Journal of Cranio-Maxillo-Facial Surgery xxx (2013) 1e6
Contents lists available at ScienceDirect
Journal of Cranio-Maxillo-Facial Surgery journal homepage: www.jcmfs.com
Perioral aging e An anthropometric appraisal Gregor F. Raschke a, c, *,1, Ulrich M. Rieger b, c,1, Rolf-Dieter Bader a, Oliver Schaefer c, Arndt Guentsch c, Marta Gomez Dammeier a, c, Stefan Schultze-Mosgau a a
Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt am Main, Academic Teaching Hospital, Johann Wolfgang von Goethe University, Germany c Interdisciplinary Research Groupe of Computational Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany b
a r t i c l e i n f o
a b s t r a c t
Article history: Paper received 3 June 2013 Accepted 8 October 2013
To adequately perform perioral rejuvenation procedures, it is necessary to understand the morphologic changes caused by facial aging. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate such changes. Photographs of 346 male individuals were evaluated using 12 anthropometric indices. Data from two groups of health subjects, the first exhibiting a mean age of nearly 20 and the second of nearly 60 years, were compared. To evaluate the influence of combined nicotine and alcohol abuse, the data of the second group were compared to a third group exhibiting a similar mean age who were known alcohol and nicotine abusers. Comparison of the first to the second group showed significant decrease of the vertical height of upper and lower vermilion and relative enlargement of the cutaneous part of upper and lower lips. This effect was stronger in the upper vermilion and medial upper lips. The sagging of the upper lips led to the appearance of an increased mouth width. In the third group the effect of sagging of the upper lips, and especially its medial portion was significantly higher compared to the second group. The photo-assisted anthropometric measurements investigated gave reproducible results related to perioral aging. Ó 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Keywords: Facial aging Smoking Aging related changes Perioral region Anthropometry
1. Introduction Facial aging, its effect on the facial morphology and surgical correction are among the most discussed issues in esthetic surgery. An area of special interest is the aging processes of the perioral region. The lips and its surrounding soft-tissue play a key role in non-verbal communication and psychological communication during speech (Leveque and Goubanova, 2004; Lopez-Jornet et al., 2010). Aging of the perioral region is among the main reasons for patients seeking surgical correction of aging related changes (Sullivan et al., 2010). Beside a throughout understanding of the underlying anatomy, a detailed knowledge of aging related changes of the perioral region is fundamental in planning successful anti-aging surgery. Most studies evaluating facial aging do not use comparable methods. To quantify facial aging processes, most authors use defined anthropometric distances and/or angles. Aging related changes are normally presented in absolute values, such as * Corresponding author. Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, D-07740 Jena, Germany. Tel.: þ49 3641 9323674. E-mail address: [email protected] (G.F. Raschke). 1 Authors contributed equally to the manuscript.
millimeters or degrees (Ferrario et al., 2001; Dickens et al., 2002; See et al., 2008). Another preferred method is the report of subjective evaluation by patients, doctors and laymen (Kennedy et al., 2003). In contradiction to these subjective and absolute methods, facial anthropometric indices described by Leslie G. Farkas provide an objectifiable and relative information about relations between at least two anthropometric distances (Farkas, 1981; Farkas and Munro, 1987; Edler et al., 2006). They have proven useful to objectively quantify pre- to postoperative changes in facial reconstructive (Raschke et al., 2012a), traumatologic (Raschke et al., 2012b) and esthetic (Raschke et al., 2011) surgery. Furthermore they are widely used in the field of planning facial changes e.g. in orthodontics (Gosman, 1950; Liou et al., 2007). In this study we investigated the effect of the aging processes on anatomic landmarks and perioral relationships on standardized frontal view and profile photographs. Results of photo-assisted anthropometric measurements of a group of healthy males with a mean age of 20 years (G20) were compared to a group of males with a mean age of 60 years (G60). Of special interest in the evaluation of the influence of harmful habits like alcohol and nicotine abuse on facial aging. To investigate the effect of combined alcohol and nicotine abuse on perioral aging
1010-5182/$ e see front matter Ó 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jcms.2013.10.012
Please cite this article in press as: Raschke GF, et al., Perioral aging e An anthropometric appraisal, Journal of Cranio-Maxillo-Facial Surgery (2013), http://dx.doi.org/10.1016/j.jcms.2013.10.012
2
G.F. Raschke et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2013) 1e6
results of the G60 were compared to a group of similar mean age exhibiting combined alcohol and nicotine abuse (G60a). 2. Material and methods All individuals presented between January 2005 and December 2012 at the Department of Cranio-Maxillofacial Surgery/Plastic Surgery at the University Hospital Jena, Germany. All subjects were male white Caucasian subjects, who exhibited a bilateral support zone in Class I dentition. Individuals exhibiting malocclusion, congenital deformities such as cleft lip and/or palate or earlier operations affecting the superficial facial morphology were excluded. We excluded patients exhibiting general diseases influencing the facial morphology e.g. via the fluid balance such as renal failure. According to patients’ history, none of the patients had had previous therapy for acne or any other facial cosmetic treatment or surgery. To reduce the influence of different quantities of sun exposure, we excluded individuals with professions with excessive sun exposure such as farmers or building workers. Individuals with habits like regular solarium visits were also excluded. The first group (G20) consisted of healthy subjects with a mean age of nearly 20 years (range 18e22 years). All individuals of this
group exhibited a type I in the Glogau Photoaging Classification (Glogau, 1996). Results of the photo-assisted photographic measurements of the first group were compared to a second group (G60) with a mean age of nearly 60 years (range 55e65 years). Subjects included in this group presented for surgical procedures not affecting the facial region. All individuals of this group exhibited a type III in the Glogau Photoaging Classification (Glogau, 1996). To evaluate the potential influence of combined alcohol and nicotine abuse on aging in facial morphology the results of the second group were compared to a third group (G60a) exhibiting a mean age of nearly 60 years (range 55e65 years) who had massive alcohol and nicotine abuse. These patients had an oral squamous cell carcinoma (OSCC). Localization and staging of the tumor were evaluated so as not to influence the superficial facial morphology. All individuals of group G60a exhibited a type III in the Glogau Photoaging Classification (Glogau, 1996). Patients exhibiting diseases, which might influence the facial morphology such as cirrhosis of the liver as a consequence of alcohol abuse were excluded from the study. A photographic comparison of the morphology of the perioral region of two sample subjects of each group is given in Fig. 1.
Fig. 1. Example of frontal and profile-view photographs of the perioral region of two health 20-(Above) and two 60-year-old subjects (Middle). Below photographs of two 60-yearold subjects exhibiting a combined nicotine and alcohol abuse.
Please cite this article in press as: Raschke GF, et al., Perioral aging e An anthropometric appraisal, Journal of Cranio-Maxillo-Facial Surgery (2013), http://dx.doi.org/10.1016/j.jcms.2013.10.012
G.F. Raschke et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2013) 1e6
3
Table 1 Used anthropometric landmarks based on the investigations by Farkas. En: Ch: Cph: Sn: Sbal: Sl: Sto: Ls: Ls’: Li:
Endocanthion Cheilion Crista philtre Subnasale Subalare Sublabiale Stomion Labiale superius Labiale superius vertical beyond the subalare Labiale inferius
2.1. Objective rating scheme Standardized photographs were taken according to earlier published guidelines of standardized photography (Ettorre et al., 2006; Schaaf et al., 2006). Colored frontal view and profile photographs with open eyes were taken by a professional photographer with a Nikon D 80 camera (objective: Nikon AF Micro Nikkor 105 mm 1:2.8 D; aperture: f13; Nikon Corp, Tokyo, Japan) and a constant distance from the patient to the camera in front of a sky blue background. In frontal view the camera height and focus point were aligned to the Frankfort horizontal line and its intersection with the midline of the face, in the profile view to the midline of the Frankfort horizontal line in the midline between tragus and lateral canthus. The patient’s head was positioned in a straight position looking directly in the camera in frontal view and in the distance in profile view. The lips were positioned in relaxed lip closure. Smiling and other facial expressions falsifying the facial anatomy were avoided. Long hair was held out of the region of interest with hair ties, hiding clothes were removed. Only photographs showing patients’ faces clearly at rest and in which the interpupillary axis was at the same level as the camera lens were selected to avoid photographic distortion (Flowers and Flowers, 1993; Ettorre et al., 2006; Schaaf et al., 2006) Photographic analysis was performed using the Adobe Photoshop CS2 (Adobe Inc, San Jose, CA) software measurement tool. On the basis of predefined landmarks (Table 1) and data (Table 2), the following anthropometric indices based on the work of Farkas and Munro (Farkas, 1981; Farkas and Munro, 1987) were investigated (see also Fig. 2): (1) Intercanthal mouth width index, representing the intercanthal width (IW, eneen), as percentage of the mouth width (MW, chech). (2) Philtrum mouth width index, the philtrum width between the two crista philtre (PW, cphecph), as percentage of the mouth width between the two cheilions (lips) (MW, chech). (3) Upper lip height mouth width index, representing the upper lip height, the vertical distance between the subnasale and the stomion (ULH, snesto) as percentage of the mouth width (MW, che ch). (4) Medial lateral cutaneous upper lip height index representing the cutaneous upper lip height, the vertical distance
Fig. 2. Schematic frontal-view image with description of the used anthropometric distances. Mouth width (MW), philtrum width (PW), lateral upper lip height (LULH), upper vermilion arc (UVA), and lower vermilion arc (LVA).
between the labiale superius and the subnasale (CULH, snels), as percentage of the lateral upper lip height, the vertical distance between the subalare and the lateral labiale superius beyond the subalare (LULH, sbalels’). (5) Upper vermilion contour index, the mouth width (MW) as percentage of the upper vermilion arc (UVA, chelsech). (6) Lower vermilion contour index, the mouth width (MW) as percentage of the lower vermilion arc (LVA, cheliech). (7) Vermilion arc index, the lower vermilion arc (LVA) as percentage of the upper vermilion arc (UVA). In the profile photographs the following data were recorded (see also Fig. 3): (1) Cutaneous total upper lip height index, the vertical distance between cutaneous upper lip height (CULH, snels) as percentage of the upper lip height, the vertical distance between subnasale and stomion (ULH, snesto). (2) Cutaneous total lower lip
Table 2 Used anthropometric distances based on the investigations by Farkas. IW: MW: PW: ULH: LLH: CULH: CLLH: LULH: UVA: LVA: UVH: LVH:
Intercanthal width, eneen Mouth width, chech Philtrum width, cphecph Upper lip height, snesto Lower lip height, stoesl Cutaneous upper lip height, snels Cutaneous lower lip height, liesl Lateral upper lip height, sbalels’ Upper vermilion arc, chelsech Lower vermilion arc, cheliech Upper vermilion height, lsesto Lower vermilion height, stoeli
Fig. 3. Schematic profile image with description of the used anthropometric distances. Upper lip height (ULH), lower lip height (LLH), cutaneous upper lip height (CULH), cutaneous lower lip height (CLLH), upper vermilion height (UVH) and lower vermilion height (LVH).
Please cite this article in press as: Raschke GF, et al., Perioral aging e An anthropometric appraisal, Journal of Cranio-Maxillo-Facial Surgery (2013), http://dx.doi.org/10.1016/j.jcms.2013.10.012
4
G.F. Raschke et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2013) 1e6
The G20 and G60 showed significant differences in nine of the evaluated anthropometric indices. The intercanthal mouth width index (p ¼ .013), medial lateral cutaneous upper lip height index (p < .001), upper vermilion contour index (p < .001), lower vermilion contour index (p < .001), and cutaneous total upper (p < .001) and lower (p < .001) lip height index showed significantly higher values in the G60 compared to the G20. The vermilion arc index (p < .001) and vermilion total upper (p < .001) and lower (p < .001) lip height index showed significantly lower values in the G60 compared to the G20. In comparison of the G60 and G60 there were significant differences in the philtrum mouth width index (p ¼ .001), upper lip height mouth width index (p ¼ .028) and medial lateral cutaneous upper lip height index (p ¼ .039). The general diseases of the patients in G60a did not show significant influence on any of the investigated anthropometric indices.
height index represented by the cutaneous lower lip height, the vertical distance between the labiale inferius and the sublabiale (CLLH, liesl), as percentage of the lower lip height, the vertical distance between the stomion and the sublabiale (LLH, stoesl). (3) Vermilion total upper lip height index represented by the upper vermilion height, the vertical distance between labiale superius and stomion (UVH, lsesto), as percentage of the upper lip height (ULH, snesto). (4) Vermilion total lower lip height index, the lower vermilion height, the vertical distance between stomion and labiale inferius (LVH, stoeli) as percentage of the lower lip height (LLH, stoesl). (5) Vermilion height index, represented by the upper vermilion height (UVH, lsesto), as percentage of the lower vermilion height (LVH, stoeli). 2.2. Statistical analysis A univariate ANOVA was conducted to look for significant differences between the three groups. In case a significant effect was found for a variable, post hoc comparisons with Bonferroni correction were applied (Table 3). A p-value of
Contents lists available at ScienceDirect
Journal of Cranio-Maxillo-Facial Surgery journal homepage: www.jcmfs.com
Perioral aging e An anthropometric appraisal Gregor F. Raschke a, c, *,1, Ulrich M. Rieger b, c,1, Rolf-Dieter Bader a, Oliver Schaefer c, Arndt Guentsch c, Marta Gomez Dammeier a, c, Stefan Schultze-Mosgau a a
Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany Department of Plastic & Aesthetic, Reconstructive & Hand Surgery, Markus Krankenhaus, Wilhelm-Epstein-Straße 4, Frankfurt am Main, Academic Teaching Hospital, Johann Wolfgang von Goethe University, Germany c Interdisciplinary Research Groupe of Computational Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany b
a r t i c l e i n f o
a b s t r a c t
Article history: Paper received 3 June 2013 Accepted 8 October 2013
To adequately perform perioral rejuvenation procedures, it is necessary to understand the morphologic changes caused by facial aging. Anthropometric analyses of standardized frontal view and profile photographs could help to investigate such changes. Photographs of 346 male individuals were evaluated using 12 anthropometric indices. Data from two groups of health subjects, the first exhibiting a mean age of nearly 20 and the second of nearly 60 years, were compared. To evaluate the influence of combined nicotine and alcohol abuse, the data of the second group were compared to a third group exhibiting a similar mean age who were known alcohol and nicotine abusers. Comparison of the first to the second group showed significant decrease of the vertical height of upper and lower vermilion and relative enlargement of the cutaneous part of upper and lower lips. This effect was stronger in the upper vermilion and medial upper lips. The sagging of the upper lips led to the appearance of an increased mouth width. In the third group the effect of sagging of the upper lips, and especially its medial portion was significantly higher compared to the second group. The photo-assisted anthropometric measurements investigated gave reproducible results related to perioral aging. Ó 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Keywords: Facial aging Smoking Aging related changes Perioral region Anthropometry
1. Introduction Facial aging, its effect on the facial morphology and surgical correction are among the most discussed issues in esthetic surgery. An area of special interest is the aging processes of the perioral region. The lips and its surrounding soft-tissue play a key role in non-verbal communication and psychological communication during speech (Leveque and Goubanova, 2004; Lopez-Jornet et al., 2010). Aging of the perioral region is among the main reasons for patients seeking surgical correction of aging related changes (Sullivan et al., 2010). Beside a throughout understanding of the underlying anatomy, a detailed knowledge of aging related changes of the perioral region is fundamental in planning successful anti-aging surgery. Most studies evaluating facial aging do not use comparable methods. To quantify facial aging processes, most authors use defined anthropometric distances and/or angles. Aging related changes are normally presented in absolute values, such as * Corresponding author. Department of Cranio-Maxillofacial Surgery & Plastic Surgery, Friedrich Schiller University Jena, D-07740 Jena, Germany. Tel.: þ49 3641 9323674. E-mail address: [email protected] (G.F. Raschke). 1 Authors contributed equally to the manuscript.
millimeters or degrees (Ferrario et al., 2001; Dickens et al., 2002; See et al., 2008). Another preferred method is the report of subjective evaluation by patients, doctors and laymen (Kennedy et al., 2003). In contradiction to these subjective and absolute methods, facial anthropometric indices described by Leslie G. Farkas provide an objectifiable and relative information about relations between at least two anthropometric distances (Farkas, 1981; Farkas and Munro, 1987; Edler et al., 2006). They have proven useful to objectively quantify pre- to postoperative changes in facial reconstructive (Raschke et al., 2012a), traumatologic (Raschke et al., 2012b) and esthetic (Raschke et al., 2011) surgery. Furthermore they are widely used in the field of planning facial changes e.g. in orthodontics (Gosman, 1950; Liou et al., 2007). In this study we investigated the effect of the aging processes on anatomic landmarks and perioral relationships on standardized frontal view and profile photographs. Results of photo-assisted anthropometric measurements of a group of healthy males with a mean age of 20 years (G20) were compared to a group of males with a mean age of 60 years (G60). Of special interest in the evaluation of the influence of harmful habits like alcohol and nicotine abuse on facial aging. To investigate the effect of combined alcohol and nicotine abuse on perioral aging
1010-5182/$ e see front matter Ó 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jcms.2013.10.012
Please cite this article in press as: Raschke GF, et al., Perioral aging e An anthropometric appraisal, Journal of Cranio-Maxillo-Facial Surgery (2013), http://dx.doi.org/10.1016/j.jcms.2013.10.012
2
G.F. Raschke et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2013) 1e6
results of the G60 were compared to a group of similar mean age exhibiting combined alcohol and nicotine abuse (G60a). 2. Material and methods All individuals presented between January 2005 and December 2012 at the Department of Cranio-Maxillofacial Surgery/Plastic Surgery at the University Hospital Jena, Germany. All subjects were male white Caucasian subjects, who exhibited a bilateral support zone in Class I dentition. Individuals exhibiting malocclusion, congenital deformities such as cleft lip and/or palate or earlier operations affecting the superficial facial morphology were excluded. We excluded patients exhibiting general diseases influencing the facial morphology e.g. via the fluid balance such as renal failure. According to patients’ history, none of the patients had had previous therapy for acne or any other facial cosmetic treatment or surgery. To reduce the influence of different quantities of sun exposure, we excluded individuals with professions with excessive sun exposure such as farmers or building workers. Individuals with habits like regular solarium visits were also excluded. The first group (G20) consisted of healthy subjects with a mean age of nearly 20 years (range 18e22 years). All individuals of this
group exhibited a type I in the Glogau Photoaging Classification (Glogau, 1996). Results of the photo-assisted photographic measurements of the first group were compared to a second group (G60) with a mean age of nearly 60 years (range 55e65 years). Subjects included in this group presented for surgical procedures not affecting the facial region. All individuals of this group exhibited a type III in the Glogau Photoaging Classification (Glogau, 1996). To evaluate the potential influence of combined alcohol and nicotine abuse on aging in facial morphology the results of the second group were compared to a third group (G60a) exhibiting a mean age of nearly 60 years (range 55e65 years) who had massive alcohol and nicotine abuse. These patients had an oral squamous cell carcinoma (OSCC). Localization and staging of the tumor were evaluated so as not to influence the superficial facial morphology. All individuals of group G60a exhibited a type III in the Glogau Photoaging Classification (Glogau, 1996). Patients exhibiting diseases, which might influence the facial morphology such as cirrhosis of the liver as a consequence of alcohol abuse were excluded from the study. A photographic comparison of the morphology of the perioral region of two sample subjects of each group is given in Fig. 1.
Fig. 1. Example of frontal and profile-view photographs of the perioral region of two health 20-(Above) and two 60-year-old subjects (Middle). Below photographs of two 60-yearold subjects exhibiting a combined nicotine and alcohol abuse.
Please cite this article in press as: Raschke GF, et al., Perioral aging e An anthropometric appraisal, Journal of Cranio-Maxillo-Facial Surgery (2013), http://dx.doi.org/10.1016/j.jcms.2013.10.012
G.F. Raschke et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2013) 1e6
3
Table 1 Used anthropometric landmarks based on the investigations by Farkas. En: Ch: Cph: Sn: Sbal: Sl: Sto: Ls: Ls’: Li:
Endocanthion Cheilion Crista philtre Subnasale Subalare Sublabiale Stomion Labiale superius Labiale superius vertical beyond the subalare Labiale inferius
2.1. Objective rating scheme Standardized photographs were taken according to earlier published guidelines of standardized photography (Ettorre et al., 2006; Schaaf et al., 2006). Colored frontal view and profile photographs with open eyes were taken by a professional photographer with a Nikon D 80 camera (objective: Nikon AF Micro Nikkor 105 mm 1:2.8 D; aperture: f13; Nikon Corp, Tokyo, Japan) and a constant distance from the patient to the camera in front of a sky blue background. In frontal view the camera height and focus point were aligned to the Frankfort horizontal line and its intersection with the midline of the face, in the profile view to the midline of the Frankfort horizontal line in the midline between tragus and lateral canthus. The patient’s head was positioned in a straight position looking directly in the camera in frontal view and in the distance in profile view. The lips were positioned in relaxed lip closure. Smiling and other facial expressions falsifying the facial anatomy were avoided. Long hair was held out of the region of interest with hair ties, hiding clothes were removed. Only photographs showing patients’ faces clearly at rest and in which the interpupillary axis was at the same level as the camera lens were selected to avoid photographic distortion (Flowers and Flowers, 1993; Ettorre et al., 2006; Schaaf et al., 2006) Photographic analysis was performed using the Adobe Photoshop CS2 (Adobe Inc, San Jose, CA) software measurement tool. On the basis of predefined landmarks (Table 1) and data (Table 2), the following anthropometric indices based on the work of Farkas and Munro (Farkas, 1981; Farkas and Munro, 1987) were investigated (see also Fig. 2): (1) Intercanthal mouth width index, representing the intercanthal width (IW, eneen), as percentage of the mouth width (MW, chech). (2) Philtrum mouth width index, the philtrum width between the two crista philtre (PW, cphecph), as percentage of the mouth width between the two cheilions (lips) (MW, chech). (3) Upper lip height mouth width index, representing the upper lip height, the vertical distance between the subnasale and the stomion (ULH, snesto) as percentage of the mouth width (MW, che ch). (4) Medial lateral cutaneous upper lip height index representing the cutaneous upper lip height, the vertical distance
Fig. 2. Schematic frontal-view image with description of the used anthropometric distances. Mouth width (MW), philtrum width (PW), lateral upper lip height (LULH), upper vermilion arc (UVA), and lower vermilion arc (LVA).
between the labiale superius and the subnasale (CULH, snels), as percentage of the lateral upper lip height, the vertical distance between the subalare and the lateral labiale superius beyond the subalare (LULH, sbalels’). (5) Upper vermilion contour index, the mouth width (MW) as percentage of the upper vermilion arc (UVA, chelsech). (6) Lower vermilion contour index, the mouth width (MW) as percentage of the lower vermilion arc (LVA, cheliech). (7) Vermilion arc index, the lower vermilion arc (LVA) as percentage of the upper vermilion arc (UVA). In the profile photographs the following data were recorded (see also Fig. 3): (1) Cutaneous total upper lip height index, the vertical distance between cutaneous upper lip height (CULH, snels) as percentage of the upper lip height, the vertical distance between subnasale and stomion (ULH, snesto). (2) Cutaneous total lower lip
Table 2 Used anthropometric distances based on the investigations by Farkas. IW: MW: PW: ULH: LLH: CULH: CLLH: LULH: UVA: LVA: UVH: LVH:
Intercanthal width, eneen Mouth width, chech Philtrum width, cphecph Upper lip height, snesto Lower lip height, stoesl Cutaneous upper lip height, snels Cutaneous lower lip height, liesl Lateral upper lip height, sbalels’ Upper vermilion arc, chelsech Lower vermilion arc, cheliech Upper vermilion height, lsesto Lower vermilion height, stoeli
Fig. 3. Schematic profile image with description of the used anthropometric distances. Upper lip height (ULH), lower lip height (LLH), cutaneous upper lip height (CULH), cutaneous lower lip height (CLLH), upper vermilion height (UVH) and lower vermilion height (LVH).
Please cite this article in press as: Raschke GF, et al., Perioral aging e An anthropometric appraisal, Journal of Cranio-Maxillo-Facial Surgery (2013), http://dx.doi.org/10.1016/j.jcms.2013.10.012
4
G.F. Raschke et al. / Journal of Cranio-Maxillo-Facial Surgery xxx (2013) 1e6
The G20 and G60 showed significant differences in nine of the evaluated anthropometric indices. The intercanthal mouth width index (p ¼ .013), medial lateral cutaneous upper lip height index (p < .001), upper vermilion contour index (p < .001), lower vermilion contour index (p < .001), and cutaneous total upper (p < .001) and lower (p < .001) lip height index showed significantly higher values in the G60 compared to the G20. The vermilion arc index (p < .001) and vermilion total upper (p < .001) and lower (p < .001) lip height index showed significantly lower values in the G60 compared to the G20. In comparison of the G60 and G60 there were significant differences in the philtrum mouth width index (p ¼ .001), upper lip height mouth width index (p ¼ .028) and medial lateral cutaneous upper lip height index (p ¼ .039). The general diseases of the patients in G60a did not show significant influence on any of the investigated anthropometric indices.
height index represented by the cutaneous lower lip height, the vertical distance between the labiale inferius and the sublabiale (CLLH, liesl), as percentage of the lower lip height, the vertical distance between the stomion and the sublabiale (LLH, stoesl). (3) Vermilion total upper lip height index represented by the upper vermilion height, the vertical distance between labiale superius and stomion (UVH, lsesto), as percentage of the upper lip height (ULH, snesto). (4) Vermilion total lower lip height index, the lower vermilion height, the vertical distance between stomion and labiale inferius (LVH, stoeli) as percentage of the lower lip height (LLH, stoesl). (5) Vermilion height index, represented by the upper vermilion height (UVH, lsesto), as percentage of the lower vermilion height (LVH, stoeli). 2.2. Statistical analysis A univariate ANOVA was conducted to look for significant differences between the three groups. In case a significant effect was found for a variable, post hoc comparisons with Bonferroni correction were applied (Table 3). A p-value of
