Ron Azaria M.D., Roy Inbar M.D.,
Neta Adler M.D.
Department of Plastic Surgery,
Rabin Medical Center, Beilinson Campus, Petah Tiqwa
Sackler Faculty of Medicine , Tel Aviv University, Tel Aviv, Israel
Facial rejuvenation procedure is known to have a major significance in cosmetic plastic surgery. The lips and nose complex plays an important role in the appearance of young, sexy and desired female face 1-4. The recent introduction of simple and feasible cheiloplasty procedures has led to an increase in the number of older patients seeking lip rejuvenation and also younger patients seeking lip enhancement and augmentation to improve their facial aesthetics.
Patients demand for changing the outer appearance of their lips is increasing over the years. While the procedure of lip augmentation has become simple, fashionable and feasible, a more accurate evaluation of the lips appearance is needed.
To clarify the desired result, patients often present the plastic surgeon with photographs from fashion magazines. The surgeon may also use a computerized image of the patient to help her decide on the particular appearance she wants. Unfortunately however, even with meticulous presurgical markings, the outcome is often less than optional, because plastic surgeons lack a standardized calibrated scale of the ideal facial features and thus it is usually done intuitively.
The aim of the present study was to formulate a proportional template of the ideal nose-lip complex for use as an aid in lip surgery. As the facial features of female supermodels are considered attractive by the general population, we used photographs of 60 selected supermodels as our reference of analysis, with the intention of establishing an ideal proportional template of the nose- lip complex.
Material and methods
Frontal two dimensional photographs were collected from Internet Web pages of the top super models of the past 10 years. The photos were stored in a computerized database and analyzed by using Adobe Photoshop 5.5 (Adobe System, San Jose, California). Only photos meeting the following criteria were included:
All photos were of famous models only;
- Visible anatomical landmarks bilaterally (Table 1). (No silhouettes);
- Anterior view (photos with horizontal and/or sagittal head rotation around the cervical axis were excluded);
- Forward gaze and natural head position;
- Lips in natural repose (photos showing smiling or twitching lips were excluded);
- Photos showing models wearing lipstick or makeup, or previous lip augmentation were acceptable;
Anatomical landmarks used on selected photographs
1. Medial canthus
2. Lateral alar nasal crest
3. Upper nostril border
4. Culammela- upper lip border
5. Philtral columns
6. Vermilion border
7. Mouth commisure
The final sample included 60 photos of famous female models. All acceptable photographs were then marked and traced onto separate transparent sheets, as shown in Figure 1, using 50% opacity lines and dots. Due to disparate scale of each photos, we used the “scale” option of the Adobe system match the referral points among the traced drawings to the extent possible. All changes in scale were made on both the horizontal and vertical planes synchronically to avoid distortions. The tracings were then layered to achieve a single template.
Marking technique on selected photographs
The result of the marked tracings derived from the 60 two-dimensional photographs of supermodels is shown in figure 2.
Outcome of layering 60 separate marked tracings
Two photographs were excluded because the models had wide, unbalanced facial features that were extremely disproportionate
Two disproportionate tracings excluded from the analysis
The lines shown in figure 2 were averaged, and the final result is presented in Figure 4.
Final result of nose-lip complex after lines averaged.
The final template achieved has some unique features (Figure. 5a).
Ratios measurements of nasal-lip complex template
A: intercanthal length. B: vertical length between medial canthus and intercommisural line. C: mouth width (intercommisural line). d’, d’’: diagonal lines between medial canthus and apex of Cupid’s bow.
The template was remarkably symmetrical with equally balanced left and right anatomical markings. Nose width at the alar levels was equal to the intercanthal distance and the mouth width (distance between the oral commissures) was 1.49 times the intercanthal distance. Two diagonal lines drawn from the inner canthus to the apex of Cupid’s bow intersect at a point caudal to the nasal tip (Figure 5a).
Measurements of the angles of the template (Figure 5b) yielded the following findings: angle of the upper lip angel with the intercommissural line 25º; angle of the apex of Cupid’s bow, 145º; angle of the base of Cupid’s bow, 140º; angel of the philtral column with the commissural line 96º.
Angles calculated within the nose-lip complex template
1) Angle of upper lip. 2) Angle of apical Cupid’s bow. 3) Angle of base of Cupid’s bow. 4) Angle of philtral column.
The ideal proportion of the lips and nose complex plays an important role in maintaining a well balanced and harmonic feature. An increasing number of patients disapprove of their lips appearance. Whether their lips are thin as a part of aging process or due to a constitutional problem, the need for full, sexy everted lips are ever more preferred today.
While the procedure of lip augmentation has become simple, fashionable and feasible, no accurate evaluation of the lips appearance can be found in the literature. Further more, many of the patients often attend the plastic surgeon with photos retrieve from fashion magazine, with the intention of imitating the ideal lips of the models. unfortunately even those surgeons who are using a computerize demonstration of their patients lips prior to the procedure, often doing it intuitively, verbally with no computerize model to assist them in the search for the ideal proportion of the nose – lip complex.
In the present study, we formulated a computerized template of the ideal lip-nose complex based on distance and angle measurements of standard final soft tissue landmarks derived from 60 photographs of young white supermodels.
The final template received after the analysis of 40 two- dimensional photographs of top supermodel, has some unique features (Fig. 5). This template is remarkably symmetrical with equally balanced left and right anatomical markings.
In their analysis of the neoclassical cannon of facial proportions in a large sample of young adult North American Caucasians, Frakas et al 5,6 noted several variations in the vertical and horizontal orientations.
In the template formulated in the present study, two of the major measurements matched the neoclassical canon: The width of the nose was equal to the intercanthal distance, and the width of the mouth (intercommissural distance) was 1.49 times the intercanthal distance.6
To localize the nasal tip, two diagonal lines were drawn from the inner canthus to the apex of Cupid’s bow (Figure 5a); the intersection of the lines should fall under the pronasion in two dimensional photographs.
The angles measured in our template (Figure 5b) are close to those reported by Bisson et al.7 In our template, the upper lip angel was 25º (compare to 30 º in Bisson at al. 7). , and angels of the right and left apices of Cupid’s bow were 145º, compared to about 134º with minimal difference of less then 0.5 degrees, In the work of Bisson at al. 7 The corresponding angle of the base of Cupid’s bow in the two studies was 140º and 130º, with difference between the angles of the apex and the base in both studies being less then 5 degrees. The angel of philtral column with the intercommisural line was 96º.
Our final temple can be utilized for preoperative planning of the new location and proportion of the upper lip with respect to the nose-lip complex, and for correcting the fullness and eversion of the vermilion and overall shape of the lateral lip borders (figures 6a- 6d). The template can also be downloaded to graphic software and for preoperative patient demonstrations.
A 34 years old female with thin upper and lower lips before augmentation chelioplasty.
The Adobe photoshop utilizes the scale option to adjust the template to the photo.
Pre-treatment marking of the desire lip width.
End result after 6 consecutive treatments with Silicone gel.
- Peck, S., Peck, L. Selected aspects of the art and science of facial esthetics. Semin Orthod. 1(2):105-26, Jun 1995.
- Romm, S. On the beauty of lips. Clin Plast Surg. 11(4):571-81, Oct 1984.
- Franz, M.L., Sokol, A.B. The proportioned philtrum: a helpful measurement and ratio. Cleft Palate J. 9:143-6, Apr 1972.
- Farkas, L.G., Kolar, J.C. Anthropometrics and art in the aesthetics of women's faces. Clin Plast Surg. 14(4):599-616, 1987.
- Farkas, L.G., Katic, M.J., Hreczko, T.A., Deutsch, C., Munro, I.R. Anthropometric proportions in the upper lip-lower lip-chin area of the lower face in young white adults. Am J Orthod. 1984 Jul;86(1):52-60.
- Farkas, L.G., Hreczko, T.A., Kolar, J.C., Munro, I.R. Vertical and horizontal proportions of the face in young adult North American Caucasians: revision of neoclassical canons. Plast Reconstr Surg. 75(3):328-38, Mar 1985.
- Bisson, M., Grobbelaar, A. The esthetic properties of lips: a comparison of models and nonmodels. Angle Orthod. 74(2):162-6, Apr 2004.