Frontal View Photographs Research Articles

Evaluation of nasolabial esthetics in 8- to 12-year-old patients with cleft lip and palate by healthcare professionals in Northeast Thailand.

To assess the aesthetics of the nasolabial appearance of patients with cleft lip and palate aged 8-12 years by experienced and inexperienced professionals. A cross-sectional study was conducted on 32 patients with cleft lip and palate, who underwent surgery and follow-up treatment at the Cleft Center. The research tools included a parent-completed survey providing GO graphic data and two-dimensional frontal view photographs of patients from both left and right sides. The aesthetic of the lip, nose, and nasolabial region was evaluated by an experienced and inexperienced medical professional team in groups of four individuals. In addition, data analysis was performed using descriptive statistics, mean values, standard deviations, Cronbach's alpha reliability coefficient, and the Wilcoxon signed-rank test. The average age of patients was 10.32 years, mainly male (65.63%), had unilateral cleft lip and palate (62.50%), and underwent bone grafting (96.88%). Regarding the assessment in three aspects, the aesthetic score assessed by experienced evaluators is fair level (2.64 ± 1.09) with an acceptable value of 0.73. In contrast, the inexperienced evaluator showed a high level (2.43 ± 0.83) with a high inter-rater reliability acceptable value of 0.60. Inexperienced evaluators showed higher scores for the lip and nasolabial region than experienced evaluators, which was statistically significant (p-values < 0.01). The inexperienced evaluators showed significantly higher scores for appearance than experienced evaluators. This result can improve surgical techniques in future procedures to meet the needs of patients seeking lip and nasolabial appearance corrections across different age groups.

Facial Analysis of the Igbo Ethnic Group of Nigeria for the Evaluation of Sexual Dimorphism

Background: Facial analysis defines the measurement of soft tissue in the face used in forensics, anthropology, artistic design, and facial reconstruction. The study aims to evaluate the sexual differences in facial parameters among the Igbo ethnic group of Nigeria.&#x0D; Methods: 400 (200 males and 200 females) subjects of Igbo origin volunteered for the study. Each subject's frontal view photographs were taken in the Natural Head Position (NHP) and analyzed using Pro-Image Facial Software Version 2 to evaluate the nasal width, nasal height, mouth width, facial width, facial height, inner canthal distance, and outer canthal distance. Data obtained were analyzed with IBM SPSS (version 23) and independent T-test as an inferential statistic.&#x0D; Results: The result showed that NW was (M=5.16±0.65, F=5.34±0.53, t=-2.91, p=0.00), NH was (M=5.61±0.62, F=5.26±0.57, t=5.92, p=0.00), MW was (M=6.64±0.7, F=6.54±0.71, t=1.46, p=0.14), FW was (M=16.17±1.31, F=15.07±2.04, t=6.39, p=0.00), FH was (M=16.63±1.11, F=16.08±1.31, t=4.36, p=0.00), En was (M=4.62±0.46, F=4.31±0.47, t=6.75, p=0.00) and Ex was (M=12.23±0.86, F=12.16±1.01, t=0.82, p=0.41).&#x0D; Conclusion: The nasal width and Height, facial width and height, and inner canthal distance show gender differences among the Igbo ethnic group of Nigeria. This study will have a practical application in Forensics, Anthropology, Artistic and Industrial design, and to medical professionals involved in facial reconstruction.

Lateral Crural Turn-Up Flap for Increasing the Volume of Cartilaginous Nasal Sidewall in Closed-Approach Dorsal Preservation Rhinoplasty.

Dorsal preservation rhinoplasty can also be applied in crooked nose cases. This article describes a lower lateral cartilage-based flap (lateral crural turn-up flap) used to correct cartilaginous nasal sidewall asymmetries. It was aimed to introduce a flap to be used in crooked nose cases operated with dorsal preservation rhinoplasty and to show possible modifications of this flap. Eight patients who had lateral crural turn-up flap due to crooked nose between July and December 2021 were included in this retrospective study. Standardized preoperative and postoperative 12-month front-view photographs were analyzed and scored for correction of midvault nasal sidewall asymmetries by 2 plastic surgeons. The Rhinoplasty Outcome Evaluation (ROE) scale was applied at 12 months. The mean score given by the surgeons for correction of midvault nasal sidewall asymmetries was 4.18. The mean ROE score was 89, and all patients were satisfied according to their ROE scores. There were no major complications. Unilateral lateral crural turn-up flap seems to be effective in correcting cartilaginous nasal sidewall asymmetries in crooked nose cases operated with dorsal preservation rhinoplasty.

An evaluation of the customized nasal clip protocol for bilateral cleft lip and palate presurgical infant orthopaedics.

Nasoalveolar moulding (NAM) has resulted in profound outcomes in the treatment of bilateral cleft lip and palate patients, including non-surgical columellar lengthening and nasal moulding. We examine an innovative alternative that is less invasive, yet provides similar results. In this study, we describe a novel approach using the Customized Nasal Clip Protocol (CNCP™) and compare the treatment outcomes of a small cohort of infants with bilateral cleft lip ± palate with published results of the Grayson nasoalveolar moulding protocol. A cohort of six bilateral-cleft-affected patients was evaluated for this study. Standardized frontal and worm's eye view photographs were obtained, and clinical measurements were utilized to garner columellar length measurements and nostril height comparisons. The initial and post-surgical results were statistically compared with a student's t-test (p < .05). Inclusion and exclusion criteria were applied to the cohort, which will be described. The resulting columellar length and nostril height increases of the CNCP™ group were comparable to a published cohort of subjects that have undergone nasoalveolar moulding. The nasal changes were found to be significant with a p-value <.01. The CNCP™ cohort also had fewer clinic visits, no complications that led to complete pauses of active treatment, and the benefit of receiving comprehensive treatment that was initiated at their first clinical presentation, in comparison to traditional NAM patients. The increase of columellar length and nostril height that resulted from utilizing the CNCP™ in bilateral cleft patients met the treatment goals of presurgical infant orthopaedics, with results on par with published results of NAM. These results, paired with the reduction in patient, family, and provider burden, further support the continued use and development of the CNCP™ for appropriate patient populations.

Correlation of social smile symmetry with facial symmetry

BackgroundThis study aimed to assess the correlation of social smile symmetry with facial symmetry.MethodsIn this cross-sectional study, frontal view photographs were obtained from 169 eligible patients at rest and smiling with a camera at the level of their nose tip. Several landmarks were selected for facial symmetry and measured at rest and social smiling at the two sides of the face. The respective formula was used to calculate the asymmetry index (AI). The mean values for each AI were calculated, and the correlation between the criteria for a symmetric smile in a social smile with the criteria for facial symmetry, and the correlation between the difference in symmetry criteria at rest and social smiling with facial symmetry criteria were analyzed.ResultsSignificant correlations were noted between Oc-b AI (smile) and Sn-B (rest) facial AI (P = 0.046), An-a (smile) AI and Gn-a (rest) facial AI (P = 0.002), An-b (smile) AI and Sn-b (rest) facial AI (P < 0.001), Pog-a (smile) and Sn-a (rest) facial AI (P < 0.001), Nt-a (smile) and Sn-a (rest) facial AI (P < 0.001), Nt-b (smile) and Sn-b (rest) facial AI (P < 0.001), Ph-a (smile) and Sn-a (rest) facial AI (P < 0.001), Ph-b (smile) and Sn-b (smile) facial AI (P = 0.007), Oc-b AI (difference) and Gn-b (rest) facial AI (P = 0.031), Oc-Pog (difference) AI and Gn-b (rest) facial AI (P = 0.041), An-b (difference) AI and Sn-b (rest) facial AI (P < 0.001), Nt-a (difference) and Sn-a (rest) facial AI (P = 0.006), Nt-b (difference) and Sn-b (rest) facial AI (P < 0.001), and Ph-b (difference) and Sn-b (rest) facial AI (P < 0.001).ConclusionsA significant correlation exists between social smile symmetry and facial symmetry.

Analysis of Hairline and Forehead Sexual Dimorphic Aesthetics in 60 Celebrities Using Artificial Intelligence.

Thirty white female and 30 white male celebrities were included. Three full-face front-view photographs of each celebrity were evaluated by a facial analysis program, using Vision framework and MATLAB. After converting pixel distances to absolute distances, midline and lateral forehead heights were calculated and compared between men and women. Forehead height was similar between attractive men and women, but forehead width was shorter in women. Analysis of forehead height at various points along the hairline demonstrated that forehead measurements above the lateral brow and brow peak were significantly greater in men. Mean forehead height above the lateral eyebrow was 3.51 cm in women and 4.16 cm in men (P = 0.017). Forehead height above the eyebrow peak was 4.34 cm in women and 5.55 cm in men (P < 0.001). Medial forehead height was similar between men and women, indicating that the greatest difference in attractive male and female foreheads is in the lateral forehead and forehead width. Analysis of attractive white celebrities demonstrated no significant differences in central forehead heights between men and women. Forehead width and lateral forehead height were significantly smaller in women, with an overall downward slanting contour. Male hairlines were more horizontal and slanting upward laterally. These results have implications in facial rejuvenation and facial gender-affirming surgery.

Importance of correcting alar base ptosis during primary cleft lip repair.

Until 1999 at our hospital, primary cleft lip repair was performed by the straight-line method and external rhinoplasty was performed by the inverted trapezoidal suture method with bilateral reverse-U incisions for children with cleft lip and palate. Subsequently, repeated surgical corrections of the external nasal morphology became necessary during the growth period, often with unsatisfactory results because repeated external rhinoplasty results in a stronger scar contracture. From 2000 to 2004, we performed external rhinoplasty after patients had stopped growing; however, delaying surgery created a psychological burden for patients. Therefore, since 2005, we have focused on improving alar base ptosis and forming the nostril sill during the primary surgery. This study was performed to subjectively and objectively evaluate whether the current surgical method or the earlier technique produces a better treatment outcome. We subjectively and objectively evaluated alar base asymmetry after primary cleft lip repair but before bone grafting for alveolar cleft repair. For the objective evaluation, we measured the angle of alar base ptosis in frontal view photographs taken at the age of 6 or 7 years in patients who underwent repair before 1999 (Group A) and after 2005 (Group B). The median angle was 2.75° in Group A and 1.50° in Group B, demonstrating a significant difference (P=0.04). The current surgical method, which reflects our focus on improving alar base ptosis and forming the nostril sill, subjectively and objectively improved the external nasal morphology.

Correction of Alar Base Retraction by Levator Labii Alaeque Nasi Muscle Dissection and Alar Rim Grafting: A Clinical Prospective Study.

Alar base retraction may result in disharmony of nose structures.Althoughcorrection of this retraction may play an important role in patient satisfaction, there is a limited number of studies on alar base retraction correction.The aim of this study was to manage alar base retraction with minimal undesirable results. Six patients underwent correction of alar base retraction using dissection of the levator labii alaque nasi muscle with or sometimes without alar rim grafting.Assessment of the defect was done using preoperative and postoperative frontal view photographs of each patient.Comparing the preoperative and postoperative photographs shows a significant improvement in the nasal base asymmetry, and all six patients have aesthetically satisfying results after a 12-month follow-up period.In conclusion, nasal base retraction is a well-known deformity that has been an area of focus in the rhinoplasty field and management of this defect has very promising results.

Objective Outcomes of Trichophytic Brow Lift and Hairline Advancement in Facial Feminization Surgery.

Importance: The upper facial third is an important area to address in facial feminization surgery (FFS). Objective: This study seeks to quantify the changes in eyebrow, hairline, and forehead heights associated with brow lift and hairline advancement surgery in the transgender patient population. Design, Setting, and Participants: A cohort study performed at an academic medical center. Main Outcomes and Measures: Pre- and postoperative frontal view photographs underwent computer-aided photograph analysis. Brow position, hairline position, and forehead height were measured. Patient self-identified race, ethnicity, as well as other demographic factors were also collected. Results: Forty-six patients underwent FFS with brow lift and hairline advancement with photographs permitting measurement. Eyebrow analysis was performed in 33 patients. Hairline and forehead analyses were accomplished in 30 patients. The mean brow elevation was 4.6 mm across all locations. The forehead reduction achieved was 9.8-11.3 mm. Conclusion and Relevance: Trichophytic brow lifting with hairline advancement outcomes was able to be reliably quantified from standardized clinical photographs. On average, 4-5 mm of brow lift, 6-7 mm of hairline lowering, and 10-11 mm of forehead reduction were achieved, contributing to a more feminine appearance of the upper facial third.

Twisted Nose: Preservation Rhinoplasty with Modified Push-Down/Let-Down Technique.

The authors present a retrospective, comparative, and analytical cohort study, that aimed to prove the utility of unilateral or asymmetrical bony wedge resection to straighten the twisted nose as applied in let-down and push-down methods. The study involved objective angle measurements preoperatively and postoperatively on frontal view photographs. Preoperative and postoperative angle measurements were made on frontal view photographs of 78 patients with twisted noses classified as type C and type I. Angles of deviation were obtained using Scion Image software, measured in degrees. Statistical analysis was performed using Excel v15.13.3. Forty-two patients had twisted nose type C and 28 patients had twisted nose type I. The mean age was 19 years. There was an 81% improvement ratio for twisted nose type C and 79% for twisted nose type I, and the angle correction for each type of nasal deformity was statistically significant ( P < 0.01). The majority of postoperative results were classified as excellent to good, with the exception of four cases with bad outcomes, including two patients with type C and two with type I deviations. Unilateral or asymmetrical bony wedge resection is a modification of the let-down rhinoplasty technique. This study demonstrates statistically significant improvements in straightening twisted noses among patients with or without preoperative hump and preserving the nasal dorsum. The authors found this modification better suited for type C deviations. Therapeutic, IV.

Impact of facial components on the attractiveness of face: A perception-based study

Magazines and television displays are not merely crammed with faces-they are filled with appealing faces, and both men and women are interested in a suitable partner's appearance. This study investigated what makes a face attractive and whether perception-related differences exist between facial attractiveness and facial components. In this descriptive-analytical study, frontal and lateral view photographs of 18 young adults (9 male and 9 female) in Class I, II, and III malocclusions were assessed by 90 orthodontists, dentists, models, and laypeople using a 7-point Likert scale in terms of attractiveness. Based on scores, attractive and unattractive groups were formed. Using image analysis software, a range of defined length, angles, perimeter, and area for lips, nose, and chin were measured for the attractive group. For statistical analysis, each group was compared using a 1-way analysis of variance. Logistic regression was performed to analyze the factors of different parameters to the attractiveness of facial components. Overall full-face width, upper lip angle, lip area, and mentolabial angle was significantly different in all the 3 classes (P≤0.05). In Class I malocclusion, nasolabial angle among orthodontists, nasofrontal angle among dentists, lower lip among models, and full-face width among laypeople were responsible for facial attractiveness variation. In Class II malocclusion, nose to upper lip among orthodontists, Cupid's bow among dentists, wider face among models, and upper lip among layperson were responsible for variation in facial attractiveness. In Class III malocclusion, lower lip angle among orthodontists and dentists, Cupid's bows among models and layperson was responsible for variation in facial attractiveness. In Class I faces, lips (Cupid's bows, lower lips, lip areas), nose (nasolabial, nasofrontal, and nasomental angles), and chin (lower lip to chin) contributed to the overall attractiveness of the face, while in Class II faces, lips (upper lip length, interbow distance, lower lip angle), nose (full facial convexity), and chin (mentolabial sulcus), as well as a greater full-face width contributed to the overall attractiveness of the face. In Class III faces, lips (lower lip angle, upper lip length), nose (nose tip angle, full facial convexity), and chin (mentolabial sulcus depth) contributed to the overall attractiveness of the face.

P-50950613-29 - Nasal Mosaic - An antropometric analysis of the South Indian nose

<h3>Introduction</h3> The nose, not only is a beauty defining feature of the face but is also considered a principal element of one's physiognomy. Nasal bone fractures are the most common fracture of the maxillofacial region and they have a direct effect on the individual's appearance. In India, the number of children born with congenital anomalies altering the facial morphology are comparatively high. There is a requirement for correction of the deformity to achieve a near normal nasal anatomy. All the above-mentioned procedures are performed based on the values obtained from studies conducted on caucasian populations. But in a country like India, surgeons require dimensions obtained from the anthropology specific to Indian population. In this study, we aim to analyze the nasal architecture of the South Indian population and give values of aesthetically pleasing dimensions of the nose. <h3>Materials and Methods</h3> 50 female and 50 male volunteers who fulfil the inclusion criteria were included in this study. Frontal, lateral and submental view photographs were obtained for the study participants. Anthropometric analysis of the nose was done including the nasolabial angle, supra-nasal tip angle and fronto-nasal angle. <h3>Results</h3> The south Indian nose belongs to mesorhinae group with a nasal index of 81.28 and 72.59 for males and females respectively. <h3>Discussion</h3> The findings of this study will be unique as we are calculating the angles in the study population as well. These values can be applied to all aesthetic procedures involving the nose of south Indian population.

Attractive Versus Golden Ratios: Formula of Utopian Beauty through Comparison of Facial Proportions among Worldwide Celebrities and Average People.

Beauty criteria change according to trends, cultures, and expectations. So, the golden ratios are not enough to understand the actual beauty concept. It is aimed to create a method and formula to define beauty in terms of different facial measurements and ratios as variables. Frontal view photographs of 50 celebrities and 50 volunteers (female [ n = 70] and male [ n = 30]) were obtained. Thirty-three specific facial points were used. Fifty-nine measurements of distances between those points and ratios of those distances are used as statistical variables. Mean values of those variables for celebrities are compared with all participants.Then, ''total beauty score'' using statically significant differences is defined. Points according to the importance level of interested value are assigned; 1 point for a significance of 0.001 ≤ P < 0.05 and 2 points for P < 0.001. Possible independent variables for the prediction of Utopian Beauty Score were determined using linear regression analysis. Finally, 10 variables (6 measurements and 4 ratios) are used to determine a formula for beauty. In celebrities, the distance between head apex and hair border, lower lip vertical length, the distance between brow medial borders and forehead vertical length were higher than the average population ( P < 0.001, 0.023, 0.034, 0.001, respectively). However, the width of columella, a length between bilateral ala nasi, horizontal face, and vertical nose length, and the distance between brow apexeyelash line were shorter ( P = 0.005, < 0.001, < 0.001, < 0.001, < 0.001, respectively). Some study variables had severely significant correlations with the total beauty point (M29, r = -0.744, P < 0.001; R19, r =-0.745, P < 0.001; and R30, r = -0.735, P < 0.001). The linear regression formula for Utopian Beauty Score was determined according to statistically significant variables as y = 86.5 - 3.6 M5 + 8.1 M14 + 11.1 M20 - 6.4 M25-8.7 M29-10.3 M30-15.6 R19 + 9.3 R20 + 16.4 R25 + 18.3 R26. A large forehead, small nose with lifted tip, plump lip, brows with lateral apex, well-spaced eyes, and ovoid, elliptical face lines are seem to be more attractive. Additionally, a method to create a formula for beauty with variables of different measurements and ratios of facial points are determined.

Effects of Positioning Errors Onto the Ratio and Angle Measurements in Photographs of Patients With Unilateral Cleft Lip and Palate.

Nasolabial esthetics is 1 of the most important issues in the evaluation of treatment outcomes in patients with unilateral cleft lip and palate (CLP). Frontal and basal view photographs are commonly used to evaluate nasolabial esthetics in patients with unilateral CLP. High-quality photography plays an important role in evaluating the treatment outcomes and poor quality photographs can result in errors, whereas evaluating the treatment results. Facial proportions and angles are important in the esthetic perception of the face. Hence, this study aimed to determine the effects of positioning errors on the ratio and angle measurements in photographs of patients with unilateral CLP. In the clinical and computer environment, a mechanism was set up to take photos at standard and at different angles. A real-size unilateral CLP silicone doll was constructed for the photographs to be taken in the clinical setting. A test-retest was performed to determine the reliability of the measured values. The correlation coefficients for the first measurement and remeasurement values were statistically significant; positive and strong correlations were obtained. Based on the data obtained from our study, the angle and ratio measurements obtained from the two-dimensional photographs provided reliable results.

Unilateral Cleft Lip Repair Using the Chang Gung Technique: An Outcome Analysis.

This retrospective study analyzed the outcomes of patients undergoing complete or incomplete unilateral cleft lip repair using the Chang Gung technique. The goal was to compare the symmetry and change of the technique through the measurement of anthropometric points on digital photographs. From 2010 to 2016, a total of 274 complete and incomplete cleft lip patients without other craniofacial deformities were included in the study. All included patients had a minimum 1-year follow-up with frontal view photographs taken. The vermilion area, lip width, vermilion height, lateral lip length, lip height, and Cupid's bow width of both cleft and noncleft sides were measured for all patients. The Cleft Lip Component Symmetry Index was used to determine the symmetry of the cleft and noncleft sides in both incomplete and complete cleft groups. A total of 152 complete and 122 incomplete cleft lip patients were included in the study. The mean Cleft Lip Component Symmetry Index values showed that the vermilion area, lip height, and Cupid's bow width were symmetric on both cleft and noncleft sides. Lip width and lateral lip length were noted to be shorter, whereas the vermilion height was thicker on the cleft side than on the noncleft side. Significant differences between the complete and incomplete cleft group measurements were found for lateral lip length and lip height, and complete cleft measurements were shorter than those for incomplete clefts. There were no significant differences in vermilion area, lip width, vermilion height, and Cupid's bow width. The outcome analysis showed that vermilion height reduction and modifications could be made for both complete and incomplete groups. The complete cleft lip has been found to have a significantly shorter lateral lip length and lip height, reflecting a more severe anatomical soft tissue deficiency in this group. A long-term outcome anthropometric point study may further verify the results of this surgical technique.

Sail excision technique for overhanging thick ala in Saudi Arabia.

Objectives:To demonstrate the correction of overhanging alar with the vestibular triangular excision technique using preoperative and postoperative photographs.Methods:This descriptive retrospective study was conducted at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Fifty patients who underwent open rhinoplasty with the vestibular triangular excision technique were retrospectively assessed. Preoperative and postoperative photographs were examined to evaluate the alar-columellar relationship. Patients included had undergone either primary or revision rhinoplasties between January 2013 and March 2018 and had a thick hanging alar with a grade IV Gunter’s rating for alar-columellar discrepancies. Patient outcomes and satisfaction were subjectively assessed using the rhinoplasty outcome evaluation (ROE) scale and visual analog scale (VAS) by independent analysis of the right lateral, left lateral, and frontal view photographs by 2 rhinoplasty surgeons, both preoperatively and 1-year postoperatively. Statistical significance was calculated by Wilcoxon signed-rank tests.Results:Patients’ ages ranged from 18 to 37 years (mean, 26.34). The study included 22 men (44%) and 28 women (56%). Mean preoperative and postoperative ROE scores were 10.12 and 19.3 and VAS scores 5.14 and 7.94. P-values for preoperative and postoperative comparison of both ROE and VAS were statistically significant (p=0.001).Conclusion:Caring of alar soft tissue during rhinoplasty is important to correct overhanging alar to improve nasal appearance and patient satisfaction. The sail excision technique is reliable and simple and provides good patient satisfaction.

Smile attractiveness of Persian women after orthodontic treatment

Achieving a balanced, attractive smile is an important goal in contemporary orthodontics. This study aimed to assess the smile attractiveness of Persian women after orthodontic treatment. In this descriptive-analytical study, frontal-view photographs were taken of posed smiles of 100 Persian women 3months after completion of their orthodontic treatment. A total of 153 laypeople aged over 15years were requested to score each smile in terms of attractiveness using a visual analogue scale (1-10). Next, 25 photographs that acquired the lowest score (group A) and 25 photographs that acquired the highest score (group B) were chosen and evaluated by 3 orthodontists regarding parameters related to an attractive smile. Data were analyzed using SPSS version18. The mean buccal corridor space in group A was significantly greater than that in group B (P=0.004). The correlation of lip line and study group was significant such that 60% of patients in group B had a moderate lip line (P=0.005). The difference in other parameters was not significant between the 2 groups (P>0.05). The buccal corridor space and lip line are important factors affecting smile attractiveness of Persian women. According to the opinion of the laypeople, smaller buccal corridor space and moderate lip line yield a more attractive smile. Thus, these parameters should be taken into account in the orthodontic treatment of Persian women.

Toward an Automatic System for Computer-Aided Assessment in Facial Palsy.

Importance: Quantitative assessment of facial function is challenging, and subjective grading scales such as House-Brackmann, Sunnybrook, and eFACE have well-recognized limitations. Machine learning (ML) approaches to facial landmark localization carry great clinical potential as they enable high-throughput automated quantification of relevant facial metrics from photographs and videos. However, the translation from research settings to clinical application still requires important improvements. Objective: To develop a novel ML algorithm for fast and accurate localization of facial landmarks in photographs of facial palsy patients and utilize this technology as part of an automated computer-aided diagnosis system. Design, Setting, and Participants: Portrait photographs of 8 expressions obtained from 200 facial palsy patients and 10 healthy participants were manually annotated by localizing 68 facial landmarks in each photograph and by 3 trained clinicians using a custom graphical user interface. A novel ML model for automated facial landmark localization was trained using this disease-specific database. Algorithm accuracy was compared with manual markings and the output of a model trained using a larger database consisting only of healthy subjects. Main Outcomes and Measurements: Root mean square error normalized by the interocular distance (NRMSE) of facial landmark localization between prediction of ML algorithm and manually localized landmarks. Results: Publicly available algorithms for facial landmark localization provide poor localization accuracy when applied to photographs of patients compared with photographs of healthy controls (NRMSE, 8.56 ± 2.16 vs. 7.09 ± 2.34, p ≪ 0.01). We found significant improvement in facial landmark localization accuracy for the facial palsy patient population when using a model trained with a relatively small number photographs (1440) of patients compared with a model trained using several thousand more images of healthy faces (NRMSE, 6.03 ± 2.43 vs. 8.56 ± 2.16, p ≪ 0.01). Conclusions and Relevance: Retraining a computer vision facial landmark detection model with fewer than 1600 annotated images of patients significantly improved landmark detection performance in frontal view photographs of this population. The new annotated database and facial landmark localization model represent the first steps toward an automatic system for computer-aided assessment in facial palsy. Level of Evidence: 4.

Effect of aging in periocular appearances by comparison of anthropometry between early and middle adulthoods in Chinese Han population

Age-related change in ocular appearance occurs throughout adulthood, and involutional alterations in periocular tissues are common in middle-aged or older adults. This study sought to investigate significant differences in periocular anthropometry between young and middle-aged adults of Chinese Han ethnic group. A total of 589 Chinese Han adults were recruited for cross-sectional investigation: 309 young adults (20 to 30 years), and 280 middle adulthood (50 to 70 years). Standardized, frontal view photographs were taken from each subject for measurements of 17 ocular anthropometric parameters (11 linear, three angular and three indicial parameters) detailing dimensions of palpebral fissures, and eyebrows. Eyelid crease morphologies were also evaluated. Distribution of eyelid crease subtypes were different between the two age-groups, and an eyelid subtype (Type VI Closed Crescent) was uniquely found in middle-aged adults. Significant differences were found in majority of the ocular parameters. For most of the fissure-related measurements, values were greater in young adults. For some distance-dimensions between eyes and eyebrows, values were greater in the middle-aged adults. Detailed evaluation of periocular parameters of different age was individually performed for two subjects, which embodied findings from the cross-sectional analysis. By comparison of anthropometries between age-groups, we found alterations in periocular and eyelid morphologies under effect of aging, with association of laxity and loss of elasticity in periocular tissues. This study was the first to provide normative periocular dimensions of early and middle adulthoods in Chinese Han, which is useful for considerations in esthetic surgical decision-making for this population.

Applicability of a pre-established set of facial proportions from frontal photographs in forensic age estimation of a Brazilian population

Child pornography on the internet is one of the crimes with highest increasing incidence worldwide. In this specific type of crime, the victim’s age has important legal implications. To overcome the lack of scientifically established protocols, European researchers explored and proposed a set of facial proportions obtained from images to estimate age. Within a validation scope, the present study aimed to test the applicability of morphological proportions from frontal photographs of the face to estimate age in a Brazilian population. Standardized frontal view photographs from 800 Brazilians (400 females and 400 males) homogeneously distributed in 4 age groups (6, 10, 14 and 18 years ± 30 days) were randomly selected from a Civilian Database of the Brazilian Federal Police. The selected images were analyzed with the aid of cephalometric landmarks. After landmarking the photographs, eighteen metric relations pre-established by Cattaneo et al. (C. Cattaneo, Z. Obertová, M. Ratnayake, L. Marasciuolo, J. Tutkuviene, P. Poppa, D. Gibelli, P. Gabriel, S. Ritz-Timme, Can facial proportions taken from images be of use for ageing in cases of suspected child pornography? A pilot study, Int. J. Leg. Med. 126 2012 139–144) were assessed and analyzed through parametric statistical tests and discriminant analysis. Two indexes had a moderate correlation with age, while ten had a weak correlation and six were not correlated with age. Eleven indexes were statistically different between sexes (p < 0.05). The discriminant analysis showed that 49.6% of the pooled sample was correctly classified into the respective age group. This percentage increased when each sex was analyzed separately: 50.2% for females and 53.5% for males. The set of facial proportions from frontal images proposed by Cattaneo et al. (2012) is related to facial development. As expected, the discriminant power of this approach did not reach optimal effectiveness in the Brazilian sample. In practice, this age estimation method must be adapted for more reliable application in Brazilians.