Craniofacial Morphologic Parameters in a Persian Population

ANATOMICAL STUDY

Craniofacial Morphologic Parameters in a PersianPopulation: An Anthropometric Study

Fariborz Amini, DDS, MS,* Ziba Mashayekhi, DDS, MS, Hajir Rahimi, DDS, MS,*and Golnaz Morad, DDS†

Abstract: Limited data are available regarding the reference rangesof facial proportions of the Persian population in Iran. This studyaimed to establish the reference range of craniofacial anthropomet-ric measurements in an adult Iranian population. On 100 individuals(men = women), aged 18 to 30 years with normal faces and oc-clusions, 34 linear and 7 angular measurements as well as 24 indiceswere calculated. The difference of measurements between men andwomen were evaluated by paired t-test. The data were comparedwith the norms of North American whites using 1-sample t-test.The subjects belonged to 5 ethnic groups (57% from Fars, 14% fromKord, 11% from Azari, 10% from Gilaki-Mazani, and 2% from Lor).All head measurements were greater in men except for the head in-dex and the head height. The subjects had leptoprosopic faces. Theintercanthal width was almost one third of the biocular width andgreater than the eye fissure length. Although the nose width ofwomen was significantly smaller, both sexes had leptorrhine noses.The chin height and lower chin height were greater in men. Incomparison with North American whites, considerable differenceswere found regarding head height and width, biocular width, noseheight, face height, mouth width, and upper chin height. In conclu-sion, the reference range of craniofacial anthropometric measure-ments established for the Iranian population might be efficientlyused for esthetic treatments.

Key Words: Anthropometry, craniofacial proportions, soft tissueanalysis

(J Craniofac Surg 2014;25: 1874–1881)

Evaluation of soft tissue proportions and parameters is a cri-tical point in diagnosis and treatment planning in patients

with maxillofacial deformities or esthetic problems. The standardsof esthetics considerably vary according to race/ethnicity, sex, andage. Determination of anthropometric measurements and referenceranges of each ethnic group is therefore essential for indicating thedegree of deviations from normal.1–4

From the *Department of Orthodontics, Dental Branch, Islamic Azad Uni-versity, Tehran, Iran; and †Research Institute of Dental Sciences, ShahidBeheshti University of Medical Sciences, Tehran, Iran.

Received June 9, 2013.Accepted for publication February 10, 2014.Address correspondence and reprint requests to Hajir Rahimi, DDS, MS,

Department of Orthodontics, Islamic Azad University, 10th Neyestan St,Pasdaran, Tehran, Iran; E-mail: [email protected]

Ziba Mashayekhi is in private practice in Tehran, Iran.The authors report no conflicts of interest.Copyright © 2014 by Mutaz B. Habal, MDISSN: 1049-2275DOI: 10.1097/SCS.0000000000000902

1874 The Journal of Cr

Copyright © 2014 Mutaz B. Habal, MD. Unauthor

At present, very limited data are available regarding thereference ranges of facial proportions and anthropometric mea-surements of the Persian population in Iran. Aiming to establish nor-mal measurements for different ethnicities, Farkas et al2 collectedanthropometric data of 1470 individuals from 25 European, MiddleEastern, Asian, and African countries including Iran. Other studieshave also evaluated the Iranian population for facial/craniofacial pro-portions.4–7 The reported data, however, are confined to certain eth-nic groups in Iran and cannot be generalized to all the Iranianpopulation.2,4–7 In addition, only particular anatomic regions areincluded in these data, whereas many essential parameters for diagno-sis and treatment planning are left unevaluated.2,7,8 Furthermore, thereare some inconsistencies between the results of these studies.2,4

It is for these reasons that measurements reported in otherpopulations, particularly North American whites (NAWs),9 are com-monly considered in the current treatment guidelines for Iranianpatients. Apparently, these measurements may not be compatiblewith the specific anthropometric characteristics of Iranian people.

This study aimed to establish the reference range of craniofa-cial anthropometric measurements in the adult Iranian population.

MATERIALS AND METHODS

SubjectsThis cross-sectional study was conducted on dental students

of the Azad University, Tehran, Iran, in 2011 to 2012. After clini-cal examination and interview of 1000 students, 100 individuals(50 men, 50 women) aged between 18 to 30 years old were enrolled.Criteria of inclusion were as follows: (1) no history of orthodon-tic treatment; (2) no history of trauma to the craniofacial region;(3) no history of plastic surgery in the orofacial region; (4) havingIranian parents and grandparents; and (5) normal face and occlu-sion, which was defined by symmetric face and occlusion, nor-mal facial height, straight profile, Cl-I molar relationship, normaloverjet and overbite, no posterior cross-bite, no dentoalveolar pro-trusion or retrusion, no considerable spacing or crowding, no miss-ing or extraction of the teeth anterior to the first molar, and/or nosupernumerary teeth anterior to the first molar.

The study was approved by the ethical committee of the uni-versity, and informed consent for reviewing the data of patients wasobtained at enrollment.

MeasurementsClinical examinations, interviews, and measurements were

performed separately by 2 orthodontic residents (Z.M. and H.R.).To assess the raters’ reliability, all the measurements were initiallytaken in 10 women and 10 men, for 3 times with 7-day intervals,and the intraclass correlation coefficient was calculated.

As demonstrated in Figures 1 and 2, 27 anatomic on thepatients’ face and head were considered for measurements and, ifpossible, were marked by a black erasable pen. These points arestandard anatomic landmarks used in previous studies.9 Using the

aniofacial Surgery • Volume 25, Number 5, September 2014

ized reproduction of this article is prohibited.

FIGURE 1. Anatomic points: tr, g, n, pronasale (prn), sn, labiale superius (ls),stomion (sto), ch, labiale inferius (li), sublabiale (sl), pg, gn, cervical point (c),orbitale (or), en, ex, and zy.

The Journal of Craniofacial Surgery • Volume 25, Number 5, September 2014 Parameters in Persian Population

Farkas9 method, 34 linear and 7 angular measurements were taken.Measurement devices included digital sliding calipers with longjaws, digital sliding calipers, digital hook depth gauge, and digi-tal protractor and level (Insize, Austria). Given the importance ofgolden ratio in treatment planning, 9 additional indices were alsotaken.10 The Frankfort line was considered as the reference line.11

Statistical AnalysisData were analyzed by the Statistical Package for the Social

Sciences (version 18; SPSS Inc, Chicago). Mean of the measure-ments taken by the 2 raters was considered for analyses. Shapiro-Wilk test confirmed the normal distribution of data. A P < 0.01 wasconsidered statistically significant. The difference of measurementsbetween men and women was evaluated by paired t-test. Moreover,the data were compared with the norms of NAWs previously reportedby Farkas9 using 1-sample t-test.

RESULTSThe 100 participants enrolled in this study were aged be-

tween 18 to 30 years old (mean, 23.7; SD, 3.4). The subjects

FIGURE 2. Anatomic points: v, n, ex, orbitale (or), al, pronasale (prn), sn,stomion (sto), sublabiale (sl), pg, zy, tragion (t), superaurale (sa), subaurale(sba), postaurale (pa), preaurale (pra), go, and opisthocranion (op).

© 2014 Mutaz B. Habal, MD

Copyright © 2014 Mutaz B. Habal, MD. Unautho

belonged to 5 ethnic groups (57% from Fars, 14% from Kord,11% from Azari, 10% from Gilaki-Mazani, and 2% from Lor).

Intraclass correlation test results are shown in Table 1. Allthe measurement except for the glabella-subnasale (g-sn) inclina-tion had perfect ICCs. The nose width (alare-alare [al-al]), headheight (vertex-nasion [v-n]), and sn-pogonion (pg) inclination hadmoderate ICCs.

The craniofacial measurements of the 5 ethnic groups, thecomparison between sexes, and their relationship to the NAWs’ ref-erence range are presented later.

HeadAll measurements were greater in men than men except for

the head index and head height (v-n). The head circumference inmen and head height in women showed the greatest variations.

In comparison with NAWs, Iranians had wider and shorterheads. Head width in 30% of the women was greater than the re-ference range of NAW women. Head index measurements showedthat, whereas NAWs have a mesocephalic head form, subjects ofthe current study were brachycephalic (Table 2).

EarThe ear dimensions were greater in men than women. How-

ever, the ear index was similar in both sexes.Comparing with the NAWs, only the ear length was signifi-

cantly greater in the Iranian men (Table 3).

OrbitsThe biocular width (exocanthion-exocanthion [ex-ex]) was

greater in men. However, other measurements were similar in menand women. The eye index revealed that the intercanthal width(endocanthion-endocanthion [en-en]) was almost one third of thebiocular width and slightly greater than the eye fissure length (en-ex).

Significantly greater biocular width (and therefore, smallereye index) was seen in the subjects in comparison with NAWs(P < 0.0001). Other measurements were comparable with NAWs(Table 4).

NoseThe nose index was significantly different between men and

women. Although the nose width (al-al) of women was significantly

TABLE 1. Correlations Between the Three Records of Each AnthropometricMeasurement

Measurement ICC* Measurement ICC Measurement ICC

g-op 0.95 al-al 0.69 sa-sba 0.99

eu-eu 0.99 sn-prn 0.84 en-en 0.94

g-op 0.99 ch-ch 0.93 ex-ex 0.96

zy-zy 0.95 sn-sto 0.99 en-ex 0.71

go-go 0.97 sn-ls 0.98 gn-c 0.95

tr-gn 0.92 ls-sto 0.92 v-n 0.67

n-gn 0.99 sto-sl 0.94 g-sn inclination 0.42

n-sto 0.74 li-sl 0.91 sn-pg inclination 0.62

tr-g 0.99 sto-li 0.73 bridge inclination 0.96

g-sn 0.97 sto-gn 0.98 sn-ls inclination 0.97

sn-gn 0.96 sl-pg 0.82 sl-li inclination 0.97

t-sn 0.95 pg-gn 0.95 mentocervical angle 0.98

t-gn 0.93 sl-gn 0.97 nasolabial angle 0.98

n-sn 0.98 pra-pa 0.95

*Poor, 0–0.2; fair, 0.3–0.4; moderate, 0.5–0.6; strong, 0.7–0.8; and perfect, >0.8.

ICC, intra class correlation.

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rized reproduction of this article is prohibited.

TABLE 2. Head Measurements in the Study Population and Their Comparison With Those of NAWs

Measurements/Indices Sex Mean (SD) Min Max NAWs, Mean (SD)

Persian Versus NAW

P Value

Width of the head eu-eu (mm) Men 158.7 (5.4) 148 169.3 153.3 (5.9) ≤0.0001*Women 151.8 (3.9) 141.4 163.4 144.4 (4.6) ≤0.0001*

Length of the head g-op (mm) Men 194.4 (6.2) 178 211 193.7 (7.6) ≤0.62

Women 186.7 (5.5) 172.9 198.1 184.9 (7) ≤0.15

Height of the head v-n (mm) Men 106.4 (5.3) 93.4 115.3 117.7 (8) ≤0.0001*Women 104.2 (6.1) 89.4 115.7 112.7 (7.1) ≤0.0001*

Head circumference on-op (mm) Men 573.1 (13.1) 545 606 568.6 (16.1) ≤0.13

Women 551.9 (13.8) 490 578 544.4 (14.8) ≤0.0098*Head index eu−eu

g−op � 100Men 81.7 (3.5) 74.2 91.3 79.2 (4.6) ≤0.003*

Women 81.4 (2.9) 74.7 88.6 78.2 (4.2) ≤0.0001*

*Statistically significant.

Min, minimum measured amount; Max, maximum measured amount.

Amini et al The Journal of Craniofacial Surgery • Volume 25, Number 5, September 2014

smaller than men (P < 0.0001), the nose form of both sexes wasleptorrhine. Similar to neoclassic canons, the nose width in womenwas almost equal to the eye fissure length. Nose width was approx-imately one fourth of the facial width in subjects. Nasal bridge incli-nation and nose height had the greatest and smallest variations,respectively.

Nose height (n-sn) in both sexes (34% of men and 66% ofwomen) was significantly greater than those of the reference rangein NAW (P < 0.0001). Therefore, the nose index was also affected.Both populations had leptorrhine noses. However, female sub-jects had smaller nasal width than NAW women (P < 0.0001).The nasolabial angle of Iranian women was also smaller than ofNAWs. In contrast to NAWs in which the nasolabial angle is signif-icantly greater in women, the men and women in the current studywere identical (Table 5).

FaceMen had bigger faces in 3 dimensions than women. How-

ever, because these differences were proportionate, the indexes werecomparable in men and women. Regarding the face index, thesubjects had leptoprosopic (long) faces. The mandible width (gonion-gonion [go-go]) was three fourths of the face width (zygion-zygion[zy-zy]), and the depth of maxilla was 43% of the mandible depth.Among facial indices, face width in women and forehead height inmen had the smallest and greatest variations. A slight convexitywas observed in the profiles of both sexes. Moreover, the resultsshowed that the 3 vertical thirds were not equal in the subjects(forehead, 30%; middle third, 35%; lower third, 35%).

The facial height and upper facial height were significantlygreater in NAWs (P < 0.0001). Mandible width, mandibular depth,

TABLE 3. Ear Measurements in the Study Population and Their Comparison With Th

Measurements/Indices Sex Mean (SD)

Ear width pra-pa (mm) Men 37.4 (2.4)

Women 34 (2.8)

Ear length sa-sba (mm) Men 63.3 (4.8)

Women 59.5 (3.5)

Ear index pra−pasa−sba � 100

Men 59.2 (4.8)

Women 57.2 (4)


Min, minimum measured amount; max, maximum measured amount.

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and maxillary depth were greater in female subjects than in NAWwomen (P < 0.0001). Regarding the facial index, although thefacial form of the NAW women is mesoprosopic, the female sub-jects were dominantly leptoprosopic. However, both Iranian andNAW men had leptoprosopic faces, and there was no significantdifference among them (Table 6).

Labio-Oral RegionMouth width, upper and lower lip height, and cutaneous up-

per and lower lip height were greater in men than women. In bothsexes, the mouth width is almost one third of the bizygomaticwidth, the upper lip height is 30% of the lower facial height, andthe lower lip height is 26% of the lower facial height. Upper vermil-ion height of the men and mouth width-facial width index in womenhad the most and least variations, respectively.

The mouth width, upper vermilion height, and cutaneouslower lip height were smaller than NAW in both sexes (P <0.0001 and P < 0.002). Lower vermilion height is smaller in malesubjects than in NAWs; however, the women of both races werethe same. Despite the lower lip inclination, which was similar toNAWs, upper lip inclination was greater in the male and femalesubjects (P < 0.0001 and P < 0.006) (Table 7).

Chin and NeckThe chin height and lower chin height were greater in men.

On average, the chin height is 43% of the lower facial height. Upperand lower chin height is 45% and 64% of the chin height, respec-tively. The throat length was approximately 42 mm, and no signifi-cant difference was observed between men and women. Upper chin

ose of NAWs

Min Max NAW, Mean (SD)

Persian Versus NAW

P Value

28.1 41.3 35.9 (2.2) ≤0.002*27.1 41.6 34.1 (2.6) ≤0.85

53.7 83.8 62.4 (3.7) ≤0.29

51 65.4 59 (3.6) ≤0.48

40.3 68 58.1 (3.9) ≤0.21

48.6 64.8 57.4 (3.8) ≤0.79



TABLE 4. Eye Measurements in the Study Population and Their Comparison With Those of NAWs

Measurements/Indices Sex Mean (SD) Min Max NAW, Mean (SD)

Persian Versus NAW

P Value

Intercanthal width en-en (mm) Men 32.8 (2.9) 26.7 38.6 32.9 (2.7) ≤0.86Women 32.2 (2.7) 25.5 40 32.5 (2.1) ≤0.53

Biocular width ex-ex (mm) Men 94.7 (4.2) 85.8 103.7 90.7 (3.8) ≤0.0001*Women 92.3 (3.6) 84.6 27.9 87.6 (4) ≤0.0001*

Eye fissure length (left) en-ex (mm) Men 31.6 (1.9) 27.7 36.1 31.2 (1.4) ≤0.24Women 31 (1.7) 27.9 35.4 30.7 (1.8) ≤0.39

Eye index en−enex−ex � 100

Men 34.6 (2.4) 29.1 40.3 37.4 (2.2) ≤0.0001*Women 34.9 (2.3) 30.2 42.6 37.2 (2.4) ≤0.0001*




height and the chin height-lower facial height in men had the mostand least variations, respectively.

The upper chin was smaller than NAWs in both sexes(P < 000.1) (Table 8).

DISCUSSIONThis study investigated the craniofacial anthropometric

measurements of an adult Iranian population in 2011 to 2012. Dif-ferent methods are available for the assessment of facial dimen-sions.6,12,13 However, the reliability of direct clinical measurementis considerably more than photography and cephalometry.14,15

We selected 34 linear and 7 angular measurements based on theFarkas9 method and calculated 24 indices from a sample of 50 menand 50 women. A few anthropometric studies have been previouslyperformed on certain ethnic/racial groups in Iran.2,4,5,7,8 In thisstudy, the sample group was chosen from Tehran, the capital ofIran, which is a multiracial city and can be a proper sample of theIranian population.16

Farkas et al2 evaluated 30 men and 30 women in Iran in theirinternational evaluation. Their findings regarding the eye fissure

TABLE 5. Nose Measurements in the Study Population and Their Comparison With

Measurements/Indices Sex Me

Nose width al-al (mm) Men 36

Women 32

Nose height n-sn (mm) Men 58

Women 56

Protrusion of the tip of nose sn-prn (mm) Men 2

Women 19

Nose indexal−aln−sn � 100

Men 63

Women 57

Protrusion of nose-nose width index sn−prnal−al � 100

Men 54

Women 58

Nose height-morphologic height of face index n−snn−gn � 100

Men 45

Women 47

Nose width-facial width indexal−alzy−zy � 100

Men 2

Women 24

Nasal bridge inclination, degrees — Men 33

Women 31

Nasolabial angle, degrees — Men 9

Women 94





length were in contrast to the current study where no significantdifference was observed between sexes (30.7 in women and 31.2in men). With respect to ear height and mouth width, the findingsof these 2 studies were compatible. However, we observed thatthe nasal bridge inclination in both sexes and nose height in menwere greater than those of the Iranian sample in the study of Farkaset al.2 This dissimilarity in results can be justified by the differentsampling methods of the 2 studies. In the study of Farkas et al,the samples were randomly selected. On the contrary, the subjectsof the current study were chosen based on a healthy population ofnormal and proportionate faces and occlusions in all 3 dimensions.The findings of Farkas et al might probably be confounded bynot strictly adhering to the proportionate face criterion for the in-clusion of samples as well as the small sample size.

Observations of Fariaby and associates4 who studied a groupof Iranian adults in Kerman, Iran, are well matched to the findingsof this study regarding the measurements of orbit, mouth width, up-per and lower lip height in both sexes, and nasolabial angle in men.However, they reported a greater nasolabial angle in women com-paring with this study. Furthermore, shorter and wider noses and

Those of NAWs

an (SD) Min Max NAW, Mean (SD)

Persian Versus NAW

P Value

.7 (2.5) 31.4 42.1 34.8 (2.7) ≤0.09

.8 (2.2) 28.4 38.5 31.9 (1.9) ≤0.03*

.4 (3.7) 50.8 66.3 53.2 (3.3) ≤0.0001*

.8 (3.4) 49.4 65.3 49.2 (2.9) ≤0.0001*0 (2.6) 13 26.2 20.6 (2.2) ≤0.21

.3 (2.2) 14.5 23.8 19.4 (1.7) ≤0.8

.1 (7) 48.3 82.5 65.8 (6.8) ≤0.05*

.9 (5.1) 48.1 70.7 65.1 (5.8) ≤0.0001*

.7 (7.2) 35.8 68.7 59.8 (7.9) ≤0.001*

.9 (7.1) 44.1 77.6 61.7 (6) ≤0.03*

.8 (2.5) 40.6 51.2 — —

.3 (2.2) 42 51.7 — —

6 (1.9) 21.5 30.5 — —

.9 (1.5) 21.9 29 — —

.7 (6.3) 14.2 43.9 31.6 (4.6) ≤0.06

.2 (5.4) 15 42.1 30 (5.3) ≤0.26

7 (8.9) 73.1 119.2 99.8 (11.8) ≤0.14

.6 (10.5) 79.7 130.1 104.2 (9.8) ≤0.0001*

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TABLE 6. Face Measurements in the Study Population and Their Comparison With Those of NAWs

Measurements/Indices Sex Mean (SD) Min Max NAWs, Mean (SD)

Persian Versus NAW

P Value

Face width zy-zy (mm) Men 141.2 (5.4) 127.7 151.7 139.1 (6.3) ≤0.08Mandible width Women 131.5 (4.3) 121.4 143 131.1 (5.3) ≤0.68Morphologic height of face go-go (mm) Men 107.9 (6.3) 97.8 121.5 105.6 (6.7) ≤0.04*

Women 101 (5.3) 86 111 94.5 (5) ≤0.0001*Face width n-gn (mm) Men 127.4 (4.8) 117.1 138.4 121.3 (6.8) ≤0.0001*Mandible width Women 120.1 (5.5) 108.2 130.8 112 (4.7) ≤0.0001*Morphologic height of face n-sto (mm) Men 79.2 (3.9) 69 88.3 74 (4.2) ≤0.0001*

Women 76.1 (4.1) 68.3 85 68.9 (3.9 ≤0.0001*Mandible height sto-gn (mm) Men 51 (3.8) 43.8 63.3 48.8 (4) ≤0.006*

Women 46.4 (2.9) 39.2 52 44.8 (3.4) ≤0.013*Facial index n−gn

zy−zy � 100Men 90.3 (4.4) 80.6 98.6 88.5 (5.1) ≤0.06

Women 91.4 (5) 78.4 101.4 86.2 (4.6) ≤0.0001*Mandible width-morphologic height of face index go−go

n−gn � 100Men 84.8 (5.5) 75 102.8 — —

Women 84.3 (5.3) 74.3 99.2 — —

Lower face-morphologic height of face index sn−gnn−gn � 100

Men 55.9 (2.3) 49.8 61.7 59.2 (2.7) ≤0.0001*Women 54.8 (2.4) 49.1 59.7 58.6 (2.9) ≤0.0001*

Mandible indexsto−gngo−go � 100

Men 47.3 (3.9) 39.2 55.1 — —

Women 46 (3.3) 39.2 53.3 — —

Mandible width-face width index go−gozy−zy � 100

Men 76.4 (3.6) 70.1 83.7 — —

Women 76.8 (3.8) 67.3 84.5 — —

Maxillary depth t-sn (mm) Men 132.6 (5.6) 121.2 145.1 131.8 (4.3) ≤0.32Women 123.2 (4.8) 114.5 137.1 119.3 (4) ≤0.0001*

Mandibular depth t-gn (mm) Men 150.4 (6.5) 135.9 166.6 148.2 (5.2) ≤0.02*Women 138.4 (5.4) 129.8 157 133.9 (5.1) ≤0.0001*

Maxilla-mandible depth indext−snt−gn � 100

Men 43.4 (5.4) 80.5 92.5 — —

Women 43.3 (4.4) 77.1 94.4 — —

Physiognomic height of face tr-gn (mm) Men 191.9 (9.7) 175.1 216.4 187.2 (12.1) ≤0.02*Women 180.1 (9.7) 154.2 198.1 173.3 (7.8) ≤0.0001*

Forehead height tr-g (mm) Men 59.2 (9.4) 41.1 79.7 57 (7.4) ≤0.11Women 53.9 (7.3) 35.6 69.2 52.7 (6) ≤0.23

g-sn distance g-sn (mm) Men 67.1 (4.2) 56.5 75 67.2 (4.9) ≤0.9

Women 64.9 (4.5) 52.8 74.5 63.1 (4.4) ≤0.01*Lower facial height sn-gn (mm) Men 71.3 (4.2) 62.7 79.6 72.6 (4.5) ≤0.09

Women 65.8 (4.2) 57.6 72.8 64.3 (4) ≤0.02*Forehead height-physiognomic height of face index

tr−gtr−gn � 100

Men 30.7 (3.8) 23.4 38.4 — —

Women 29.8 (3) 23.1 36.9 — —

g-sn distance-physiognomic height of face index g−sntr−gn � 100

Men 35.1 (2.6) 27.1 42.1 — —

Women 36.1 (2.6) 30.6 41 — —

Lower facial height-physiognomic height of face index sn−gntr−gn � 100

Men 37.2 (2.1) 33 42.2 — —

Women 36.6 (2) 31.4 40.8 — —

Upper profile inclination g-sn inclination, degrees Men 3.5 (3.6) −7.4 13.8 1.3 (3.5) ≤0.004*Women 1.6 (3.2) −5.7 7.1 1.6 (2.5) ≤1.0

Lower profile inclination sn-pg inclination, degrees Men −8.9 (7.8) −23.4 18.3 −10.6 (5.3) ≤0.12Women −11.7 (6.7) −24.5 11.5s −13.3 (4.5) ≤0.04*




greater binocular width were reported for the evaluated population.In addition to racial differences between the people from Tehran andKerman, using photographs instead of direct clinical measurementmay account for the inconsistencies between the 2 studies.Photographs have been proved to be generally less reliable than di-rect measurement for anthropometric studies. However, the reliabil-ity of photographs in the assessment of labio-oral and angularmeasurements were shown to be greater than the alternatives.14

The similarity of labio-oral measurements between the 2 studiesfortifies the assumption that the abovementioned variations maybe the result of distortions in photographs. Moreover, the n point

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considered in the current study was lower than that in the study ofFariabi et al. This might be the reason for the differences in noseheight between the 2 studies.

Heidari and coworkers7 assessed the nasal and facial formof Sistani and Baloch women from southeast Iran. The leptor-rhine nose and leptoprosopic face were reported as the dominantforms in both study groups, which is in accordance with the cur-rent study. On the other hand, based on their observations, the noseheight of Sistani and Baloch women were 53 and 49.5, and thenose width were 32.3 and 31.4, respectively. They reported thatthe nose index of Sistani women (69.7) is greater than of Baloch



TABLE 7. Labio-Oral Measurements in the Study Population and Their Comparison With Those of NAWs


Persian Versus NAW

P Value

Mouth width ch-ch (mm) Men 50.5 (3.5) 43.5 57.7 53.5 (3.6) ≤0.0001*Women 47 (3.1) 40.2 54.3 49.8 (3.2) ≤0.0001*

Upper lip height sn-sto (mm) Men 22.1 (2.6) 17.4 26.8 21.8 (2.2) ≤0.53Women 20.1 (2.2) 15.2 24.3 20.1 (2.3) ≤1.0

Cutaneous upper lip height sn-ls (mm) Men 15.3 (2.8) 10.6 23.2 14.8 (2.6) ≤0.56Women 12.9 (2.3) 7.14 17.8 13.5 (2.2) ≤0.42

Upper vermilion height ls-sto (mm) Men 7 (1.7) 2.2 10.5 9.5 (1.5) ≤0.0001*Women 7.6 (1.5) 4.4 10.7 8.6 (1.6) ≤0.002*

Mouth width-facial width indexch−chzy−zy � 100

Men 35.8 (2.6) 30.5 43.6 — —

Women 35.8 (2.1) 31.3 40 — —

Upper lip-lower facial height indexsn−stosn−gn � 100

Men 30.9 (2.9) 24.7 36.9 32.4 (3.1) ≤0.01*Women 30.5 (2.5) 25.5 36.4 31.1 (2.6) ≤0.24

Cutaneous upper lip height-upper lip height indexsn−lssn−sto � 100

Men 69.2 (8.5) 52.2 89 67.3 (5.1) ≤0.40Women 64.4 (8.8) 44.8 84.2 69.4 (6.3) ≤0.07

Upper lip inclination sn-ls inclination, degrees Men 5.6 (8.6) −12.5 31.3 1.5 (8.7) ≤0.006*Women 8.9 (9.3) −17.2 30 0.8 (7.5) ≤0.0001*

Lower lip height sto-sl (mm) Men 18.7 (2.1) 14.8 23.6 18.8 (2.5) ≤0.83Women 17.4 (2) 13.4 22.3 16.7 (2.3) ≤0.11

Cutaneous lower lip height li-sl (mm) Men 10.1 (2) 5.6 14.3 11.9 (2.2) ≤0.0001*Women 8.6 (1.7) 5.2 11.9 9.9 (2.4) ≤0.002*

Lower vermilion height sto-li (mm) Men 9.9 (1.6) 4.9 13.3 11 (2.2) ≤0.005*Women 10 (1.5) 6.4 13.8 10 (1.5) ≤1

Lower lip-lower facial height indexsto−slsn−gn � 100

Men 26.3 (2.9) 20.1 34 26.8 (3.0) ≤0.40Women 26.5 (2.3) 22.8 32.3 26.5 (2.2) ≤1

Cutaneous lower lip height-lower lip height indexsl−listo−sl � 100

Men 54.4 (9.1) 28.3 75.5 63 (9.1) ≤0.0001*Women 49.3 (8.1) 32.1 69.1 61.1 (16.7) ≤0.0001*

Lower lip inclination sl-li inclination, degrees Men 47.2 (8.2) 25.4 66.1 46.6 (17.8) ≤0.82Women 50.5 (9.5) 27.7 74 48.6 (14.1) ≤0.37



TABLE 8. Chin and Neck Measurements in the Study Population and Their Comparison With Those of NAWs


Persian Versus NAW

P Value

Upper chin height sl-pg (mm) Men 13.9 (3.6) 9 31.7 16.9 (3.6) ≤0.0001*Women 13.1 (2.9) 8.5 23.4 17.3 (2.3) ≤0.0001*

Lower chin height pg-gn (mm) Men 20.6 (4) 10.1 28.4 20.4 (3.7) ≤0.79Women 18 (3.4) 9.4 24.8 17.6 (2.2) ≤0.49

Chin height sl-gn (mm) Men 30.8 (2.9) 23.7 38.2 30.1 (3.3) ≤0.26Women 28.3 (2.9) 20.9 35 28.2 (2.6) ≤0.86

Throat length gn-c (mm) Men 41.9 (6.7) 21.6 56.8 — —

Women 42.4 (6.1) 26.1 57.6 — —

Chin height to lower facial heightsl−gnsn−gn � 100

Men 43.3 (3.6) 34.2 52.2 42.9 (4.7) ≤0.63Women 43.1 (4.6) 35.3 60.3 44.4 (3.2) ≤0.10

Upper chin height-chin height indexsl−pgsl−gn � 100

Men 45.3 (12.1) 28.8 108.7 — —

Women 46.8 (11.1) 30.1 78.5 — —

Lower chin height-chin height index pg−gnsl−gn � 100

Men 66.8 (11.2) 37.4 89.4 — —

Women 63.6 (10.4) 37.4 79 — —

Mentocervical angle, degrees — Men 86.3 (15.2) 53.4 113.8 78.3 (7.9) ≤0.003*Women 79 (12.3) 55.3 105 83.9 (9.3) ≤0.04*

* Statistically significant.



© 2014 Mutaz B. Habal, MD 1879

Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.


women (59.2). Given the definition of nose index as nose width-height ratio, the accuracy of their findings should be consideredwith skepticism.

Jahanshahi and associates8 studied a population from Gorgan,Iran, consisting of 2 races of Fars and Turkman. In both races, thedominant facial form was euryprosopic in women and mesopro-sopic in men. There are 4 possible explanations for this difference be-tween the reported results and the current study. The first is the racialdifference in the 2 samples. Second, the n point was considered lowerin their study, which led to a smaller face index. Third, a Martinspreading caliper with the millimeter gauge was used in their study,whereas in the current investigation, the long-jaw sliding caliper withthe accuracy of 0.01 was used. Finally, Jahanshahi et al determinedthe facial forms based on the Banister classification, which is differentfrom the classification considered in this study as well as the studyof Farkas et al.2

Pezeshki Rad et al5 investigated anthropometric linear mea-surements of a group of normal adults in Mashhad, Iran, with amethod similar to this study. The measurements of orbits, ears,and noses and the mouth width in their report were similar to thepresent findings. However, although the 2 studies documented sim-ilar measurements of the head length in both sexes and the headwidth in women, the head width in men was smaller than ourobservations. Overall, the findings of the 2 studies were almostcompletely comparable.

The present study also compared the data collected fromthe Iranian population with those reported for the NAWs. Becauseboth NAWs and most of the current study population were whites,more similarities were anticipated. However, considerable differ-ences were found between the 2 populations with respect to theirhead height and width, biocular width, nose height, face height,mouth width, and upper chin height. Farkas et al2 observed that,compared with NAWs, Iranian women had longer faces than NAWwomen, which was the only difference between the 2 groups withregard to the facial height and width. These findings were generallycorroborated in our study. However, the face height of Iranian menwas approximately 10 mm greater than the facial height of Iranianmen in the study of Farkas et al.2 Moreover, Farkas et al reported that,in Iranians, the eye fissure length and intercanthal width were ex-tremely significantly smaller than NAWs in both sexes, whereas thebiocular width (ex-ex) in men and women was significantly greaterand smaller, respectively. There is a lack of conformity between thesefindings and those of the current study. According to this investiga-tion, the biocular width of Iranian women was 92.3, whereas Farkaset al found it to be 79.8.

Comparing the measurements in men and women, the cur-rent study revealed that both sexes have a brachycephalic head formwith a slight tendency to mesocephalic form, and the mean head in-dex was 81.5. On the contrary, the NAWs have a mesocephalic headform. The eye fissure length and, therefore, the eye index in bothsexes were smaller than NAWs.9 The nose form in both sexes wasleptorrhine, similar to NAWs. However, the nose index was signi-ficantly smaller in Iranian women.9 The facial form was mostlyleptoprosopic. The 3 vertical thirds were not equal, and the upperthird was smaller. Whereas the NAWs men have leptoprospic faces,the women have mesoprosopic faces. The mouth width and uppervermilion height were smaller than NAWs.9,17 As expected, mostof the linear measurements were greater in men. However, becausethe differences were proportionate, it had not affected the indices.18–20

Similarly, Farkas et al19 showed no significant difference betweensexes with regard to the neoclassic canon proportions. In our study,the nose index of women reveals that they have longer noses withsmaller width compared with men. The study performed by Ngeowand Aljunid supports this observation.21 Moreover, we found thatcutaneous upper and lower lip height in men is a greater percentage

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of the total lip height, which is in accordance with the findings ofNgeow and Aljunid22 and Farkas et al.17

In comparison of the findings of this study with those reportedfor neoclassic canons,23 trichion (tr)-g, g-sn, and sn-gnathion (gn)were not equal, and the forehead height (30% of the face height)was smaller than the other thirds, which are equal to each other. Theear height was also greater than the nose height in the studied subjects.

The upper lip, lower lip, and chin have been suggested asthe equal thirds of lower facial height. Other views claim that theupper lip and the lower lip are one fourth of the lower facial height,whereas the chin constitutes the remaining half of the lower facialheight.17,23,24 However, none of these proportions were seen in thesubjects of the current study (lower lip, 26%; upper lip, 30%; chin,44%). Our results confirmed the equivalence between en-en anden-ex. However, whereas the nose width was equal to the intercanthalwidth in women, it was wider in men. The equation of zy-zy = 4 �al-al was observed in women but not in men (because of theirwider noses). Moreover, the equation of cheilion-cheilion (ch-ch) =1.5 � al-al was not obtained in the subjects.25–27 Accordingly, theneoclassic canons are not quite comparable with the Iranian popu-lation evaluated in this study. Similar to the study of Farkas et al,19

this inconsistency is more prominent in the vertical proportions.On the whole, the findings of the current study showed that,

despite that the Iranian population mostly consists of whites, con-siderable differences with regard to the measurements of head, or-bits, nose, ears, face, labio-oral, and chin regions exist betweenthem and the NAWs. These differences were clinically significant.

Because the facial anatomic proportions are of utmost im-portance in determining the beauty and attractiveness of the face,the reference ranges of each measurement might be used asreferences to treat the disproportions in patients and improve theirappearance.

The differences found between the values measured in thecurrent study and those reported in textbooks underscore that refer-ence ranges of other populations cannot be generalized to Iranianraces. The present study tried to establish the reference range of cra-niofacial anthropometric measurements in an adult Iranian popula-tion. These measurements might be efficiently used as referencesfor esthetic treatments.

CONCLUSIONSAccording to the findings of this study, most linear mea-

surements were greater in men than in women, although the dif-ferences did not affect the indices. It was also shown that both sexesof normal adult Iranian population have brachycephalic heads,leptoprosopic faces, and leptorrhine noses.

In comparison with NAWs, considerable differences were ob-served in the head, face, orbits, labio-oral, nose, and chin regions.These differences were more prominent in the head region of bothsexes as well as the face and nose regions in women. Whereas Iranianwomen were found to have leptoprosopic faces, NAWs women havemesoprosopic faces. The least differences between the 2 populationswere related to the ear region.

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Craniofacial Morphologic Parameters in a Persian Population

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