Latifa El Mouden*, Salma Jdii, Safaa Elbaghdadi & Farid El Quars
Department of Dentofacial Orthopedics, University of Hassan II Casablanca, Morocco
*Correspondence to: Dr. Latifa El Mouden, Department of Dentofacial Orthopedics, University of Hassan II Casablanca, Morocco.
Copyright © 2019 Dr. Latifa El Mouden, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Facial aesthetic has always been a major preoccupation, for patients as well as dentists, orthodontists, maxillofacial and plastic surgeons. Therefore, this study was conducted to evaluate the new female facial proportions that can influence the appreciation of facial beauty based on the most prominent models of the last decade “face photos” to consider the impact of its new values on current orthodontic therapeutic choices.
A photogrammetric cross-sectional descriptive study of a sample of the most famous model photos was conducted. To verify the reliability of the comments between the score and the manipulation of the measurement software a test-retest with a 30-day interval was performed.
The comparison between the means of the measured face ratios at the two samples showed significant differences (p <0.05) between the two groups, reflecting an increase in the percentage of the upper third of the face in the sample of the new models and a decrease in the percentage of the lower third of the face in the same group. The comparison of the measured angles showed a significant difference for the distal chin angle and the chin protrusion in favor of an increase in the group of new models.
The comparative analysis of facial and contour measurements in photos of the new and the 90s models in this study showed a significant reduction in the height of the lower third of the face and an increase in the protrusion of the chin for the sample of new models.
A popular axiom about physical attractiveness states: "Beauty is in the eyes of the one who is watching". In the 21st century, we live in a world full of norms and rules that we try to respect. This is the case, for example, when we discuss physical appearance; and therefore physical beauty criteria in men and women. However, women's image projected by the media, such as advertising and fashion magazines, seem to be perfect and most Modern women are constantly trying to improve themselves to rise to this "ideal" beauty.
The use of the classic standards was propagated by the artists and the anatomists of 17th and 19th centuries in the field of the medicine. However, scientific and systematic studies on the attractiveness took their sense during the last 30 years .
The conception of beauty was never so eclectic and free as today. The feminine beauty exists under diverse forms, for example, all the ethnic groups can be represented, or any style of clothing, in addition to the opening of the world through the media.
To measure the facial proportions allows obtaining invaluable indications and criteria of diagnosis as well as information potentially usable in the clinical practice. This is the way in the reconstructive and aesthetic surgery, the proportions are estimated by using anthropometric techniques and guidelines to correct the deformations and/or the disproportions. In addition, orthodontics or maxillofacial surgical techniques are used to obtain aesthetically superior results for patients .
In the early years of orthodontics, the "Angle paradigm" asserted that a perfect occlusion had to be obtained, and then the beauty of the face would follow. In subsequent years, the development of cephalometric analysis drew orthodontists’ attention on dental and facial structures. More recently, it has been recognized that orthodontic and surgical treatments should focus on the harmony and soft tissue proportions of the profile.
For this reason, facial analysis has become today a fundamental step in the evaluation of patients requiring aesthetic or reconstructive facial interventions. Anthropometric and soft tissue analysis was used to define the soft-tissue relationships of different parts of the face and this set the standards for preoperative objective facial analysis based on standard photometric methods. More recently, the evolution of technology has provided us with several precise three-dimensional methods for measuring anthropometric parameters such as plaster facial scans, digitization of anatomical landmarks recorded directly to patients, and laser surface scan. Dimensional methods for measuring anthropometric parameters such as plaster facial scans, digitization of anatomical landmarks recorded directly to patients, and laser surface scanners . Thus we try to maintain, to find or to get closer as far as possible, during our treatments, to standardized aesthetic, facial and cephalometric standards. However, old standards of beauty determined by anthropometric, photometric and cephalometric data cannot match current public perceptions of facial beauty; for this, the validity of conventional canons must be questioned when they are used to restore more contemporary faces.
It is in this approach that this study has been performed; to describe the mathematical differences of measurements, taken in the photographs of the most famous models; then to discuss the influence of the new criteria on the current orthodontic therapeutic choices. The null hypothesis is that there is no significant difference between the two samples.
Material and Method
This work consists of a descriptive cross-sectional study; In a sample of the most prominent models seen all over the world in the last decade; Through the most prestigious fashion magazines versus the most celebrity models of 90s.
The list of new models was selected through their appearance in the cover of fashion magazines in their new editions. A comparison group was also composed of a sample of the most famous models of the 90s from exhaustive web research.
After web research, a list of 50 of the most famous new models and a list of 48 old models were established. Face and profile photos were gathered from the web for each model. Photos were standardized, rotated along the sagittal axis in front photos and according to the plane of Frankfort for the profile photos; all photos were converted to black and white. All photos selected were taken with neutral expressions, closed mouth with no visible teeth, hair pulled back, with no or minimal makeup.
Two categories of photos were obtained:
- Front pictures to face analysis
- Profile photos for profile analysis.
Landmarks were drawn on the front and profile photos of each model photo by two operators for each of the two categories.
For the models in the comparison group, old photos of the models in the same age range as the study group; were chosen to counteract the effect of facial changes related to the aging process.
The photometry or the measurement of the distances and angles through the previously described markers was carried out by two investigators (the analysis of face by one and the analysis of profile by the other) by the software GIMP version 2.8.22 (http: //www.gimp.org/downloads/).
Distances and angles were measured for each photo.
The statistical data for this study were captured, analyzed and compared using the Microsoft Excel 2010 software; and the Spss software, Version 23.0. Armonk, NY: IBM Corp.
The Student's T test was used for the intergroup comparison with alpha level of significance alpha =5% (corresponds to a 95% confidence) . P <0.05 value was considered significant.
A Test-Retest was performed for face and profile analysis to verify intra-investigator stability by calculating the intra-class correlation coefficient (ICC) with a 4 week interval between the two measurements.
Our study sample consisted of collected frontal view and lateral view photographs, taken from 50 models for the study group and 48 models for the comparison group.
54% of the first group were of European origin while 38% were of American origin, 4% of Asian origin, 2% of African origin and 2% of Australian origin. In the comparison group 40.4% were of European origin, while 53.2% were of American origin, 2.1% African, Australian and Asian.
The ICC calculated for the Retest test for the reliability of the face measurements was at 0.98 (0.97-0.99) with a 95% confidence interval (CI), as for the ICC of the reliability of the profile measurements, it was at 0.94 (0.76-0.99) with 95% CI.
The results of the various measurements made on the face and profile photos of the models selected in the study and comparison groups were obtained using the GIMP version 2.8.22 software.
Using the Student's T test with a significance threshold of p <0.05, the comparison between the means of the ratios measured at the sample face of the new and the old models showed significant differences between the two groups, reflecting increases in the percentage of the upper third of the face in the sample of new models and a decrease in the percentage of the lower third of the face in the same group.
The comparison of the angles measured in the two samples by the Student's T test showed a significant difference for the distal angle of the chin and the protrusion of the chin.
Before discussing the results of our study, it is important to talk over the bias that it may involve. Among the main errors that can be included in this survey, we can describe two types:
- Sampling bias
- Measurement bias
This work focused on the faces of the most fashionable models. This being based on an exhaustive web search. However, the use of photographs downloaded from the internet doesn't allow standardization of measurements. The fact that the head can be slightly rotated, can lead to reducing the accuracy of measurements. In addition, the different photographs were taken on different scales, which made the calculation of reproducible linear measurements impossible. For those reasons, we were limited in our analysis to angular measurements and ratios of distances.
Measurement biases can relate to all the values studied. They are attributable to the investigator during the survey of anatomical points, and a factor of unpredictability also lies in the measurements made by the software. Each of these errors can contribute to distorting the results .They can intervene like a risk to decrease the power of the statistical test. To minimize these bias for their share of investigators and software, an intra-investigator test-retest was performed to test their stability, using the CCI with scores greater than 0.90 for all comparisons, reflecting good reliability of the measurements performed.
The definition of beauty is dynamic and changes over time. The beautiful face is a fundamental theme that has been debated by philosophers and, more specifically, by plastic surgeons, psychologists, estheticians, and orthodontists. The beauty of the face has been studied from the point of view of science, philosophy and sociocultural phenomena .
Although there is a distinction between the main objectives of "beauty" and the requirements of the viewer as defined by Socrates, who distinguished two forms of arrhythmia and who considered beauty as partly objective and subjective .
As a result, the aim of this study was to develop an objective scale for measuring facial attractiveness. This will be achieved by determining average facial and contour ratios for the most famous new models. Also, to compare these averages with those older models from the 90s, as well as determining the direct influence of these new proportions on current orthodontic therapies.
Many authors have reported that the average faces are different from the attractive faces and that the attractive faces differ greatly depending on the breed. Recently, some researchers have attempted to unify the beauty of the face using the concept of golden proportions. Namely, the divine proportion or the golden ratio has shown many limitations of traditional morphometry in research on facial attractiveness . A face is perceived as attractive when its facial shape approximates the average or facial means of a population . Although cephalometric facial analysis is still a specific method for assessing facial beauty. The ideal values are based on the old average values of the general population. This results cannot be used as supporting data to reflect the concepts. Contemporary beauty or attractive face configurations. The values suggested by old cephalometric standards have not changed for many years. In the present, the use of these standards alone produces inconsistencies between the perspectives of physicians and the desires of patients.
The comparison of the facial index value between the two groups did not show any significant differences.
A study conducted by Mommaerts et al  on the reliability of clinical measures used in the determination of facial indexes concluded that the facial index should be 0.87 by the same author in 2011 . A Comparative study between the ideal proportions of contemporary and ancient faces confirmed that contemporary female faces differed from all others assessed. In fact, the beautiful face has a significantly small classic facial index, indicating that the height of the face is less, or the width of the face is larger. According to the concept of the Dental smile design, the prominent cheekbones are considered a beauty feature and provide a younger look.
As a rule, the face can be divided into three equal thirds. In our study, the new models group had shortening of the lower part against an increase in the upper part of the face in comparison with the former models group.
Mommaerts confirmed that a small chin in a woman is always better than a large chin, in both vertical and transverse dimensions . According to Prendergast, facial levels are rarely equal. Among Caucasians, the third part of the face is less than the middle's part. In East Asia, the average third of the face is often larger .
Kini et al conducted a study on the correlation of anthropometric measures with dental measurements, according to his statistics the ratio of Ricketts is 1.29 . Thus, Banu et al found a value of 1.31 in an assessment study of the correlation of facial measurements and confirmed that the current description of the labial beauty consists of open fleshy lips and plumper . A study conducted by Torsello et al, whose objective was to determine whether neoclassical canons were still valid for describing the beauty of the face in Italian women. This study confirmed that a decrease in the distance between the eyes was observed as well as a relative widening of the inter-commissural distance .
In his comparative study between ancient and contemporary faces Mommaerts concluded that the stomiongnathion portion is equivalent to more than double the portion of the upper lip of the nasal sub-stomion. A good gun for both sexes today must have a stomion-gnathion distance of 70% of the subnasal-stomion distance .
A study conducted by Milosevic et al showed an angle (g, sn, pg) in women of 169.05 ± 4.72. These results are therefore lower than the values of our sample which confirms that the current beautiful profiles are more convex .
The study conducted by Bisson and Grobbelaar concluded that the beauty canons evolve towards more prominent and thicker lips .
Other studies also suggested that the Caucasian face featured a markedly more protruding upper lip .
In our study the nasal angle (se, prn, sn) showed a non-significant difference between the two groups. However, it can be said that the nasal angle is more closed in contemporary faces.
For Sforza et al the nasal angle is more acceptable at 94.99 ± 5.01 and the values found in this study fall within this range .
Various studies on the Profile showed different values for the nasal angle. There could be many reasons for the inconsistency between different studies such as racial origin, head orientation, measurement methodology, and age. Some studies were anthropometrically other photometric, while some looked at very young subjects [10,13].
With regard to the nasofrontal angle (g, se, prn) in this study it is more closed in new models. This is in agreement with the results of the study conducted by Li et al on the morphometric analysis of nasal forms and angles in young adults .
According to the study of a plastic surgeon, Pousti et al on the management of the nasofrontal angle in rhinoplasty, the ideal angle for women should be 134° .
The nasolabial angle is formed by two independent lines, one on the nose, another on the upper lip. The angular measurement described by these two lines is a resultant of their individual inclination. This angle alone provides insufficient information because it does not reveal which component is responsible for the variability of its value. It could be the nose, the lip, or both. Thus, the nasolabial angle can be modified by orthodontic treatments and depends on the anteroposterior position or the inclination of the upper anterior teeth.
In the study of Armijo et al on profile photographs of 10 men and 10 women who underwent rhinoplasty performed by senior surgeons. The authors found an apparent upper rotation of the nose and concluded that the ideal nasolabial angle for women is 97.7 ± 2.32 .
According to Bergman regardless of whether an orthodontic or surgical correction is indicated, this angle must be 102 ° ± 8 .
The comparison of the chin protrusion angle revealed a statistically significant difference between the two groups in this study.
The distal angle of the "classic" chin also shows a significant difference between the two groups. We notice an apparent and statistically significant increase in chin angles resulting in a more protruding chin over time.
Ousehal et al confirmed that a review of the photographs in the literature showed that the chin is more prominent in contemporary canons than 30 or 40 years ago .
In recent decades, there has been a growing interest in improving facial aesthetics in orthodontic treatment planning [19-22].
As a result, very recent studies examining the assessment of changes in visual attention; influenced by facial angles and smiling during the evaluation of facial attractiveness, have revolutionized the evaluation of facial aesthetics [23,24].
Determining the aesthetics of the face is considered highly subjective. To improve it, orthodontists need to be aware of what the public sees as an ideal profile. Considering that malocclusions affect psychological conditions and cause changes in appearance, it can be assumed that the presence of malocclusion may influence the perception of facial attractiveness and/or facial esthetics. Thus, to establish a personalized diagnosis in cosmetic dentistry; the objective morphological features observed at different facial angles and the subjective perception studies according to different models of malocclusion may be useful in the future.
The study was approved by the doctoral committee of Hassan II University that serves as the ethics committee.
Consent to Participate: Not applicable