Chapter 54: Facial Plastic and Reconstructive Surgery

Facial Analysis

Facial Landmarks

1. Trichion: midline point of hairline (Figure 54-1)

2. Glabella: most prominent portion of forehead in midsagittal plane, superior to root of the nose

3. Nasion: deepest point in the nasofrontal angle; location of nasofrontal suture

4. Radix: root of nose; contains the nasion

5. Rhinion: junction of bony and cartilaginous nasal dorsum; thinnest skin of the nose

6. Tip defining point: most anterior projection of nasal tip, corresponds to the apex of the lobular arch of the lower lateral cartilage

7. Subnasale: meeting of the columella and the upper lip

8. Stomion: midpoint of the oral fissure determined with the lips closed

9. Pogonion: anterior-most border of chin

10. Menton: inferior-most border of chin

11. Cervical point: innermost area of the intersection between the submental region and neck

General Facial Assessment

1. Vertical fifths (width): Facial width can be divided into five equally spaced segments.

   1. Demarcated by lateral auricle, lateral canthus, medial canthus, medial canthus, lateral canthus, and lateral auricle.

   2. Each fifth approximates the width of one eye, which equals the intercanthal distance.

2. Horizontal thirds (height): Facial height can be divided into three equally spaced segments demarcated by trichion, glabella, subnasale, and menton.

3. Lower facial thirds: Lower third of face further divided into thirds.

   1. Subnasale to stomion = one-third of lower facial height

   2. Stomion to menton = two-thirds of lower facial height

4. Ideal width to length ratio of face: 3:4.

Facial Angles

1. Nasofacial angle: Intercept of glabella to pogonion line (facial plane) with nasion to tip line (nasal dorsal line); normally 30 to 40 degrees (Figure 54-2)

2. Nasolabial angle: Intercept of line from the subnasale to the most anterior point on columella (columella point) with line from the subnasale to the vermillion border of upper lip; ideal range is 90 to 105 degree in men, 95 to 120 degree in women

3. Nasofrontal angle: Intercept of glabella to nasion line with nasion to tip line (nasal dorsal line); ideal range is 115 to 130 degree

4. Nasomental angle: Intersection of nasal dorsal line with tip to pogonion line (nasomental line); ideal range is 120 to 132 degree

5. Mentocervical angle: Intercept of glabella to pogonion line with menton to cervical point line; ideal range is 80 to 95 degree

Chin and Midfacial Surgery

Preoperative Assessment

1. Anterior projection of chin assessed in relation to a line dropped from the lower lip vermilion border.

   1. Women: Chin ideally 1 to ...