Facial plast Surg 2016; 32(04): 444-451
DOI: 10.1055/s-0036-1584234
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Nasofrontal Angle and Nasal Dorsal Aesthetics: A Quantitative Investigation of Idealized and Normative Values

Farhad B. Naini
Department of Orthodontics, Maxillofacial Unit, St. George's Hospital and Medical School, London, United Kingdom
Martyn T. Cobourne
Department of Orthodontics, King's College London, London, United Kingdom
Umberto Garagiola
Department of Orthodontics, Universita Degli Studi di Milano, Milan, Lombardy, Italy
Fraser McDonald
Department of Orthodontics, King's College London, London, United Kingdom
David Wertheim
Faculty of Science, Kingston University, Kingston upon Thames, London, United Kingdom
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Publication History

Publication Date:
05 August 2016 (online)


This study is a quantitative evaluation of the influence of the lower component of the nasofrontal angle on perceived attractiveness and threshold values of desire for rhinoplasty. The nasofrontal angle of an idealized silhouette male Caucasian profile image was altered incrementally between 106 and 148 degrees. Images were rated on a Likert scale by pretreatment patients (n = 75), laypeople (n = 75), and clinicians (n = 35). The results demonstrated that a nasofrontal angle of approximately 130 degrees is ideal, corresponding to a lower component of 60 degrees, with a range of 127 to 142 degrees deemed acceptable. Angles above or below this range are perceived as unattractive, and anything outside the range of 118 to 145 degrees is deemed very unattractive. Reduced nasofrontal angles, simulating a nasal hump deformity, of less than 115 degrees were deemed the least attractive. In terms of threshold values of desire for surgery, for all groups a threshold value of 148 degrees indicated a preference for surgery: for patients, the threshold value was 121 degrees or less; for lay people, the threshold value was 124 degrees or less; and similarly for clinicians, the threshold value was 118 degrees or less. Clinicians were the least critical, and patients appeared to be less critical than lay people. This stresses the importance of using patients as observers, as well as laypeople and clinicians, in facial attractiveness research. From the results of this study, it is recommended that in rhinoplasty planning, the range of normal variability of the nasofrontal angle, in terms of observer acceptance, is taken into account as well as the threshold values of desire for surgery.