The perception of attractiveness of the facial profile among people of Telangana ethnicity

Agrima Thakur; Prasad Chitra

doi:10.4103/jdrntruhs.jdrntruhs_19_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 11 | Issue : 3 | Page : 193-199

The perception of attractiveness of the facial profile among people of Telangana ethnicity

Agrima Thakur, Prasad Chitra
Department of Orthodontics, Army College of Dental Sciences, KNR University, Secunderabad, Telangana, India

Date of Submission	18-Feb-2021
Date of Decision	31-Aug-2021
Date of Acceptance	01-Sep-2021
Date of Web Publication	26-Dec-2022

Correspondence Address:
Dr. Prasad Chitra
Army College of Dental Sciences, KNR University, Secunderabad, Telangana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jdrntruhs.jdrntruhs_19_21

Abstract

Background: The success of orthodontic treatment to a significant extent is largely dependent on the patient's and lay peoples' perception. Treatment can influence the soft tissue profile of the face, which is why, it is important for orthodontists to perceive what is considered attractive and unattractive amongst locals, and further, incorporate this knowledge in their diagnosis and treatment planning for population-specific groups.
Aim: To evaluate differences in perception of attractiveness of the human face (in profile view) among ethnic Telangana subjects when compared to ideal Caucasian facial profile attractiveness standards.
Methods: Profile silhouettes of ethnic Telangana subjects with straight, convex and concave facial profiles were rated by 10 adult laypersons (ethnic Telangana origin) and scored from least to most attractive. Fifteen relevant soft-tissue parameters from the Ricketts, Legan-Burstone, Steiner's and Z-Merrifield analysis were then evaluated on lateral cephalometric radiographs of the highest scoring subjects (considered most attractive) and sample t test statistical analysis was done in order to investigate differences between obtained values of the 'attractive' group as compared to standard values given in these analyses.
Results: Of 15 parameters compared, significant differences from standard cephalometric values were evident for- vertical lip-chin ratio, lower lip protrusion, mento-labial sulcus and Z- angle. These measurements were smaller in the evaluated population group as compared to orthodontic norms.
Conclusion: People of ethnic Telangana origin considered a shorter and less prominent lower lip and chin and a shallower mento-labial sulcus to be more attractive, as compared to standard orthodontic cephalometric norms of Caucasian populations.

Keywords: Cephalometry, esthetics, orthodontic treatment, profile attractiveness

How to cite this article:
Thakur A, Chitra P. The perception of attractiveness of the facial profile among people of Telangana ethnicity. J NTR Univ Health Sci 2022;11:193-9

How to cite this URL:
Thakur A, Chitra P. The perception of attractiveness of the facial profile among people of Telangana ethnicity. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Feb 7];11:193-9. Available from: https://www.jdrntruhs.org/text.asp?2022/11/3/193/365019

Introduction

Beauty and attractiveness of an individual are completely subjective parameters, since a number of physical, social and psychological factors govern what is regarded as 'beautiful' or 'attractive'. For example, current trends, gendered perspectives, age-wise opinions, cultural tastes and personal preferences can all influence one's idea of beauty, as is evident from shifting trends noted in the literature.^[1] Despite these factors, some ideals of beauty have been popularized across the world because of various reasons such as the heavy influence of Western trends and culture and the wide acceptance of European/American scientific literature within the research community.

Patients, especially in India, primarily seek orthodontic treatment due to esthetic concerns, which in turn has a heavy impact on their psycho-social wellbeing and treatment success. Orthodontics enhances appearance by not only improving alignment of teeth in the mouth, but also effects the soft tissues of the mid-facial region.^[2] There are a number of norms and values in the literature that dictate the success or failure of orthodontic treatment or orthognathic surgeries. Soft-tissue cephalometric analyses are replete with 'standard values' of normal facial proportions, but most of these are the average cephalometric properties of a particular demographic of subjects. Such norms and values may not hold true in the opinion of lay persons in other parts of the world. Therefore, it is important to investigate and identify factors that contribute to the perception of facial attractiveness in specific areas and incorporate the findings into treatment plans for greater acceptability by patients.

It is inappropriate to apply one single standard of cephalometric norms or facial esthetics to a population varied in race and ethnicity.^[3] A number of previous studies^{[4],[5],[6],[7]} have discussed perception of facial attractiveness in the profile view for Caucasians (white Americans, Iranians), Mongoloids (Chinese, Japanese) and even African-Americans. Ethnic Indian Telangana population groups have never been assessed as yet. Moreover, studies have used various methods for evaluating the attractiveness of the human face in profile view, utilizing line drawings, sketches and photographs;^[5],[8] however, the use of silhouettes to evaluate cephalometric differences in perceived 'attractive' silhouettes from standard cephalometric norms has not yet been studied in subjects of ethnic Telangana origin.

The objective of the current study was to understand how local Telangana subjects perceived attractiveness and non- attractiveness of the facial profile amongst their own population, as well as scientifically analyze the differences of such perceptions from standard soft-tissue cephalometric norms. The research questions were:

What were the parameters that contributed to attractiveness of the soft-tissue profile of ethnic Telangana people?
How were the parameters of said 'attractive' ethnic Telangana subjects different from soft-tissue cephalometric values proposed in the Ricketts, Legan-Burstone, Steiner's and Z- Merrifield analysis, which are majorly norms concerning Caucasians of European ancestry?

Methodology

Population and sample collection

This study was carried out on 70 randomly selected subjects (35 males, 35 females) who sought dental treatment at the institution and fulfilled the inclusion criteria as given below. A previous study done on Iranian population was the base for determining sample size of this study to obtain test powers >95% for the comparisons.^[9] The inclusion criteria comprised of the following-

Subjects' willingness to participate in the study (those who consented to have their profile photographs clicked and if required further in the study, lateral cephalometric radiographs taken),
Age and ethnicity of the subjects- adult subjects (aged 18- 25 years) of ethnic Telangana origin (grandparents and parents from Telangana, without history of inter-regional or inter-racial marriages were included)
Relatively symmetric face as evaluated by an orthodontist (one of the authors)
No history of previous facial surgeries (trauma surgery/plastic or orthognathic surgical procedures) or orthodontic treatment
No history of trauma or craniofacial deformities.

The study was reviewed and approved by the Ethics Committee of the institution (ACDS/IEC/66/Jan 2021). Written informed consent was obtained from all subjects after thorough oral explanation of the procedures involved prior to beginning. Ethical committee approval was obtained on 18-01-2019.

Photographs of the subjects were clicked in right profile view using a digital SLR camera (Canon 1500D) mounted with a 100mm f 2.8 1:1 magnification macro lens mounted on a tripod. Distance between the subject and the camera was standardized at 6.9 feet (as done in a previous study),^[10] head of subjects was oriented in the natural head position, Frankfurt Horizontal (FH) plane kept parallel to the floor, eyes looking straight and with teeth in maximum intercuspation [Figure 1].

Figure 1: Photographic setup

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Preparation of silhouettes

The profile photographs of selected subjects were converted into black silhouettes on a white background using PhotoScape photo- editing software (MOOII Tech, Korea). The soft tissue of the profile for each photograph was traced and black color was filled within the traced area, while the rest of the area was filled with white color. This minimized the effect of factors such as skin complexion, eye shape, color and cosmetic appearance on the perception of the raters. Only the profile from the forehead (below the hairline) to just below the chin was kept, so that gender-based bias that might arise among raters due to hair would be negated [Figure 2].^[9]

Figure 2: Right profile photograph of subjects, conversion into silhouette, lateral cephalogram

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Method of rating

A panel of 10 local laypersons (5 males and 5 females; mean age = 31.5 years) of ethnic Telangana origin, whose occupation was not related to the perception of beauty, were selected randomly from the general public for assessing and rating silhouettes [Table 1]. The 70 silhouettes were flashed in front of the selected panelists one by one for an interval of 30 seconds each (total time 35 minutes). The panelists rated the images from a score of 1 (least attractive) to 5 (most attractive). The scores of all the panelists were summed up and assigned to each of the silhouettes. Hence, the total score of each soft tissue profile silhouette was between 10 and 50. Amongst evaluated samples, those profiles that obtained a score of above 40 were considered most attractive and soft-tissue cephalometric analysis was carried out.

Table 1: Details of the raters

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Cephalometric and statistical analysis

Lateral cephalograms were taken for the most attractive group (n = 15) in natural head position, ear rods in place and teeth in maximum intercupsation. The radiographs were taken with parameters 78 kV, 10 mA and 0.6 seconds using a standard cephalostat–Satelec Xmind, Acteon Ltd. Cephalometric landmarks were identified for all subjects in the most attractive group by two different investigators and compared for major differences. Soft-tissue cephalometric analysis was carried out using NemoCeph 2D imaging software version 10 (build 10.4.2.58, Biotech Dental Company, Madrid, Spain).

15 important soft-tissue values were identified from the Ricketts, Legan-Burstone, Steiner's and Z-Merrifield cephalometric analysis and the values obtained were compared with standard norms. One sample t test was used for comparison between most attractive group and standard orthodontic norm. The level of significance was set at 0.05 with 95% confidence interval [Table 2].

Table 2: Comparison of soft-tissue cephalometric values of reference caucasian norms with the attractive profile group

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Results

The measurements of the most attractive group were compared with standard norms in the selected soft tissue analyses. The following parameters were larger in the study group compared with the orthodontic norms: Lower lip to E-plane; facial convexity angle; mandibular prognathism; upper lip protrusion; inter-labial gap; vertical height ratio; lower vertical height-depth ratio.

The following measurements were smaller in the study group compared with the orthodontic norms: naso-labial angle; maxillary prognathism; lower lip protrusion; mento-labial sulcus; vertical lip-chin ratio; upper lip to s-line; lower lip to S-line; Z angle.

Orthodontic norms were not statistically different from the following measurements in the study group: Lower lip to E- plane; naso-labial angle; facial convexity angle; maxillary prognathism; mandibular prognathism; upper lip protrusion; inter- labial gap; vertical height ratio; lower vertical height- depth ratio; upper lip to S-line; lower lip to S-line [Table 2] and [Figure 3].

Figure 3: Comparison of soft- tissue cephalometric values of reference Caucasian norms with the attractive profile group

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Statistically significant results (P ≤ 0.05) were obtained for the following parameters: vertical lip-chin ratio, lower lip protrusion, mento-labial sulcus and Z- angle [Figure 4], [Figure 5], [Figure 6], [Figure 7].

Figure 4: Variables that had a significant difference from standard Caucasian norms: Lower lip protrusion

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Figure 5: Variables that had a significant difference from standard Caucasian norms: Mento- labial sulcus

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Figure 6: Variables that had a significant difference from standard Caucasian norms: Vertical lip chin ratio

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Figure 7: Variables that had a significant difference from standard Caucasian norms: Z angle

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Discussion

Soft tissue cephalometry has been of importance in treatment planning of orthodontic and ortho- surgical cases. Clinicians generally aim to achieve ideal or near-ideal parameters which have been dictated in literature, such as a straight profile, prominent chin and esthetically positioned lips. Several investigators in their comparison between hand- traced and computer-aided cephalometric tracing have found no significant differences between the two methods.^{[11],[12],[13]} Therefore, we used cephalometric tracing software to analyze and compare carefully selected soft tissue parameters which can actually be influenced by orthodontic treatment or orthognathic surgery in our study.

The basic differences between soft tissue values of Caucasian samples (those prominent in standard literature) and regional Indian samples have been studied previously, using subjects from North India,^[14] Karnataka,^[15] Kerala^[16] and other areas. However, only few investigators have evaluated the difference in perception of attractiveness. This study was conducted to analyze the esthetic preferences and cephalometric parameters of facial profiles in people of the Telangana region of India. The perception of dental students and the general population with regard to attractiveness of the facial profile have also been studied,^[17] but these studies involved the evaluation of only a few profiles, by a large sample of raters. Our study uses a much bigger sample of silhouettes to rate, which is expected to bring about a thorough understanding of perception of facial attractiveness of people in this region. The panel of 10 laypersons selected to rate the silhouettes was chosen because it was assumed that their judgment would be reflective of the general public's perception, without the bias of training in facial esthetics or orthodontic norms. The gender of the raters was equally distributed and there was no way to identify the gender of the silhouettes, so as to keep gender bias to a minimum.

The perception of attractiveness according to Telangana population has been evaluated by Verma et al.^[17] previously, where they studied difference of opinion of orthodontists, general dentists, specialist dentists and general population with regard to facial proportions and lip competency using frontal photographs. It was found that while orthodontists and other dental specialists found mesoprosopic faces to be more attractive, the general public was inclined toward euryprosopic facial types. The difference in opinion of the general public was one of the reasons for conducting a similar study in profile view, where additional cephalometric parameters could be evaluated.

Jain et al.^[14] compared standard soft tissue cephalometric values given in the Legan Burstone analysis to those of a sample of North Indians. They concluded that North Indians had more convex faces, acute nasolabial angles and more protrusive lips as compared to Caucasians. A similar study comparing standard Soft Tissue Cephalometric Analysis (STCA) values to that of a sample of South Indian population concluded that South Indians have thinner lips and mid-facial structures. In our study, among the parameters derived from the Legan Burstone analysis, it was found that Telangana locals preferred less prominent lower lips.^[15] Accordingly, it can be inferred that while South Indians have thinner lips, Telangana locals consider less prominent lower lips as more attractive.

The Z angle from Tweed- Merrifield analysis^[18] has seldom been analyzed in regional populations across the world. It is measured from a line connecting soft tissue Pogonion (Pog') to the most prominent point on the lips and the FH plane. This angle indicates the convexity of the face with respect to lips and chin, with smaller values indicating convex profiles and higher angle indicating straight/concave profiles. In our study, a lesser and statistically significant value of the Z angle was obtained for attractive Telangana profiles when compared to standard norms, indicating that local people considered more convex profiles with less prominent chins to be more attractive.

An interesting finding was that the mentolabial sulcus also contributed to profile esthetics which was in contrast to the result of an Iranian study by Ghorbanyjavadpour et al.^[9] This reinforces the conclusion that Telangana laypersons have a preference for softer profiles and less prominent chins. The vertical lip-chin ratio is an important parameter when assessing the lower 1/3^rd of the face. Harmonious vertical proportions between the lips and chin are achieved if the upper lip is 1/3^rd the length of the lower lip and chin combined, with the normal range extending up to 0.5 (as given in the original Cephalometrics for Orthognathic Surgery analysis).^[19] A smaller value for vertical lip-chin ratio was obtained in our study, further elucidating the fact that standard cephalometric norms should only be used as a guide and not as the rule for facial esthetics.

Strengths and limitations

Our sample consisted of subjects with all types of facial profile patterns and occlusion, ensuring inclusivity for all face types that are generally seen in Telangana. This helped us obtain a thorough understanding of attractiveness in the eyes of laypersons, and not just those trained in esthetics or facial symmetry. The selected soft tissue parameters from 4 different cephalometric analyses also provide a nearly holistic approach to all factors of profile esthetics in our study. Although our sample size was high enough to represent all types of facial profiles, a more extensive study with higher sample size could be carried out in the future. Difference in the perception of males and females can also be evaluated in future.

Conclusion

Each ethnic group and race comes with a different set of perceptions about beauty. Therefore, it is important to understand the viewpoint and expectations of the local population and incorporate them into our orthodontic diagnosis and treatment planning. It can thus be concluded that people of ethnic Telangana origin consider relatively convex profiles with less prominent lips and chin to be attractive. Furthermore, there are considerable differences in the preference of local Telangana population from that of standard cephalometric norms given in literature which should be kept in mind by orthodontists while planning treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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