Archives of Facial Plastic SurgeryVol. 14, No. 6 Free AccessLeonardo da Vinci's Aesthetic Analysis of Nasal Tip ProminenceFarhad B. NainiFarhad B. NainiCorrespondence: Dr Naini, Department of Orthodontics, St George's Hospital and Medical School, Blackshaw Road, London, SW17 0QT, England, UK (E-mail Address: farhad.naini@yahoo.co.uk).Search for more papers by this authorPublished Online:1 Nov 2012AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Aesthetic nasal evaluation requires the nose to be analyzed both as an independent facial unit and in terms of its size, morphologic characteristics, and position relative to its neighboring facial structures and the entire craniofacial complex. Nasal tip projection describes an actual change in the distance from nasal ala to tip, that is, the alar-tip distance. If there is increased tip projection, the nasal tip extends an excessive distance from the face and is perceived as disproportionately prominent.A number of methods have been described to evaluate sagittal nasal tip projection in profile view, each having its limitations.1 These include the nasofacial angle, described by Jacques Joseph (1865-1934), one of the pioneers of modern rhinoplasty, using a drawing of Leonardo da Vinci's to describe what he termed the “profile angle.”2,3 Tip projection has also been analyzed in relation to upper lip height (Simons method4), as nasal height to projection ratio (Goode method1; Baum method5), as a triangle method (Crumley and Lanser method6), as tip projection to nasal length ratio (Byrd and Hobar method7) and as tip projection relative to sagittal upper lip position.1In addition, Baud8 described the “facial circle” method for analyzing nasal tip projection in relation to the sagittal projection of the forehead and chin (Figure 1). The midpoint of the anterior semicircle was taken as the midpoint of the external auditory canal, but an alternative landmark is the tragion, which is the notch on the superior border of the tragus (Behrbohm modification1). A line from tragion to pronasale forms the radius of a circular arc; ideally, the trichion (hairline) and soft-tissue pogonion (the anterior projection of the chin) should be located on the path of this arc. Assuming normal forehead and chin position, if the nasal tip falls outside this circle it is considered to be overprojected. Interestingly, a strikingly similar aesthetic analysis has now been identified in the notebooks of Leonardo da Vinci (Figure 2).Figure 1. Baud's “facial circle.”8 A line from the tragion to the pronasale forms the radius of a circular arc; ideally, the trichion (hairline) and soft-tissue pogonion (anterior projection of the chin) should be located on the path of this arc. Assuming normal forehead and chin position, if the nasal tip falls outside this circle it is considered to be overprojected. Reprinted with permission. Copyright 2011 Farhad B. Naini and Wiley-Blackwell.Figure 2. The facial circle method as depicted by Leonardo da Vinci (1452-1519). Folio 2 (back) and folio 3 (front) from Manuscript A (circa 1490-1492); detail from folio 2 (“profile of human head”) highlighted. Interestingly, as well as the arc from the ear to the nasal tip, there is also a fainter arc from the ear to the glabellar region. 21.3 × 14.8 cm. Bibliothèque de l'Institut de France, Paris, France. Reproduced with kind permission from Reunion des Musees Nationaux, Bibliothèque de l'Institut de France. Copyright 2012 Bibliothèque de l'Institut de France.The study of the proportions of the human figure was of special interest to the ancient Greeks, particularly in relation to sculpture, and to the Romans, mainly in relation to architecture. The existing works from antiquity became available in the Renaissance, leading to a revival of interest. Leonardo would have studied what was available, but following from and advancing Leon Battista Alberti's methods, he took his own anthropometric measurements in order to find “ideal” proportional relationships.Twelve manuscripts, donated by Count Galeazzo Arconati to the Biblioteca Ambrosiana in the 17th century, were removed in 1796 at the express order of Napoleon Bonaparte, then commanding the French troops who had just entered Milan. They were taken to Paris, to the Institut de France, where they were assigned identifying letters ranging alphabetically from A to M. These manuscripts have various formats, ranging from rapid sketches and quickly jotted notes to accurate text and drawings. Manuscript A originally consisted of 114 folios, of which only 63 remain. (The missing pages were removed in the 19th century by Guglielmo Libri, who fled to England and sold a volume he had put together from these sheets together with others from Manuscript B, to Lord Ashburnham.)The image depicted is from Manuscript A and in the original occurs on a page with unrelated text on matters of natural history (Figure 2). Leonardo did not provide any explanatory text to accompany the image. The image is, as far as we know, a one-off. It is a relatively early drawing (circa 1490-1492) and probably corresponds to a stage when Leonardo was working out how best to tackle the proportions of the body. There are no other drawings that use this method, and it was unusual for Leonardo to make use of circles in his study of the proportions of the human head.9 Yet, the image appears to depict the facial circle method and predates Baud by nearly 5 centuries.This image provides another example of this Renaissance polymath—a man clearly ahead of his time whose mark of genius was an incessant activity of mind and insatiable curiosity for understanding the natural world.Conflict of Interest Disclosures: None reported.REFERENCESNaini FB. Facial regional analysis: the nose.. In: Naini FB, ed. Facial Aesthetics: Concepts and Clinical Diagnosis. Oxford, England: Wiley-Blackwell; 2011:214-237 Google ScholarJoseph J. Nasenplastik und sonstige Gesichtsplastik nebst einem Anhang über Mammaplastik und einige wietere Operationen aus dem Gebiete der äusseren Körperplastik.. Leipzig, Germany: Curt Kabitzsch; 1931 Google ScholarNaini FB. Leonardo da Vinci's Portrait of a Young Woman in Profile: studies of beauty and “ideal” proportions.. Arch Facial Plast Surg. 2012;14(2):148–149 22431818 Abstract, Google ScholarSimons RL. Nasal tip projection, ptosis, and supratip thickening.. Ear Nose Throat J. 1982;61(8):452–455 Google ScholarBaum SJ. Introduction.. Ear Nose Throat J. 1982;61(8):426–428 Google ScholarCrumley RL, Lanser M. Quantitative analysis of nasal tip projection.. Laryngoscope. 1988;98(2):202–208 3339933 Google ScholarByrd HS, Hobar PC. Rhinoplasty: a practical guide for surgical planning.. Plast Reconstr Surg. 1993;91(4):642–656 8446718 Google ScholarBaud C. A new way of measuring the profile.. SSO Schweiz Monatsschr Zahnheilkd. 1966;76(9):741–748 5225830 Google ScholarNaini FB. Facial proportions: classical canons to modern craniofacial anthropometry.. In: Naini FB, ed. Facial Aesthetics: Concepts and Clinical Diagnosis. Oxford, England: Wiley-Blackwell; 2011:18-44 Google ScholarFiguresReferencesRelatedDetails Volume 14Issue 6Nov 2012 InformationCopyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Farhad B. Naini.Leonardo da Vinci's Aesthetic Analysis of Nasal Tip Prominence.Archives of Facial Plastic Surgery.Nov 2012.463-464.http://doi.org/10.1001/archfaci.2012.855Published in Volume: 14 Issue 6: November 1, 2012PDF download