COMMENTARY
Leslie G. Farkas
Pioneer of Modern Craniofacial Anthropometry
L
ESLIE GABRIEL FARKAS,
MD (1915-2008)
( F i g u r e ), may be
described as the
pioneer of modern
craniofacial anthropometry. His life-
long devotion to research in cranio-
facial anthropometry generated a de-
tailed body of work over nearly half
a century that represents a major
contribution to our understanding
of the craniofacial complex.
Leslie Farkas was born on April
18, 1915, in Rózsahegy, Hungary
(present day Slovakia). He gradu-
ated from medical school in 1941
and served as a military doctor in
World War II. Following the war, he
moved to Prague where he became
a member of the plastic surgery team
at Charles University. His interest in
craniofacial morphology began dur-
ing his period in Prague. Early in his
surgical career, he became dissatis-
fied with the determination of the
morphologic changes in the head
and face by visual assessment, and
so he began to explore the use of
classical anthropometric methods for
the quantitative analysis of faces pre-
operatively and postoperatively. He
collaborated with anthropologist
Professor Karel Hajniš to develop an
empirical system of facial measure-
ments to analyze the faces of pa-
tients with cleft deformities and fa-
cial deformities due to trauma.
In 1968, he was invited by Wil-
liam K. Lindsay, MD, to develop this
research work at the Hospital for
Sick Children in Toronto, Ontario,
Canada. Amidst political upheaval
in Prague in 1968, he immigrated to
Canada. Employed at the Hospital
for Sick Children, he continued ex-
ploring his interest in craniofacial
anthropometry.1 His expertise con-
tinually developed, eventually into
international renown, and his ever-
present desire to improve the un-
derstanding of the craniofacial com-
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plex led to extensive international
collaboration, though he always re-
mained the engine pulling the train.
The work of Farkas has had a con-
siderable influence on modern facial
plastic surgery. He modernized cra-
niofacial surface anthropometry,
bringing techniques into the main-
stream of craniofacial research and pa-
tient management. Since normative
data of craniofacial dimensions of
North American whites did not ex-
ist, Farkas spent much of his career
measuring faces and compiling a huge
database of “norms.”
Science, it is said, is built of facts
the way a house is built of bricks; but
an accumulation of facts is no more
science than a pile of bricks is a
house. Farkas soon realized that just
taking linear craniofacial measure-
ments was not enough. The rela-
tions of measurements—craniofa-
cial proportions—are of paramount
importance in the evaluation and un-
derstanding of the craniofacial com-
plex. From the large quantity of an-
thropometric data collected between
1968 and 1984 from over 2500 indi-
viduals, Farkas and his team pro-
vided 166 individual facial ratios, pre-
sented as proportion indices, which
involve 2 linear craniofacial anthro-
pometric measurements, the smaller
being expressed as a percentage of the
larger. Each proportion index has a
mean index value and a range of
variation for a given population group
based on age, sex, and ethnicity. The
standard deviation (SD) determines
the normal range of variability of an
index, from 2 SD below to 2 SD above
the mean. Index values within this
normal range are regarded as varia-
tions of normal proportions. Mea-
surements within ±1 SD of the mean
are regarded as optimal. The rela-
tionship between 2 measurements is
disproportionate if the proportion in-
dex value lies outside the normal
range. These research findings were
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141
Leslie G. Farkas, MD (1915-2008)
(reprinted from Naini1 with
permission from Elsevier Inc,
Burlington, Massachusetts).
published in a book, Anthropometric
Facial Proportions in Medicine
(1987),2 coauthored with the sur-
geon Ian R. Munro, MD, a student of
Paul Tessier, MD, and subsequently
an authority on the pioneering cra-
niofacial reconstructive techniques of
Tessier. Farkas’s continued re-
search in anthropometric facial pro-
portions and related topics was pub-
lished in 2 editions of Anthropometry
of the Head and Face in Medicine (1981
and 1994)3 and included the appli-
cation of anthropometric facial sur-
face data in cleft lip and palate re-
search, clinical genetics, craniofacial
dysmorphology diagnosis, and fo-
rensic identification.
Farkas was also responsible for
revising the craniofacial propor-
tional canons of antiquity by com-
paring the relevance of such can-
ons to modern anthropometric data
derived from population aver-
ages.4,5 Thus, the proportional rela-
tionships currently used in the di-
agnosis and treatment planning of
craniofacial reconstructive surgery
are directly or indirectly derived
from this work.
Farkas was very much aware that
the North American white norma-
tive data he compiled could not be
applied to different ethnic groups.
 He took great effort to collect as di-
verse data as possible to differenti-
ate the normative data of different
ethnic groups while encouraging sci-
entists from around the world to col-
lect their own population’s norma-
tive measurements.6 He traveled the
world to measure Chinese and Afri-
can faces.3 An extensive interna-
tional anthropometric study was un-
dertaken under the guidance of
Farkas, the initial findings pub-
lished in 2005. 7 One of his last
wishes was to embark on the collec-
tion of craniofacial anthropometric
data of some local Canadian aborigi-
nal groups, a task unfortunately not
accomplished during his lifetime.1
Farkas was also aware that an-
thropometric data required for clini-
cal use had to be age- and sex-
specific. An anthropometric study
was undertaken to evaluate age-
related changes in North American
whites aged 16 to 90 years.8 Though
the data are cross-sectional, it has
paved the way for further longitu-
dinal data collection and analysis. An
understanding of normal craniofa-
cial growth is paramount if the cra-
niofacial surgeon is to understand
the potential pathways of aberrant
craniofacial growth and resulting
growth anomalies.9,10 Anthropomet-
ric data derived from evaluation of
various craniofacial syndromes re-
main significant in the diagnosis of
facial anomalies and treatment plan-
ning for corrective surgery.11-14
Other researchers have followed
in Farkas’s footsteps, collecting and
analyzing anthropometric data from
diverse population groups. The
Archives has been at the forefront in
presenting such data for the use of
facial plastic surgeons. Craniofa-
cial anthropometric data have been
presented for African American
women and men 15,16 and Asian
women of Korean,17,18 Southern Chi-
nese,19 and Javanese ethnicity.20 Fur-
ther evidence has been provided to
aid objective evaluation for facial aes-
thetic and reconstructive surgery of
various facial parameters,21 to con-
tribute to the assessment of facial
asymmetry,22 to develop and pro-
mote computer imaging software for
facial analysis,23 and to provide out-
come measures in facial plastic sur-
gery.24 All of these advances owe a
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debt of gratitude to the work of Leslie
Farkas.
“Nothing great was ever achieved with-
out enthusiasm.”
Ralph Waldo Emerson (1803-1882)
Essays (First Series). Essay X: Circles
Nothing great in the world has
ever been accomplished without
enthusiasm and passion, infectious
attributes that Leslie Farkas pos-
sessed in abundance. During his
career, Farkas published 244 scien-
tific works and 4 books. The cranio-
facial normative data that he col-
lected relating to children and adults,
normal and “attractive” character-
istics,25 comparison of different eth-
nic groups’ features, and compari-
sons with various craniofacial
deformities continue to be used. It
is for his tireless pursuit and end-
less endeavor to further his be-
loved profession that he is the ac-
knowledged father of modern
craniofacial anthropometry.
Farhad B. Naini, BDS, MSc,
FDSRCS, MOrthRCS,
FDSOrthRCS, FHEA
Author Affiliation: Department of
Orthodontics, St George’s Hospital
Medical School and Kingston Hos-
pital, London, England.
Correspondence: Dr Naini, Depart-
ment of Orthodontics, St George’s
Hospital Medical School, Black-
shaw Road, London SW17 0QT, En-
gland (farhad.naini@yahoo.co.uk).
Financial Disclosure: None re-
ported.
REFERENCES
1. Naini FB. In Memoriam: Leslie G. Farkas
(1915-2008). Am J Orthod Dentofacial Orthop.
2009;136(4):614.
2. Farkas LG, Munro IR. Anthropometric Facial Pro-
portions in Medicine. Springfield, IL: Charles C
Thomas; 1987.
3. Farkas LG. Anthropometry of the Head and Face.
2nd ed. New York, NY: Raven Press; 1994.
4. Farkas LG, Hreczko TA, Kolar JC, Munro IR.
Vertical and horizontal proportions of the face in
young adult North American Caucasians: revi-
sion of neoclassical canons. Plast Reconstr Surg.
1985;75(3):328-338.
5. Farkas LG, Forrest CR, Litsas L. Revision of neo-
classical facial canons in young adult
Afro-Americans. Aesthetic Plast Surg. 2000;
24(3):179-184.
6. Farkas LG, Katic MJ, Forrest CR. Comparison of
craniofacial measurements of young adult African-
American and North American white males and
females. Ann Plast Surg. 2007;59(6):692-698.
WWW.ARCHFACIAL.COM
142
7. Farkas LG, Katic MJ, Forrest CR, et al. Interna-
tional anthropometric study of facial morphol-
ogy in various ethnic groups/races. J Craniofac
Surg. 2005;16(4):615-646.
8. Farkas LG, Eiben OG, Sivkov S, Tompson B, Katic
MJ, Forrest CR. Anthropometric measurements
of the facial framework in adulthood: age-related
changes in eight age categories in 600 healthy
white North Americans of European ancestry from
16 to 90 years of age. J Craniofac Surg. 2004;
15(2):288-298.
9. Farkas LG, Posnick JC. Growth and development
of regional units in the head and face based on
anthropometric measurements. Cleft Palate Cra-
niofac J. 1992;29(4):301-302.
10. Farkas LG, Hreczko TM, Katic MJ, Forrest CR.
Proportion indices in the craniofacial regions of
284 healthy North American white children be-
tween 1 and 5 years of age. J Craniofac Surg. 2003;
14(1):13-28.
11. Farkas LG, Kolar JC, Munro IR. Craniofacial dis-
proportions in Apert syndrome: an anthropomet-
ric study. Cleft Palate J. 1985;22(4):253-265.
12. Kolar JC, Farkas LG, Munro IR. Surface morphol-
ogy in Treacher Collins syndrome: an anthropo-
metric study. Cleft Palate J. 1985;22(4):266-
274.
13. Farkas LG, Posnick JC, Hreczko T. Anthropom-
etry of the head and face in 95 Down syndrome
patients. Prog Clin Biol Res. 1991;373:53-97.
14. Farkas LG, Forrest CR, Phillips JH. Comparison
of the morphology of the “cleft face” and the nor-
mal face: defining the anthropometric differences.
J Craniofac Surg. 2000;11(2):76-82.
15. Porter JP, Olson KL. Anthropometric facial analy-
sis of the African American woman. Arch Facial
Plast Surg. 2001;3(3):191-197.
16. Porter JP. The average African American male face:
an anthropometric analysis. Arch Facial Plast Surg.
2004;6(2):78-81.
17. Choe KS, Sclafani AP, Litner JA, Yu GP, Romo
T III. The Korean American woman’s face: anthro-
pometric measurements and quantitative analy-
sis of facial aesthetics. Arch Facial Plast Surg. 2004;
6(4):244-252.
18. Choe KS, Yalamanchili HR, Litner JA, Sclafani AP,
Quatela VC. The Korean American woman’s nose:
an in-depth nasal photogrammatic analysis. Arch
Facial Plast Surg. 2006;8(5):319-323.
19. Sim RS, Smith JD, Chan AS. Comparison of the
aesthetic facial proportions of Southern Chinese
and white women. Arch Facial Plast Surg. 2000;
2(2):113-120.
20. Reksodiputro MH, Koento T, Boedhihartono, Scla-
fani APAPAP. Facial anthropometric analysis of the
Javanese female. Arch Facial Plast Surg. 2009;
11(5):347-349.
21. Spörri S, Simmen D, Briner HR, Jones N. Objec-
tive assessment of tip projection and the nasola-
bial angle in rhinoplasty. Arch Facial Plast Surg.
2004;6(5):295-300.
22. Chatrath P, De Cordova J, Nouraei SA, Ahmed J,
Saleh HA. Objective assessment of facial asym-
metry in rhinoplasty patients. Arch Facial Plast
Surg. 2007;9(3):184-187.
23. Tollefson TT, Sykes JM. Computer imaging soft-
ware for profile photograph analysis. Arch Facial
Plast Surg. 2007;9(2):113-119.
24. Rhee JS, McMullin BT. Outcome measures in fa-
cial plastic surgery: patient-reported and clinical
efficacy measures. Arch Facial Plast Surg. 2008;
10(3):194-207.
25. Farkas LG, Kolar JC. Anthropometrics and art in
the aesthetics of women’s faces. Clin Plast Surg.
1987;14(4):599-616.