Facial Proportions Research Articles

Influence of incisor inclination and anterior vertical facial height on facial attractiveness in an adult Asian male

Balanced facial proportions and hard tissue relationships are important factors in facial attractiveness. The objective of this study was to determine the most pleasing maxillary incisal inclination (MII) on the lateral profile and the impact of various lower anterior facial height (LAFH) ratios (at rest and with a smile) on facial attractiveness. This cross-sectional study was performed with 66 raters equally divided into 3 panels: general dentists (GD), orthodontic residents (OR), and laypersons (LP). Lateral profile view photographs of an Asian man were modified using Photoshop software (Adobe Systems, San Jose, Calif) to show altered MII and LAFH ratios at rest and when smiling. Subjective evaluations of facial attractiveness were performed by raters using a visual analog scale. Kruskal-Wallis test was used to compare esthetic scores among raters, and the Mann-Whitney U test was applied to compare ES between groups. Kruskal-Wallis test showed significant differences in esthetic scores among raters for -10° (P=0.028) and -15° MII (P=0.030). Similarly, significant differences were found in ES for 8% LAFH ratio (P=0.022), and 4% LAFH ratio (P=0.035) at rest. Mann-Whitney U test showed significant differences between raters for -10° and -15° MII and between 8% and 4% LAFH ratio at rest. All groups rated -5° inclinations to be most attractive. General dentists and orthodontic residents found normal LAFH to be the most attractive, whereas long facial height was less attractive with smile. In addition, smile had a camouflaging effect on LAFH.

Face Proportions, and Analysis of Maxillary Anterior Teeth and Facial Proportions in a Thai Population

Background: Esthetics is the primary consideration for patients looking for prosthetic treatment. Determining the facial types of Thai populations is important because most studies conducted in Caucasian populations mention their facial types, and describe the gender comparisons, and GP of the teeth. Objectives: This study compared facial proportions, analyzed the maxillary anterior teeth proportions and determined the relationships between teeth with facial measurements using the Golden Proportion (GP) and Golden Standard (GS) in a Thai population. Methods: A total of 200 students (18-35 years) with well-aligned maxillary anterior teeth participated in this study. Face heights and widths were measured from the face using digital calipers and faces were classified as narrow, average, and broad. Teeth and face proportions were compared with GP and GS. One-way ANOVA was performed to compare maxillary anterior teeth proportions and facial proportions with different face types (α= 0.05). Pearson’s correlation was used (α= 0.05) to determine the correlation between facial proportion and teeth dimension among different facial types. Results: The findings showed 82.50% narrow face, 13.50% average, and 4% broad face among Thai subjects. No GP or GS was found in the face and anterior teeth, but teeth and face proportions other than GP and GS were found. No significant correlation was found between the Width of the Central Incisor (WCI) with interpupillary distance and alar width. Conclusion: In this study, the GP was not found in the facial and teeth proportion. The data obtained from this study may help to provide guidelines for prosthetic and orthodontic management and help to select the proper size and form of the maxillary anterior teeth to achieve proper esthetic outcomes in the Thai population.

Application of Berry’s Index in the Analysis of Bite Mark

Background: This study was done to evaluate the importance of applying Berry’s index in bite markanalysis.With that, it is able to highlight the usefulness of Berry’s index in aiding the analysis of bite markof an individual.Methods: The study was conducted among 60 students between the ages of 18-30 from Saveetha DentalCollege, Chennai. The data that was obtained was then tabulated and statistically analyzed.Conclusion: The results of the study revealed that the widths of both maxillary central incisors and thebizygomatic width were higher in males when compared to females. A positive correlation can be found inmales compared to females in regard to both of the widths obtained. Berry’s index is a useful tool of highforensic value and can be used to help in the identification of an individual’s facial proportions based on thecalculated width of the central incisors. Thus, it can be of correlation to that of forensic facial reconstruction.

Vertical Proportion of the Face: A Cephalometric study

Introduction: Balance in vertical facial proportion is an important criteria for good esthetics. Variations in vertical growth are common and have certain orthodontic implications. The objectives of this study were to determine mean upper anterior facial height and lower anterior facial height, ratio between UAFH to LAFH and their difference among genders in skeletal Class I patients with different vertical growth pattern among patients visiting department of Orthodontic and Dentofacial orthopedics, Tribhuvan University Dental Teaching Hospital, Kathmandu. Materials and Method: This study was descriptive observational cross sectional study with 105 sample aged from 18-25 years. Pretreatment cephalometric radiograph of Skeletal Class I patients were taken and divided into three growth patterns as group I (normal growth pattern), group II (horizontal growth pattern ) and group III (vertical growth pattern ). Upper anterior facial height (N-ANS) and lower anterior facial height (ANS-Me) of all samples were measured on lateral cephalogram with cephalometric tracing ruler parallel to true vertical line. Descriptive statistics was used to calculate mean, minimum, and maximum values standard deviations with p value <0.05. Result: The upper anterior facial height (UAFH) and lower anterior facial height (LAFH) measurements in normal growth pattern was 52.37 and 64.4 , in horizontal growth pattern was 53.0 and 62.2, in vertical growth pattern was 53.37 and 64.42 respectively. The mean ratio of upper and lower anterior facial height in normal, horizontal and vertical growth pattern was 0.81, 0.85 and 0.79 respectively. There was no statistically significant difference in upper and lower facial heights between males and females. There was no statistically significant difference in UAFH between normal, horizontal and vertical growth pattern but statistically significant difference was observed in LAFH between groups. Conclusion: The cephalometric values for different vertical groups in skeletal class I can be used more specifically for diagnosis and treatment planning of Nepali population.

Kajian Proporsi Wajah Wayang Potehi Perempuan di Gudo, Jombang dengan Proporsi Rasio Emas

The interaction of Nusantara with various nations that has occurred since long ago led to the acculturation of local and immigrant cultures and produced a new culture. One of them is Wayang Potehi which comes from China and develops in Java. The purpose of this study is to find and describe the facial proportions of the female character of Wayang Potehi in Gudo, Jombang. The method used is a quantitative research method by measuring the facial proportions of several female characters of Wayang Potehi in Gudo with the golden ratio theory and calculating the average. In addition, this research also applies interviews with the chairman, Toni, and the puppeteer of Hok Ho An (Wayang Potehi Gudo group), Sonny, as well as direct observation. The golden ratio theory is not used to assess the proportion of Wayang Potehi but as a tool to find the average size of the proportion. The result of this study is the acculturation of Chinese and Javanese culture in visuals, language, stories, characters and characteristics as well as the artists behind the Potehi Wayang. The majority of Wayang Potehi are recognized by the symbols on their clothes and accessories, especially for female characters. Some of the female characters of Wayang Potehi created by the sculptor and Toni's team are quite different from the female characters of Wayang Potehi from China. This shows that the background of the artist (Javanese) influences the work of Wayang Potehi production.

Role of presurgical nasoalveolar molding in the repair of unilateral cleft lip

Aim: A study aims to reappraise the merits of nasoalveolar molding before the repair of unilateral cleft lip. Materials and Methods: A prospective study was conducted with 20 cases of the unilateral complete cleft lip for 3 years. We counseled the parents, offered them to choose the surgical procedure with/without preoperative nasoalveolar molding (NAM), and obtained consent from them. The nasolabial closure was done either after aligning the cleft segments with NAM or without preoperative NAM. The patients were followed up for 1 year and assessed. Both groups are then compared with normal healthy individuals of the same age group. Results: Depending on preoperative NAM, the patients were divided into Groups A (without NAM) and B (with NAM). All the facial proportions and angles (except oral commissural width: facial width and nasal tip angle) of Group B are much closer to the values of normal age-controlled individuals. However, a significant difference existed between the Group A values and normal individuals. Group B showed better nasal symmetry and restoration of normal proportions. The quality of scar produced was significantly superior in Group B when compared to Group A. Body weight change was also significantly different in the two groups. Group B seemed to catch the 15th percentile while Group A stayed at the 3rd percentile in the postoperative period. Conclusion: Presurgical NAM helps to restore the normal facial proportions and produces a healthier scar. Furthermore, the bodyweight of patients seems to improve as the NAM plate acts as a feeding plate.

Facial height proportion based on Angle’s malocclusion in Deutero-Malayids

Background: Facial aesthetics are closely related to the harmonious proportions of the facial components. One of the components is facial height. The reference of facial height proportion of certain racial groups needs to be known by orthodontists and surgeons to create treatment outcomes that can be specifically designed for these particular demographics. One of the factors that can affect facial height proportion is malocclusion. Purpose: This study aimed to determine facial height proportion based on Angle’s classification of malocclusion in Deutero-Malayids. Methods: This study used a descriptive cross-sectional method, which was conducted on 116 Deutero-Malayid subjects. The subjects’ malocclusion was first examined using Angle’s classification of malocclusion. Upper and lower facial height were then measured to determine the proportion of these dimensions. The results were then grouped based on each malocclusion class. Results: It was found that the upper and lower facial height proportions in the class I malocclusion group were 46.74% and 53.26% in males and 47.52% and 52.48% in females, respectively. The upper and lower facial height proportions in the class II malocclusion group were 48.46% and 51.54% in females. Upper and lower facial height proportions in the class III malocclusion group were 45.31% and 54.69% in males and 46.29% and 53.71% in females, respectively. Conclusion: The largest proportion of upper facial height in Deutero-Malayids was seen in the class II malocclusion group, followed by class I and class III. The largest proportion of lower facial height in Deutero-Malayids was seen in the class III malocclusion group, followed by class I and class II.

The Correlation Between Facial Proportion Measurement and the Beauty Satisfaction in College Students

The Correlation Between Facial Proportion Measurement and the Beauty Satisfaction in College Students

Titanium Mesh versus Medpor Implant in Orbital Floor Reconstructions: A Comparative Study.

Background:Treating orbital injuries is interesting and difficult in the facial trauma. The balance in facial proportions and also the facial esthetics are required to achieve an anatomical harmony.Objective:To compare the functional results of individual reconstruction of orbital floor using either titanium mesh or Medpor in terms of various factors.Materials and Methods:There were two study groups including eight subjects with orbital floor fracture, namely A (Medpor) and B (titanium mesh). Various parameters were analyzed postoperatively at intervals of 1 week, 3 week, 6th week, and 3 months after the surgery.Statistical Analysis:Comparison of the different time points with respect to pain scores in the two study groups by Wilcoxon matched pairs test was done. P value was significant in the study Group A with P = 0.0431* and was insignificant in the study Group B with P = 0.1088.Results:All three cases of titanium mesh in orbital floor reconstruction had signs of infection, tenderness, and radiographic proof after 1 week in two subjects and 3 weeks in one patient. Pain was seen in all eight patients 1 week postoperatively.Conclusion:Although orbital reconstruction is a technique sensitive procedure both Medpore and Titanium mesh functions.

Computed tomography assessment of maxillary bone density for orthodontic mini-implant placement with respect to vertical growth patterns.

To quantitatively measure and report bone density of maxilla in the interradicular (alveolar and basal bone) and infrazygomatic crest (IZC) region in various growth patterns among Dravidian individuals. This was a retrospective spiral computed tomography (CT) study. The study was conducted at the Department of Orthodontics, Saveetha Dental College and Hospital, Tamil Nadu, India. Sixty CT scans (24 men, 36 women; mean age = 25.3 years and 23.8 years, respectively) divided equally into three groups based on vertical facial proportions were included. Bone density measurements in Hounsfield units (HU) were performed using Philips and RadiAnt DICOM viewers. Buccal cortical, palatal cortical and cancellous bone regions were analysed in a Philips DICOM viewer and IZC region was analysed in a RadiAnt DICOM viewer. Statistical analysis with one-way ANOVA and post-hoc Tukey HSD test was done. The hypodivergent group had a significantly higher bone density at the buccal cortex in posterior region (P < 0.05) when compared to the normodivergent and hyperdivergent groups. Buccal basal bone was denser than buccal alveolar bone (P < 0.05) in all three groups. In the IZC region, hypodivergent groups had significantly higher density values when compared to the normodivergent and hyperdivergent groups (P < 0.05). The present study concluded that cancellous bone density in the interradicular regions was greatest in the anterior sites and was not influenced by growth pattern. Hypodivergent groups tend to have higher density in the posterior regions (buccal and palatal cortical bone) and at the IZC region compared to normodivergent and hyperdivergent groups.

Facial morphology analysis in osteogenesis imperfecta types I, III and IV using computer vision

AbstractObjectiveOsteogenesis imperfecta (OI) is an autosomal dominant genetic disease that mainly affects the COL1A1/A2 genes. Individuals affected by OI types I, III, and IV have been reported to demonstrate characteristic facial manifestations of the disease. This study aimed to quantitatively assess OI patients’ morphological characteristics.Materials and MethodsThis retrospective case‐control study involved 306 individuals (145 male and 161 female). It used automatic facial annotation and statistical shape analysis to compare facial photographs of individuals affected by OI types I, III, and IV with a normocephalic control group. Four facial ratios were used to compare facial proportions. Additionally, we proposed a novel approach to facial analysis using 68 landmarks and statistical shape analysis to compare morphological features. A predictive model (PCALog) was trained to detect whether a subject was affected by OI, based on facial landmarks.ResultsOur findings correlate with previous reports of OI type III patients’ facial characteristics being the most severely affected among the three types studied. Our novel approach facilitated an interpretation and comparison of morphological changes. Moreover, we successfully trained our PCALog model to automatically detect OI based on landmark features.ConclusionWe found patients’ facial manifestations of OI to be more pronounced at the level of the eyes and temples. Our morphological approach facilitates the comparison of various groups and should be considered for future craniofacial analysis studies. Machine learning models can be trained using facial landmarks to detect the presence of conditions that affect facial morphology.

Association of masseter muscles thickness and facial morphology with facial expressions in children.

ObjectiveTo evaluate the potential influence of muscular capacity and facial morphology on facial expressions in children.Materials and methodsA cross‐sectional study was carried out on 40 healthy children (ages 9–13), without previous orthodontic treatment. Masseter muscle thickness and anthropometric facial proportions were measured using ultrasound and digital calipers respectively. A three‐dimensional infrared face‐tracking system was used to register facial expressions. The maximal amplitude of smile and lip pucker (representing maximal lateral and medial commissure movement) were used for analysis. Stepwise regression was used to investigate whether muscle thickness or anthropometric facial proportions were associated with the quantity of commissure movement.ResultsWhen performing maximal smile, children with thicker masseter muscles were found to have more limited displacement of the commissures (R = 0.39; p = 0.036). When performing lip pucker, children with thicker masseter muscles were found to have greater commissure movement (R = 0.40; p = 0.030). No significant associations were found between anthropometric facial proportions and facial expressions.ConclusionMasseter muscle thickness seems to be associated with facial expressions in children. Those with thicker muscles show more limited commissure movement when smiling, but greater movement with lip pucker. This indicates that masticatory muscles may serve as a surrogate for mimic muscle activity. Facial morphology of the subjects does not seem to be associated with facial expression.

Photoanthropometry in forensics: Comparison of facial images with frontal and lateral views

Photoanthropometry quantify the facial proportions of an individual facilitating the comparison of facial patterns for human identification. The coordinates and vertical distances in pixels of the photoanthropometric landmarks on images of the same individual in frontal and profile views were analyzed and compared. A total of 116 pairs of photographs of Brazilian individuals were evaluated. The photographs were adjusted in size and rotation, and marked in the software Two-dimensional Forensic Facial Analysis System. For each face, 16 landmarks were considered: glabella (g), nasion (n), ectocanthion (ec), pronasale (prn), subnasale (sn), alare (al), cheilion (ch), upper lip (ls), lower lip (li), stomion (sto), labiomental (lm), gnathion (gn), superaurale (sa), subaurale (sba), postaurale (pa) and upper ear lobe (slb); the x- and y-coordinates of each landmark were obtained. Twenty-seven vertical distances between the points were proposed, which were measured by subtracting the values of the y-coordinate. The data were analyzed descriptively and inferentially using the Kolmogorov-Smirnov test, intraclass correlation coefficient (ICC) and Mann-Whitney test (α=5%). The mean age of the sample was 25.9 years (± 4.7), and 50.9% (n=59) were males. When the coordinates were evaluated, a low correlation was obtained between the images (ICC&lt;0.4). Of the 27 proposed measures, 77.7% (n=21) indicated agreement between the images in the two views (p&gt;0.05). A comparison of ls-g, sa-ec, pa-ec, slb-ec, sba-sa and slb-sa showed disagreement between the images. Therefore, there is agreement between the facial measures in the frontal and lateral images, except for ls-g and for the distances between the ear landmarks.

The Nasoalveolar Molding Cleft Protocol: Long-Term Treatment Outcomes from Birth to Facial Maturity.

The authors present outcomes analysis of the nasoalveolar molding treatment protocol in patients with a cleft followed from birth to facial maturity. A single-institution retrospective review was conducted of cleft patients who underwent nasoalveolar molding between 1990 and 2000. Collected data included surgical and orthodontic outcomes and incidence of gingivoperiosteoplasty, alveolar bone grafting, surgery for velopharyngeal insufficiency, palatal fistula repair, orthognathic surgery, nose and/or lip revision, and facial growth. One hundred seven patients met inclusion criteria (69 with unilateral and 38 with bilateral cleft lip and palate). Eighty-five percent (91 of 107) underwent gingivoperiosteoplasty (unilateral: 78 percent, 54 of 69; bilateral: 97 percent, 37 of 38). Of those patients, 57 percent (52 of 91) did not require alveolar bone grafting (unilateral: 59 percent, 32 of 54; bilateral: 54 percent, 20 of 37). Twelve percent (13 of 107) of all study patients underwent revision surgery to the lip and/or nose before facial maturity (unilateral: 9 percent, six of 69; bilateral: 18 percent, seven of 38). Nineteen percent (20 of 107) did not require a revision surgery, alveolar bone grafting, or orthognathic surgery (unilateral: 20 percent, 14 of 69; bilateral: 16 percent, six of 38). Cephalometric analysis was performed on all patients with unilateral cleft lip and palate. No significant statistical difference was found in maxillary position or facial proportion. Average age at last follow-up was 20 years (range, 15 years 4 months to 26 years 10 months). Nasoalveolar molding demonstrates a low rate of soft-tissue revision and alveolar bone grafting, and a low number of total operations per patient from birth to facial maturity. Facial growth analysis at facial maturity in patients who underwent gingivoperiosteoplasty and nasoalveolar molding suggests that this proposal may not hinder midface growth. Therapeutic, IV.

Revealing Stature and Facial Proportions from Teeth: An Adjunct to Forensic Science

Background: Teeth and skull remains are often some of the evidences available that can be used reliably for identification in medicolegal cases. Determination of Stature and facial proportions from teeth dimensions have not been utilised fully in the field of forensics. This study was designed with the aim to estimate stature as well as facial proportions from teeth and head measurements. Objectives: To correlate height of an individual to combined mesiodistal width (CMDW) of maxillary anterior teeth and head circumference and to correlate the facial height and facial width to the cervicoincisal and mesiodistal dimensions of maxillary central incisor. Methodology: This was a descriptive cross-sectional study conducted among 1000 patients of age group 18–30 years of Kerala origin by birth and domicile who fulfilled the inclusion and exclusion criteria. Study variables included length and width of the face, combined mesiodistal (MD) width of maxillary anterior teeth, mesiodistal and cervicoincisal dimension of maxillary central incisor, circumference of the head and height of the individual. The results were statistically analysed using Karl Pearson’s correlation coefficient. Results: Correlation between height and head circumference, height and combined mesiodistal width of maxillary anterior teeth, width of face to mesio-distal width of maxillary central incisor showed significant correlation with p value &lt;0.05, but the correlation coefficients were very weak. But while correlating facial length to cervicoincisal length of maxillary central incisor the values obtained were not statistically significant.

Esthetic Considerations in Orthodontics: An Overview

AbstractEsthetics has been an ever-evolving concept and has gained considerable importance in the field of orthodontics in the last few decades. The re-emergence of the soft tissue paradigm has further catapulted the interest of the orthodontist. So much so that achieving a harmonious profile and an esthetically pleasing smile has become the ideal goal of treatment and is no longer secondary to achieving a functional dental occlusion and/or a rigid adherence to skeletal and dental norms. Esthetics in the orthodontic sense can be divided into three categories: macroesthetics, miniesthetics, and microesthetics. Macroesthetics includes the evaluation of the face and involves frontal assessment and profile analysis. The frontal assessment involves assessment of facial proportions, while the profile analysis involves evaluation of anterior–posterior position of jaws, mandibular plane, and incisor prominence and lip posture. Miniesthetics involves study of the smile framework involving the vertical tooth–lip relationship, smile type, transverse dimensions of smile, smile arc, and midline. Microesthetics involves the assessment of tooth proportions, height-width relationships, connectors and embrasures, gingival contours and heights, and tooth shade and color. The harmony between these factors enables an orthodontist to achieve the idealized esthetic result and hence these parameters deserve due consideration. The importance placed on a pleasing profile cannot be undermined and the orthodontist should aim for a harmonious facial profile over rigid adherence to standard average cephalometric norms. This article aims to give an overview of the macro, mini, and microesthetic considerations in relation to orthodontic diagnosis and treatment planning.

Forehead Reduction Surgery via an Anterior Hairline Pretrichial Incision in Asians: A Review of 641 Cases.

Forehead reduction is gaining in popularity, as facial proportions that include shorter upper and lower thirds are currently more aesthetically pleasing. In this first large-scale study, we present an analysis of several important aspects of surgical design and postoperative complications associated with forehead reduction performed via a pretrichial skin excision. Patients who underwent surgery from 2006 to 2018 were reviewed retrospectively. Data included the amount of skin excised, postoperative complications experienced during the first three months, and forehead length measured 2years postoperatively. Objective outcomes reported by three independent surgeons and subjective satisfaction reported by patients at three months postoperatively were evaluated on 5-point Likert scales that addressed both postoperative scarring and overall aesthetics. A total of 641 patients underwent forehead reduction surgery. The average lengths of the skin excisions were 16.64mm, 15.36mm, and 15.33mm from regions at the center and at the left and right mid-pupillary lines, respectively. Long-term follow-up of 85 patients revealed forehead lengthening that exceeded the initial postoperative measurements by 2.44mm (15.04%), 1.98mm (11.53%), and 2.51mm (15.8%) at the left, center, and right, respectively. Means (standard deviation [SD]) for subjective and objective measures of postoperative scarring were 1.32 (0.49) and 1.78 (0.66), respectively. The means (SD) for subjective and objective postoperative aesthetic scores were 4.38 (0.47) and 3.98 (0.39), respectively. Forehead reduction surgery via a pretrichial skin excision is a straightforward procedure that is easy to perform, has few complications, and result in high rates of patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Determining of canine position by multiple facial landmarks to achieve natural esthetics in complete denture treatment

Statement of problemAnterior tooth selection is an important step in complete denture treatment as it plays a pivotal role not only in esthetics but also in mastication and pronunciation. However, conventional methods for tooth selection are not well established and rely on facial measurements and proportions, which vary among different ethnicities. PurposeThe purpose of this clinical study was to investigate the relationship between interalar width and intercanine distance and to compare different clinical methods for determining the position of the canine tooth. Material and methodsTwo hundred Thai participants (100 men and 100 women) aged 18 to 25 years with 6 full maxillary anterior teeth were enrolled in this study. The interalar width and intercanine distance were measured with digital vernier calipers and compared by using the paired-samples t test. To determine the canine position, 2 reference lines—the alar line (A line) and the inner canthus of the eye to alar line (IA line)—were drawn through the canine on both sides. The horizontal distances from each reference line to the canine cusp tip and distal contact point were evaluated and then analyzed using the 1-sample t test. ResultsAll measurements were significantly different between men and women (P<.01). Interalar width was greater than intercanine distance in both sexes. In men, the A line coincided with the canine distal contact point (P>.05). In contrast, the IA line was distal to the canine distal contact point by 3.5 ±3.6 mm on the left side and by 3.9 ±3.4 mm on the right side. In women, the A line was situated between the canine cusp tip and distal contact point. It was mesial to the distal contact point by 2.0 ±2.0 mm on the left side and by 1.8 ±2.0 mm on the right side. The IA line was distal to the canine distal contact point by 1.2 ±2.6 mm on the left side and by 1.6 ±2.7 mm on the right side. ConclusionsThe interalar width is greater than the intercanine distance in both sexes. The A line is more clinically relevant than the IA line for predicting canine position. The A line can directly determine the distal contact point of the canine in edentulous male patients. However, in women, a distance of approximately 2 mm should be added distal to the A line to locate the distal contact point of the canine on both sides.

The Development and Initial Validation of PUMC Localized Scleroderma Facial Aesthetic Index: A Pilot Study.

Localized scleroderma (LoS) is an autoimmune connective tissue disorder leading to serious long-term aesthetic impairment on patients. Objective evaluation methods are badly needed to facilitate the evaluation of the surgical treatment on individual patients and clinical studies. To develop and assess the reliability and validity of Peking Union Medical College LoS facial aesthetic index (PUMC LoSFAI). Twelve experts devoted their time and resources in the development and validation. LoS patients in the stable phase were recruited. Reliability and validity was then assessed. LoS patients were evaluated by two plastic surgeons using PUMC LoSFAI and LoS skin damage index (LoSDI). The PUMC LoSFAI comprises 4 domains for the local assessment (surface area of lesion, dyspigmentation, skin thickness and soft tissue atrophy) and 3 domains for the overall assessment (facial symmetry, proportion and profile) to describe LoS facial aesthetic impairment. Face-Q was completed by patients at each visit. Thirty-two LoS patients had 96 visits, during which 138 lesions were assessed. PUMC LoSFAI and 7 domains demonstrated substantial to excellent inter- and intra-rater reliability (ICC 0.995, κw 0.72-0.91, r 0.85-0.99, respectively). Seven domains considered to be important to extremely important variables (mean rank 3.2-3.8) had high I-CVI (> 0.78) and S-CVI (0.93). PUMC LoSFAI correlated excellently with LoSDI (r = 0.933, P < 0.001), and correlated fairly with Face-Q (r = - 0.399, P = 0.001). PUMC LoSFAI was developed and evaluated to play as a tool of aesthetic impairment assessment for LoS patients, which may facilitate the evaluation of the treatment on individual patients and clinical studies. PUMC LoSFAI demonstrated high reliability and validity, and further study in larger patient samples is needed to confirm these preliminary findings. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Reharmonize: Aesthetic Modalities Founded on the Concepts of Restoring, Reshaping, and Resurfacing for the Comprehensive Treatment of Millennials

Background: Non-surgical minimally invasive procedures, typically in combination, are now becoming the norm. The integrated use of these modalities can be offered to millennial patients, who have unique demands and aesthetic goals. Objective: We aimed to demonstrate the effects of Definisse™ Fillers, Definisse™ Threads and Definisse™ Peel Program in combination to treat two millennials, one female and one male. Case description: The male subject had noticeable change in his facial proportions with correction of hollows over the malar and suborbital areas and a more prominent chin with the help of both Definisse™ Fillers and Definisse™ Threads (double needle and free floating). There was also noticeable improvement in the pigmentation with a more even and clearer skin tone after Definisse™ Lightening Peel application. The patient verbalized a high level of satisfaction with the effects of the treatment overall. The female subject had a noticeable correction of the prominence on her nasal bridge. There was a slightly pronounced lateral and upward lifting of the cheeks. Her uneven pigmentation was also seen to diminish following Definisse™ Peel Program. She was likewise very satisfied and happy with the result of her treatment. Conclusion: The prejuvenation effect of a combination of minimal invasive procedures provides an optimal aesthetic option for millennials. The results obtained confirm the importance of the reharmonize approach to male and female aesthetics. And this is accomplished by working from deep to superficial facial, with satisfactory and long-lasting aesthetic outcomes.