Qualitative (without numerical measurements) evaluation procedure in face analysis
part 2
Analysis of the face from the profile
The convex structure emerges by combining the lines passing through the ear on the face.
In the lateral profile evaluation of the face, lines are drawn starting from the ear, extending to the front hairline, nose root, nose tip and chin. When these are combined, a convex border appears on an attractive and pleasant face. Flattening or being concave spoils the facial appearance. If it is concave, it is called plate-dish or witch’s face-wich face. However, these can be corrected with aesthetic surgical processes or medical aesthetic applications. The increase in convexity is called bird face-bird face.
In the evaluation of the face from this point of view;
Total height of the face is evaluated by comparing it with the upper, middle and lower face parts of this height. The forehead, eyes, nose, upper lip, lower lip and chin in these parts are valued.
In the profile view of the face, the area around the eyes, cheekbones, nasal root, nose, tip of the nose, lips and chin, which project from back to front without error, are valued.
In this respect, the slopes of the outer borders of the forehead, nose, under the eyes, nasal columella, upper and lower lips, under the chin, and length are also examined.
If it is a nice method to be chosen in the profile evaluation of the face; It is the drawing of a vertical and horizontal line passing through the subnasale, which is the junction of the nose with the upper lip. This percentage is useful in the evaluation of all anatomical areas and the interest in the middle.
Division and comparison of the face with vertical and horizontal lines passing through the subnasal
In the profile analysis of the face, it is priced in length. For this purpose, the truth bends to the length of the head. During this movement of the head, many wrinkles and folds appear due to the lactasis of the skin and soft tissues, and this is called the “Accordion sign”.
“Accordion sign” on the neck. In the first photograph, when the patient tilts his head to its length, wrinkles and folds occur in its length. The disappearance of these symptoms after one-on-one aesthetic attempts.
In the profile evaluation of the face, the evaluation is made without looking at the face angles numerically.
Many aspects are used in this aesthetic analysis. Such as forehead-nose angle, nose-chin angle etc.
Angles in percent
In the profile analysis of the face, these angles are not measured numerically. These angles are horizontally dividing by exactly 2. Thus, the angles that the anatomical areas that create the angle are responsible for are determined. For example, in the photo below, the patient’s nose-upper lip angle is enlarged. When this angle is divided by 2 horizontally, it is understood that the anatomical region responsible for this enlargement is caused by the very upper rotation of the nasal tip.
When the angles on the face are divided into two horizontally, the anatomical areas forming the angle are evaluated more properly.
In the qualitative evaluation of the face, general face evaluation from special anatomical areas can also be made.
For example, the lower sclera-whiteness of the eye is visible (inferior scleral show); In the normal head position, the sclera is not visible because the lower eyelid covers the eye completely. However, angling the head up or down increases its visibility. This is called “false inferior scleral show”. For this reason, it is extremely valuable that the head is in its natural position and the eyes are looking straight ahead while evaluating it.
The sclera is not visible in the first photo. However, the upward and downward angulation of the head causes this to become visible in the opposite gaze of the eyes.
The actual scleral show may be regional or due to general problems of the face. For example, the lower eyelid is pulled down, the eyeball is about to be too far forward. Or the underdevelopment of the middle part of the face may be due to “maxilla hypoplasia”. For example, in the photograph below, the patient has “maxilla hypoplasia”.
The visibility of the sclera in this patient is due to the developmental insufficiency of the maxilla.
Another valuable area in the special area assessment is the mandible, the lower jawbone. This special area is most adequately priced in oblique and profile postures of the face. The outer end of the mandible, edge stiffness, angle, overlying soft tissue and ptosis of the tissue are examined.
In the first patient below, the soft tissue thickness on the mandible is thin and thick in the second patient.
The edge plane of the mandible is drawn. This is extremely valuable in evaluating the lower 1/3 of the face, the contour of the chin and the projection of the chin. In addition, the rotation of the mandible with this plane is checked.
In the first patient, the rotation of the extra-mandible line counterclockwise is observed, which causes the lower 1/3 of the face to appear shorter and the chin to be sharply defined. In the second patient, the mandibular outline is ideal. In the last patient, the mandibular outer border rotated clockwise, causing the lower part of the face to appear longer, the projection of the chin was lost and the facial contour of the patient was irregular in the side profile.
In the evaluation of the total length of the face, oblique and profile photographs of the face are used without measuring. With this system, facial tooth-jaw-facial deformities are defined. With this aim, the borders passing through the nasion-upper-ear point, nose-type-tragus upper point, subnasion-under-tragus, stomion-under-ear and mandible corner-pogonion are drawn in oblique and profile photographs. On these drawings, the angles of the silhouettes they make in front of the face are looked at. A line appears in the form of an accordion. Angles and slopes are flattened in the “open accordion” view. In the “closed acardion”, sharp facial angulations and obvious slopes are observed.
For example, the enlarged accordion view in the first 2 photos; the face is elongated and the angles and slopes are flattened. In the 3rd and 4th photos, the narrowed acardium view; the face shortened, the angles became steeper and the slopes became more pronounced.
The relationship of cheekbone-nose-lips
A curve was determined for the connection of the cheekbone-nose-lips (cheekbone–nasal base–lip curve). Aesthetically, this curve on an ideal face should be convex and uninterrupted as in the photo below. This curve starts in front of the ear, progresses on the cheekbone and reaches the cheekbone point marked with 1 in the photo. Then, the forward and downward truth curves and reaches the maxilla point marked with 2 in the photograph, and from there, it follows parallel to the nasolabial fold, and ends outside the mouth corner.
Cheekbone point is the most prominent part of the face on an aesthetically ideal face and is 20-25 mm below and 5-10 mm in front of the outer corner of the eye. Flattening of the cheekbone point can be seen in cheek and maxillary developmental delays.
The posterior placement of the upper jawbone causes this curve to flatten at the maxilla point, or even concave, to flatten the cheekbone point, and to restructure the lower eyelid on the clock side. In oblique facial views of these patients, S-like facial contours and flattening of the cheeks are observed.