31. Facial Analysis

10.1055/b-0038-163155

Janae L. Kittinger, Raman C. Mahabir

Skin type and complexion
- Fitzpatrick classification: Ranks the skin’s tendency to tan or burn after actinic exposure (Table 31-1)
Skin texture and thickness
- Total dermal thickness decreases approximately 6% per decade.
- Actinic exposure and smoking increase the rate of dermal deterioration.
Photoaging
- Glogau classification: Ranks the degree of skin wrinkling and severity of photoaging (Table 31-2)
Severity of facial rhytids
- Classification of rhytids
  - Grade I: No rhytids at rest or on animation
  - Grade II: Superficial rhytids on animation only
  - Grade III: Deep rhytids on animation only
  - Grade IV: Superficial rhytids at rest, deep on animation
  - Grade V: Deep rhytids at rest, deeper on animation

**Table 31-1** Fitzpatrick Skin Type Classification
Skin Type	Sun Exposure History/Skin Color
I	Never tans; burns easily and severely; extremely fair skin
II	Usually burns; tans minimally
III	Burns moderately; tans moderately
IV	Tans moderately and easily; burns minimally
V	Rarely burns; dark brown skin
VI	Never burns; dark brown or black skin

**Table 31-2** Glogau Classification
Photoaging Group	Degree of Skin Wrinkling and Photoaging
I Mild (age 28-35)	Little wrinkling or scarring; no keratosis; requires little or no makeup
II Moderate (age 35-50)	Early wrinkling, mild scarring; sallow color with early actinic keratosis; requires little makeup
III Advanced (age 50-65)	Persistent wrinkling; discoloration with telangiectasias and actinic keratosis; wears makeup always
IV Severe (age 60-75)	Wrinkling; photoaging: gravitational, dynamic; actinic keratosis with or without skin cancer; wears makeup with poor coverage

Classical Greek canons of proportion were formulated and documented by the Renaissance artists. These neoclassical canons are as follows (Fig. 31-1):

The head can be divided into equal halves by a horizontal line through the eyes.
The face can be divided into equal thirds, with the nose occupying the middle third.
The head can be divided into equal quarters, with the middle quarters being the forehead and nose.
The length of the ear is equal to the length of the nose.
The distance between the eyes is equal to the width of the nose.
The distance between the eyes is equal to the width of each eye. (The face width can be divided into equal fifths.)
The width of the mouth is 1½ times the width of the nose.
The width of the nose is a fourth the width of the face.
The nasal bridge inclination is the same as the ear inclination.
The lower face can be divided into equal thirds.
The lower face can be divided into equal quarters.

Tip:

The golden ratio of Fibonacci (1:1.618) is a common theme seen throughout facial aesthetics.

Vertical fifths: Lines drawn adjacent to the most lateral projection of the head, the lateral canthi, and the medial canthi (Fig. 31-2, A)
Horizontal thirds: Lines drawn adjacent to the menton, nasal base, brows at the supraorbital notch level, and hairline
- The lower third can be divided into an upper third and lower two thirds by a line drawn through the oral commissures (Fig. 31-2, B)
- The lower third can be divided into halves by a horizontal line adjacent to the lowest point of the lower lip vermilion (Fig. 31-2, C)
Horizontal line through the labiomental groove divides the stomion-to-menton distance into a 1:2 ratio (Fig. 31-2, D)
Width of the mouth and the stomion-to-menton distance are equal (Fig. 31-2, E)
Width of the mouth approximates the distance between the medial limbi of the corneas (Fig. 31-2, F)
The width of the face at the malar level is equal to the distance from the brows to the menton (Fig. 31-2, G)
The distance from the infraorbital rim to the base of the nose equals the nasal base length, which is equal to half of the length of the middle third of the face (Fig. 31-2, H)

The face profile can be divided into horizontal thirds.
- The lower third can be divided into an upper third and lower two thirds by a line drawn through the oral commissure (Fig. 31-3, A)
The distance from the mandibular angle to the menton is half the distance from the hairline to the menton (Fig. 31-3, B)
The desired lip-chin complex relationship is an upper lip that projects ~2 mm more than the lower lip (Fig. 31-3, C)
- In women the chin lies slightly posterior to the lower lip.
- In men the chin is slightly stronger.