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Consultant, Director of Research and Graduate Education, Orthodontic Department, St Georges Hospital and Medical School, Kingston Hospital,
London, United Kingdom.
b
Professor, Orthodontic Department, Royal London Hospital, London, United
Kingdom.
c
Consultant, Orthodontic Department, Eastman Dental Hospital, London,
United Kingdom.
Reprint requests to: Dr Farhad B. Naini, Consultant, Orthodontic Department,
St Georges Hospital and Medical School, Blackshaw Rd, London, SW17 0QT,
United Kingdom; e-mail, farhad@naini.freeserve.co.uk.
Submitted, April 2005; revised and accepted, September 2005.
0889-5406/$32.00
Copyright 2006 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2005.09.027
The assessment of facial beauty is essentially subjective.21 In the 16th century, the artist Albrecht Drer
clinical implications. If a patients vertical facial proportions are to be altered with surgery, the treatment
plan must take into account the proportion of the
patients total face height to his or her standing height
and stature. The use of absolute numeric values of
facial measurements rather than facial proportions can
be misleading, because the vertical facial height of a
patient who is 6 feet tall is different from that of a
patient 5 feet tall.
Drer, in 1525, maintained the importance of studying facial proportions, criticizing artists of his day, and
saying, They have not learnt Geometry, without which
no one can either be or become an absolute artist.22
Therefore, the guidelines used by clinicians today are
mainly based on those initially described in art. The
orthodontic specialty, however, has been at the forefront in the assessment of the facial soft-tissue profile,28
mainly because of the use of lateral cephalometric
radiographs that provide many analyses.29-35
Clinicians therefore can assess facial esthetics more
objectively by diagnosing and helping to correct facial
disproportions.
Since the establishment of our specialty over 100
years ago, orthodontic theory and practice have been
based on the Angle paradigm.36 The goal of treatment
was to produce perfect occlusion of all the teeth, and
facial beauty was thought to follow. Although this
concept was discredited with the introduction and
growth of cephalometrics, the basic idea that the
dentofacial skeleton determined the goals of treatment
remained intact.37
It is only recently that the concept of the soft-tissue
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