Nasofacial angle and nasal prominence: a quantitative investigation of idealized and normative values

PURPOSE: A quantitative evaluation of the influence of the nasofacial angle on perceived attractiveness and threshold values of desire for rhinoplasty. MATERIAL AND METHODS: The nasofacial angle of an idealized silhouette male Caucasian/white profile image was altered incrementally between 21° and 48°. Images were rated on a Likert scale by pretreatment patients (n = 75), laypersons (n = 75), and clinicians (n = 35). RESULTS: A nasofacial angle of approximately 30° was deemed to be ideal, with a range of 27°-36° deemed acceptable. Angles above or below this range were perceived as unattractive. Angles outside the range of 21°-42° were deemed very unattractive. Excessive nasal prominence (nasofrontal angle of 48°) was deemed the least attractive. In terms of threshold values of desire for surgery, for all groups a threshold value of ÔëÑ39° and Ôëñ24° indicated a preference for surgery, with clinicians least likely to suggest surgery. The patient group assessments demonstrated the greatest variability, stressing the importance of using patients as observers, as well as laypersons and clinicians, in facial attractiveness research. CONCLUSIONS: 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 threshold values of desire for surgery.