview and Clinical Diagnostic Records 65 Introduction to Section 1 65 Diagnosis 65 Terms of direction, position and movement 65 Chapter 5 Patient Interview and Consultation 67 Introduction 67 Presenting complaint 67 History of presenting complaint 68 Psychosocial history 68 Medical history 68 Danger signals and the ''problem'' patient 69 References 69 Chapter 6 Clinical Diagnostic Records, Natural Head Position and Craniofacial Anthropometry 71 Introduction 71 Clinical diagnostic records 71 Radiographs 71 Clinical photographs 73 Study models 73 Serial height measurement 74 Three-dimensional hard and soft tissue imaging 74 Natural head position 74 The Frankfort Craniometric Agreement and the Frankfort Plane 74 The unreliability of anatomical reference planes 75 Natural head position: the key to diagnosis 76 Choice of horizontal and vertical reference planes 77 Orientation of the patient in natural head position 78 The self-balance position 78 The mirror position 78 The aesthetic position (or ''photographic position'' of the head) 78 Clinical photography 79 Equipment for digital photography and data storage 79 Patient consent forms 79 Background and lighting 79 Facial views 80 Intraoral views 80 Craniofacial anthropometry 81 Anthropometric craniofacial surface landmarks 81 References 85 Chapter 7 Cephalometry and Cephalometric Analysis 86 Introduction 86 Cephalometric landmarks and planes of reference 87 Landmarks, lines, planes and volumes 87 Hard tissue lateral cephalometric (skeletal) landmarks 88 Hard tissue lateral cephalometric (dental) landmarks 90 Soft tissue lateral cephalometric landmarks 91 Cephalometric planes of reference 92 Hard tissue lateral cephalometric reference planes 93 Soft tissue lateral cephalometric reference planes 95 Posteroanterior cephalometric radiography 95 Hard tissue posteroanterior cephalometric landmarks 96 Hard tissue posteroanterior cephalometric reference planes 97 Cephalometric analysis and geometric principles 98 Description of dentofacial deformities 98 Sagittal skeletal relationships 100 Sagittal positional relationships 100 Size relationships of maxilla and mandible 108 Sagittal dentoalveolar relationships 110 Inclination of the maxillary incisors 110 Sagittal position of the maxillary incisors 112 Inclination of the mandibular incisors 113 Sagittal position of the mandibular incisors 114 Inclination of maxillary to mandibular incisors 115 Vertical skeletal relationships 115 Convergence of horizontal facial planes (Sassouni analysis) 116 Anterior and posterior face height 116 Linear cephalometric measurements and normative values 119 Angular cephalometric measurements and normative values 120 Vertical dentoalveolar relationships 121 Inclination of the occlusal plane 121 Anterior maxillary dental height 121 Posterior maxillary dental height 121 Anterior mandibular dental height 121 Posterior mandibular dental height 122 Transverse skeletal relationships 122 References 122 Section 2 Facial Aesthetic Analysis: Facial Type, Proportions and Symmetry 123 Introduction to Section 2 123 ''Rules'' versus ''guidelines'' in facial aesthetic evaluation 123 Clinical inspection - the ''process'' 123 Clinical inspection - the ''education of the eye'' 124 The diagnostic process - clinical evaluation 124 Qualitative evaluation 124 Quantitative evaluation and analysis 124 Clinical evaluation - the sequence 126 References 126 Chapter 8 Facial Type 127 Introduction 127 The fictional conception of the ''normal'' 127 Proportion indices 127 Head type 129 Cephalic index 129 Ethnic differences 130 Ethnic differences in white individuals 130 Head circumference 130 Ethnic differences 130 Facial type: frontal view (norma frontalis) 130 Facial shape 130 Facial height-to-width ratio/proportion 131 Facial index 131 Facial type: profile view (norma lateralis) 132 Facial divergence 132 Sagittal facial profile contour 134 Angle of facial profile convexity (clinical/soft tissue) 134 Angle of facial profile convexity (cephalometric/skeletal) 135 Facial angle (clinical/soft tissue) 135 Facial angle (cephalometric/skeletal) 136 Cranial base angle 136 Anterior cranial base length 137 Parasagittal facial profile contour 137 Vertical facial profile form 137 Vertical facial growth pattern and hyperdivergent facial type 137 Horizontal facial growth pattern and hypodivergent facial type 138 Mandibular plane angle (clinical) 138 Mandibular plane angle (cephalometric) 139 Gonial angle (Ar-Go-Me) 139 Convergence of horizontal facial planes (Sassouni analysis) 140 Facial height to horizontal facial depth ratio (cephalometric) 140 Facial growth axes (cephalometric) 141 Facial curves and curvilinear relationships 141 Curvilinear relationships - frontal and profile views 142 Angularity of facial contour lines 142 Facial profile curves and ''S-shaped'' curvilinear considerations 142 Contour defects 143 Sexual variation: the main differences between male and female faces 144 ''Ethnic'' variation: considerations in facial aesthetic evaluation 145 Historical background 145 Considerations in facial aesthetic evaluation 145 Facial ageing 146 Skin 146 Fat 147 Muscle 147 Dentoalveolus 147 Recognizing the visible effects of ageing 147 References 149 Chapter 9 Facial Proportions 150 Introduction 150 Craniofacial height to standing height proportion 151 Classical, Renaissance and neoclassical proportional canons 151 Anthropometric data 155 Attractiveness research 155 Clinical implications 156 Vertical facial proportions 156 Vertical craniofacial bisection 156 Vertical facial trisection (Vitruvian trisection) 156 Vertical craniofacial tetrasection 157 Artist''s facial ''grid'' 157 Validity of proportional canons 157 Cephalometric evaluation - anterior face height ratio 158 Lower anterior facial proportions 158 Anthropometric vertical facial measurements 159 Comparison of proportional canons with modern measured proportional ratios 159 Attractiveness studies 159 Clinical implications 160 Transverse facial proportions 160 The central fifth of the face 160 The medial fifths of the face 163 The lateral fifths of the face 164 References 164 Oblique lateral (three-quarter) view 171 Transverse occlusa.