Determining Facial Attractiveness for Orthodontic Treatment: A Study of Facial Characteristics of Female Caucasian Beauty Pageant Winners

Research Article

J Dent & Oral Disord. 2017; 3(6): 1077.

Determining Facial Attractiveness for Orthodontic Treatment: A Study of Facial Characteristics of Female Caucasian Beauty Pageant Winners

Hylan-Cohen JA¹, Tsay TP² and Manasse RJ²*

¹Private Practice in Orthodontics in the Chicago, IL, USA

²Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, USA

*Corresponding author: Robert J. Manasse, Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, USA

Received: October 12, 2017; Accepted: November 13, 2017; Published: November 20, 2017


Introduction: Soft tissue esthetics is a crucial component in orthodontic treatment planning. Previously, various norms or standards were derived as guidelines for evaluating facial esthetics and set as treatment goals. However, the validity of these standards was vague. This study described an attempt to obtain facial esthetic characteristics from publically judged attractive females using beauty pageant winners.

Methods: Twenty-seven current beauty pageant winners between the ages of 20 to 47 were photographed. Profile, frontal and smiling photos were obtained and composite images were generated. This data was also compared with the existing facial esthetic “norms”.

Results: Statistical tests indicated that 8 out of 13 variables in the study showed significant differences from published adult norms. Significantly the composite beauty pageant queens have a decreased lower facial height, retrusive upper lip, increased inter-labial gap, retrusive forehead and more nose projection.

Conclusion: These findings demonstrate subtle contributions of several facial components to an attractive face. Most importantly, this study presents facial esthetic guidelines to improve orthodontic and orthognathic surgical diagnosis and treatment planning.

Keywords: Facial attractiveness; Orthodontic treatment; Faces


Obtaining facial attractiveness is an important consideration in orthodontic treatment. Patients seek treatment not to look average, but to look beautiful [1,2].

Historically, scientists and philosophers have attempted to define the parameters of attractive faces. Currently, Hollywood celebrities, beauty queens, and models represent ideal esthetic goals for many people. Medical professionals in various fields such as plastic surgery, oral surgery, orthodontics and prosthodontics have the ability to transform individuals’ facial tissues to reach these esthetic goals. The knowledge of what constitutes an attractive face is essential.

The importance of facial esthetics in orthodontic diagnosis and treatment planning has long been recognized. Edward Angle, the father of orthodontics, believed the most important outcome of treatment was a Class I occlusion. Angle suggested a properly aligned dentition would pave the way for acceptable soft tissue harmony [1]. Tweed, a student of Angle, began to emphasize facial proportions. Tweed believed premolar extractions were an important treatment protocol to promote dental stability. Unlike Angle’s belief that soft tissue balance would result from correcting the malocclusion, Tweed’s philosophy employed simultaneous consideration of soft tissue with occlusal stability [3].

In 1957, Riedel [4] proposed incorporating the public’s views of soft tissue attributes into orthodontic treatment norms or standards. In 1970, Peck and Peck [5] tried to decipher the difference between patients’ and health providers’ perceptions of attractive faces. They acknowledged the importance of the public’s opinion regarding facial attractiveness. The esthetic characteristics of beauty queens, professional models, and celebrities, known for their appearance, were studied using cephalometric analyses and photograph. This represented the departure from the traditional practice of imposing subjective opinion on treatment planning to incorporate public opinion in evaluating facial esthetics. This study concluded that the public preferred more protrusive dental and soft tissue characteristics than the established cephalometric standards.

In the 1980’s and the 90’s, Legan and Burstone [6], Powell and Humphreys [7], Arnett and Bergman [8], summarized attractive soft tissue norms suitable for adults based on models known for their beautiful facial attributes. This study was undertaken to determine whether the standards from 1980’s and 90’s are still currently valid by comparing existing norms of adult female facial characteristics to the facial esthetics of recent beauty pageant winners.

In 1992, Johnston et al. [9,10] developed a method called FacePrint that mimics evolution with a mathematical algorithm. This study using FacePrint had participants rank their most preferred male or female facial features over a series of generations. The participants used a computer keyboard to rank phenotypes’ attractiveness on a 10-point beauty scale. Ultimately, a beautiful composite face was produced and evaluated for attractiveness by Caucasian participants. The composite face was compared with anthropometric measurements of random female faces from their local population. Their study concluded that an attractive female face is not an average face and possesses unique facial proportions such as a decreased lower facial height and increased fullness of the lips. Their study found the highest ranked attractive face had an anterior lower facial height of an 11-year-old female according to the Farkas [11] growth curve.

Today, orthodontists use various norms for diagnosis and treatment planning. Since people seeking orthodontic treatment are largely motivated by a better dentition and cosmetic concerns [10], the treatment goals should aim at eliminating malocclusion while simultaneously improving facial attractiveness [11]. It is evident that an attractive facial norm or guideline is necessary for our profession.

This study describes an attempt to obtain facial esthetic characteristics from publically judged attractive females using beauty pageant winners.

Material and Methods

This research evaluated recent and current titled beauty pageant queens’ facial features. Their frontal and profile soft tissue attributes were compared with published norms (University of Illinois at Chicago Institutional Review Board Research Protocol Number: 2010-0927).

According to pageant documents and interviews with pageant judges, judging criteria for pageant queens are based on: beauty, poise, intelligence, personal interview, physical fitness, evening gown, on stage question and costume competition. Pageant judges stated that beauty and attraction were more than 80% of the judging criteria [12]. The pageant judges consisted of prior pageant queens, celebrities and medical professionals.

Pageant directors were contacted so that attendance to beauty pageants would be allowed for this study. On the interview day of the Mrs. Georgia America, Mrs. Missouri America, Mrs. Wisconsin America, and Mrs. Iowa America beauty pageants, the subjects were recruited with a “Verbal recruitment to participate in research” form. Before participation, subjects were asked to sign an informed consent. For participation in the study, each subject completed an eligibility questionnaire and a photographic questionnaire. Subjects were asked to state their age, previous pageant participation and titles, confirmation [13,14]. The inclusion criteria for participation in this study are as follows:

1. Caucasian female

2. Beauty pageant winner within the past five years.

The photographs were taken using a Sony Alpha Nex-5 digital SLR camera (Sony, New York, New York) mounted on a Velbon Victory 150 tripod with an 18-55 mm zoom lens, locked at 55mm. The images collected consisted of profile with lips at repose, frontal photographs with lips at repose, and Stage Two smiling frontal photographs [15]. Peck and Peck defined three stages in the genesis of a full smile. Stage Two is explained as the maximum movement of the upper lip and maximum appearance of the nasolabial fold using four facial muscles: levator labii superioris, zygomaticus major and superior fibers of the buccinators.

Participants were asked to sit in a chair and place their feet on a line in front of a black felt background five feet from the camera. To ensure natural head position, the participants were asked to look at a white sign behind the photographer as if looking off to the horizon. For the profile and frontal photograph at repose, participants were asked to lick their lips gently, and then relax [8]. For the Stage Two smiling frontal photograph, participants were asked to smile fully until their lips encountered resistance at the nasolabial fold [15]. With the camera in place, the participant was placed in a fixed position for the profile photo.

To ensure resolution standardization, the photographs were uploaded to Adobe Photoshop CS, version 7.0 and calibrated to 300 pixels per inch (Adobe, San Jose, CA). The profile photos were captured in Dolphin Solutions TM version 11.5 Premium (Dolphin, Chatsworth, CA) in the lateral x-ray view function. For standardization, the participants were oriented with the Frankfort horizontal plane parallel to the floor for later calibration using the digitizing landmark function in Dolphin for linear and angular measurements. The landmarks for the profile photographs are based on prior published definitions [5, 6,8,16] (Figure 1).