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Understanding Facial Esthetics and The Key Relationship to the Mouth, Lips, Teeth, Smile

The Face – Our Primary Representation of Ourself & Identity To the World Although we are admonished “don’t judge a book by its cover”, we repeatedly defy that warning as we go about our daily lives responding to people on the basis of their facial appearance.(2) The findings fall in line with the ecological theory which states that facial qualities are useful in guiding adaptive behavior in others (and is often accurate). The results of a study from “Why Appearance Matters” are conclusive: 1) We form first impressions from faces despite warnings not to do so. 2) People’s faces provide adaptive information about the social interaction opportunities(3) 3) People’s faces provide adaptive perception of the individual’s perceived traits (their character, who they are) 4) Ecological theory assumes that our perceptions of faces, both trained and social interaction will often be accurate because they are learned (aka adaptive)

In-Depth Knowledge Section: Ecological Theory

Ecological theory intersects with evolutionary psychology theories(4) and it has much in common with a long line of research on nonverbal communication that is also concerned with reactions to facial cues (DePaulo & Friedman, 1998).  It also complements contemporary models of face perception in the cognitive neuroscience literature. One is the dual process model that differentiates mechanisms for the perception of identity versus the perception of emotion and other changeable facial qualities(5) Ecological theory adds to these models by emphasizing that face perception guides behavior, expanding the domain of face perception to include perceived traits and social interaction opportunities, and predicting these perceptions from the overgeneralization of adaptive responses.

No one should feel guilty. Generalizing, or “overgeneralization” across faces is just one instance of the broader cognitive mechanism of stimulus generalization that is essential for adaptive behavior (aka survival). The world would be quite overwhelming if we had no expectations about our social and non-social environment because we failed to generalize from known cases to similar unknown ones. Regardless of cultural or temporal differences, the face is ordinarily the first thing that people (Dr. May included) see when we come upon another person. We then use that experience to form our initial impression of the person. That very first critical impression, the visualization of an individual’s facial appearance, is the very focal point of an individual since it is usually the most exposed body part and our reptilian brains use the information of facial appearance to quickly formulate and extrapolate an opinion. In other words, 87% of the subjective interpretation of a person’s substance is generated from an instantaneous judgment from their face. For example, good-looking individuals are assumed to be more intelligent, have better personalities, and to be sexually warmer than those who are not. This phenomenon, although not universally accepted, is frequently referred to as the ‘halo effect.’ The opposite can also be experienced. The negative halo effect refers to an unfavorable impression that is attached to those less attractive. It is no wonder that Americans spend over $27 billion of dollars annually to attempt to improve their looks. Cultural differences aside, there are certain components of what is considered an attractive face that seems to be universal. Of the $27 billion, $17 billion is spent on dentistry and improving the smile.  Why 60% of the USA spends their Look Improvement money on Cosmetic Dentistry When studies compared several facial features and how the impact the instantaneous formulation of a person’s substance and status, the mouth and smile accounted for 61% of the impact.

Elements that Define Facial Beauty & Optimal Esthetics

According to David Perrett, Professor of Psychology at University of St. Andrews and head of the Perception Lab in Scotland, the attributes of an attractive face can be divided into two categories: 1) absolute conditions of physical preferences 2) relative conditions of physical preferences. Absolute conditions apply to everyone. For example, these may include the horizontal symmetry, how close the face is to aesthetic ideals and what emotions and expressions the face presents, etc. On the other hand, the relative conditions may included similarity (resemblance), difference, and discrepancy of beliefs, etc. These relative conditions result in different preferences of beauty among individuals. Four conditions of beauty that major theories on facial attractiveness have in common are; 1) youthful appearance 2) horizontal symmetry 3) balanced and ideal proportions 4) facial features/characteristics fitting the age and sex The 5th) is positive emotions and bright, happy countenances, which Perrett believes complete the absolute conditions of beauty. In other words, the ideal cephalometric proportions and balance, rather than the golden ratio, may create individual beauty. Cephalometric Analysis The objective of Cephalometric Analysis is to evaluate the relationships, both horizontally & vertically, of the five major components of face: 1. the cranium & cranial base 2. the skeletal maxillae 3. the skeletal mandible 4. the maxillary dentition and alveolar process 5. the mandibular dentition and alveolar process i.e to estimate the relationships, vertically & horizontally, of the jaws to the cranial base & to each other & the relationship of the teeth to their surrounding bone.

Key Facial Esthetic Concepts at the Macro Level

Key 1: Facial Symmetry Key 2: Facial Proportions Key 3: Facial Features & Placement of Features

Table 1:

Facial Beauty Analysis – What Matters Most

Facial Symmetry is Proven Beauty Determinant Studies have shown that even infants, who clearly have no training or cultural input into what is considered attractive, routinely focus on those with symmetrical faces rather than those with asymmetries even if they are not looking at a parent. Whereas minor asymmetries are often overlooked, more significant ones can detract significantly from a person’s appearance. Think of an individual with a crooked smile or nose or a marked difference in orbital size. Facial Proportion As Just as Important to Beauty Determination Another component in judging an individual’s looks is a matter of proportion. For example, if someone has a large facial skeleton, you will not be surprised or put off if they have a large nose. But if that same nose is attached to a patient with a small face, it attracts negative attention. Sometimes the nose is appropriately proportioned for the face, but looks outsized because the maxilla is retrusive. Observers similarly evaluate the eyes, ears, and jaws as they size up one another. Facial Features and their Placement Equally is Another Powerful Determinant of Facial Beauty In addition to assessing the symmetry of facial features, one also subliminally and quickly appraises the facial features themselves along with their placement to see if they are where they should be. Individuals with hypo- or hypertelorism are easily noted, even by the casual observer. Perhaps subtler placement aberrations can be appreciated in patients who have abnormalities of the horizontal facial thirds or vertical facial fifths. These alterations can also diminish one’s subjective beauty rating. While symmetry, proportion and features are important signposts of beauty, all the facial components contribute to the overall appearance. We virtually instantaneously assess a person’s appearance, looking at the features mentioned above in addition to the individual components of their eyes, nose, smile, teeth, lips, hair, and of course, the quality of their skin. When it comes to correcting shortcomings in this area there are numerous overlapping dental and medical specialists who would lay claim to all or part of the face. All in all, facial beauty is not just about an ear or an eye or a nose and so on. It is the sum of everything between the clavicles and the top of head including the enveloping skin and hair, which is why this text is so unique and important. Experienced practitioners from seven different specialties, all focused on the appearance of the mouth, face, and jaws have contributed to this volume: cosmetic dentistry, prosthetic dentistry, oral and maxillofacial surgery, dermatology, facial plastic surgery, plastic surgery, hair restoration, and oculoplastic surgery.

Table 2:

Features Value Scale – What Matters Most in a Face
Face Shape2%
Skin Quality6%
Total Face100%

Introduction: Facial Esthetics in Smile Design

Dental facial esthetics can be defined in three ways: 1) Macro Esthetics 2) Micro Esthetics 3) Nano Esthetics The smile analysis/design process begins at the macro level, examining the patient’s face first, progressing to an evaluation of the individual teeth, and finally moving to design and material selection considerations. • Traditionally, dental and facial esthetics have been defined in terms of macro and micro elements, but after years of perfecting smile design and esthetics, Dr. May added a third critical element: nano smile esthetics. o Macro esthetics encompasses the interrelationships between the face, eyes, lips, mouth o Micro gingiva, teeth, bite, jaw interaction and the balance of the oral ecosystem o Nano esthetics involve the esthetics of an individual tooth and the perception that the color, anatomy, imperfections, proportion, light distribution (light refraction, light reflection), texture, size, shape, and interrelation to the other teeth is ideal • Historically, accepted smile design concepts and smile parameters help to design esthetic treatments. These specific measurements of form, color, and tooth/ esthetic elements aid in transferring smile design information between the dentist, ceramist, and patient. However, esthetics in dentistry can encompass a broad area known as “the esthetic zone. • Rufenacht delineated smile analysis into facial esthetics, dentofacial esthetics, and dental esthetics, encompassing the macro and micro elements described in the first definition above.2 Further classification identifies five levels of esthetics: facial, oral-facial, oral, dentogingival, and dental (Table 1).1,3 • Dr. Yuriy May, studying and focusing specifically on biomimetic esthetics choose to incorporate a third developing element, the nano esthetic which has become critically important among the world’s elite veneer and crown laboratories, dental lab veneer designers, and also for the most critical patients who expect nothing less than perfection and beauty masterfully delivered to enhance their smile.

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Initiating Smile Analysis: Evaluating Facial and OroFacial Esthetics

The smile analysis/ design process begins at the macro level, examining the patient’s face first, progressing to an evaluation of the individual teeth, and finally moving to material selection considerations. Multiple photographic views ( e.g., facial, sagittal) facilitate this analysis. At the macro level, facial elements are evaluated for form and balance, with an em­phasis on how they may be affected by den­tal treatment. 3A During the macro analysis, the balance of the facial thirds is examined (Fig 1). If something appears unbalanced in any one of those zones, the face and/ or smile will appear unesthetic. Such evaluations help determine the extent and type of treatment necessary to affect the esthetic changes desired. Depending on the complexity and uniqueness of a given case, orthodontics could be considered when restorative treatments alone would not produce the desired results (Fig 2), such as when facial height is an issue and the lower third is affected. In other cases but not all restorative treatments could alter the vertical dimension of occlusion to open the bite and enhance esthetics when a patient presents with relatively even facial thirds (Fig 3).