ORIGINAL ARTICLE

Anteroposterior lip positions of the most-

favored Japanese facial profiles
Hideki Ioi,aⴱ Shunsuke Nakata,b Akihiko Nakasima,c and Amy L. Countsd
Fukuoka, Japan, and Oklahoma City, Okla

Introduction: Soft tissue analysis is a basic tool in planning orthodontic treatment. However, the compo-
nents of a well-balanced Japanese facial profile have not yet been established. The purpose of this study was
to assess the most-favored or most well-balanced profile from a series of facial silhouettes with varying
anteroposterior lip positions by a group of Japanese orthodontists and a group of young adult Japanese
dental students. Methods: Average female and male profiles were constructed from the profiles of 30
Japanese men and women with normal occlusions. The lips in each average profile were protruded or
retruded in 1-mm increments, and the 13 images were arranged with the average profile in the center. Forty
two orthodontists and 42 dental students were asked to select the 3 most-favored, well-balanced profiles for
each sex and rank them in order of preference. Results: Both the orthodontists and the students preferred
a profile with slightly retruded lips. The dental students favored a more retruded lip position for women. The
least-favored profile was the most protrusive. Conclusions: These findings suggest that Japanese
orthodontists and young adults prefer a retruded profile, even though Japanese profiles have historically
been characterized by more convex facial features. (Am J Orthod Dentofacial Orthop 2005;128:206-11)

T
reatment-planning goals for orthodontic
treatment and orthognathic surgery are based
on established normal values for each ethnic
group. For example, the average anteroposterior lip
position in Japanese adults is regarded as relatively
more protrusive to that of white people.1 The per-
ceptions of nonorthodontists should be considered in
determining a well-balanced, pleasant profile, be-
cause the goals of orthodontic treatment are not only
to achieve a functional occlusion, but also to create
an esthetic profile.2 Soft tissue analyses of well-
balanced Japanese faces have been previously con-
ducted3-14 from the 1950s to the 1970s.3-10 However,
there are no studies of profiles evaluated by young
adults who could become orthodontic patients. At the
present time, young adults experience much expo-
sure to mass media–ie, the Internet and worldwide
communication and travel. The perception of a pleas-
a
Assistant professor, Department of Orthodontics, Faculty of Dentistry, Kyushu
University, Fukuoka, Japan.
b
Associate professor, Department of Orthodontics, Faculty of Dentistry, Ky-
ushu University, Fukuoka, Japan.
c
Professor, Department of Orthodontics, Faculty of Dentistry, Kyushu Univer-
sity, Fukuoka, Japan.
d
Associate professor, Department of Orthodontics, College of Dentistry,
University of Oklahoma, Oklahoma City.
Reprint requests to: Hideki Ioi, Department of Orthodontics, Faculty of
Dentistry, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582,
Japan; e-mail, ioi@dent.kyushu-u.ac.jp.
Submitted, December 2003; revised and accepted, April 2004.
0889-5406/$30.00
Copyright © 2005 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2004.04.030
206
ing facial profile might be changing because of these
international influences. In light of these rapid de-
velopments, this study aimed to determine the per-
ceptions of Japanese orthodontists and young adult
Japanese dental students of well-balanced, pleasing
profiles. Facial silhouettes were chosen for rating
facial profiles, rather than facial photos, to avoid
subjective considerations.15,16 The purpose of this
study was to assess and determine the range of soft
tissue anteroposterior lip position of the top 3 most-
favored, well-balanced profiles of each sex from a
series of varying lip positions in facial silhouettes.
MATERIAL AND METHODS
Average Japanese silhouettes were constructed
from 30 cephalometric radiographs (15 men and 15
women) of adults aged 22 to 26 years. Inclusion
criteria for this study were an ANB angle between 2°
and 5°, a normal occlusion with minor or no crowd-
ing, all teeth present except third molars, no previous
orthodontic treatment, and no prosthetic replacement
of teeth.
All lateral cephalometric radiographs were taken
with the teeth in maximum intercuspation in a
cephalostat oriented to the Frankfort horizontal
plane. The radiographs were taken with a DR-155-
23HC (SSR-2B) cephalostat (Hitachi Medical Cor-
poration, Tokyo, Japan) and exposed at 100 kV, 10
mA. All radiographs were traced by hand on matte
acetate sheets and digitized on a personal computer
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 128, Number 2
Fig 1. Soft tissue cephalometric reference points and
analysis: 1, angle of nasal prominence; 2, collumellar
length angle; 3, nasal tip angle; 4, nasolabial angle
(Cm-Sn-Ls); 5, upper lip protrusion (Ls to Sn-Pg’); 6,
lower lip protrusion (Li to Sn-Pg’); 7, inferior labial sulcus
angle; 8, facial convexity (G’-Sn-Pg’); 9, Z-angle (chin/
lip line to FH plane).
by an orthodontist (H.I.) to eliminate interexaminer
variability. Cephalometric analyses were performed
with a cephalometric software program (Winceph
5.5, Rise, Sendai, Japan), on a personal computer.
Soft tissue reference points and angles are shown in
Figure 1. We obtained 7 angular and 2 linear mea-
surements, and 1 ratio-related measurement for the
soft tissue analysis (Table I).
The mean and standard deviations (SD) for soft
tissue measurements were determined for each sex
(Table I). These values were found to be within 1 SD of
current Japanese cephalometric dimensions.17 With
these mean values, average Japanese profile silhouettes
were constructed for men and women. Alcalde et al14
reported that the mean ⫾ SD for Japanese cephalomet-
ric norms for nasolabial angle, Ls to Sn-Pg’, and Li to
Sn-Pg’ were 102.34° ⫾ 11.62°, 5.79° ⫾ 2.12°, and
5.03° ⫾ 2.49°, respectively.
Ioi et al 207
To assess method error, 10 cases were randomly
selected and traced at 3 separate times. One-way
analysis of variance, used to test the equality of means
for the cephalometric measurements, suggested that it
was done consistently. Mean scores for the soft tissue
measurements (P ⫽ .82) did not significantly differ
among the 3 separate measurements. The method error
can be considered negligible.
Series of 13 profiles were developed for men and
women (Fig 2). The average profile7 was in the center.
The lips were protruded or retruded in 1-mm incre-
ments from the average profile, and the lip positions
were changed parallel to the Frankfort horizontal plane.
Profile 1 is the most retrusive, and 13 is the most
protrusive.
The profile raters were 42 Japanese orthodontists
(20 men, aged 38.0 ⫾ 10.3 years; 22 women, aged 27.6
⫾ 2.3 years), and 42 dental students (30 men, aged 24.6
⫾ 1.9 years; 12 women, aged 25.1 ⫾ 2.7 years). They
were asked to choose the top 3 most-favored profiles
and rank them, with number 1 as the best. They were
also asked to choose the least-favored profile.
RESULTS
For the orthodontist raters, the top 3 most-favored
male profiles were 6, 5, and 4; the most-favored female
profiles were 5, 4, and 6 (Fig 3). For the dental students,
the 3 most-favored male profiles were 5, 4, and 6, and
the 3 most-favored female profiles were 3, 4, and 5 (Fig
3). The orthodontists and the dental students both chose
13 as the least-favored profile for men and women.
From the most-favored profiles rated by the orthodon-
tists, the ranges of the following soft tissue measure-
ments were determined: lip protrusion to Sn-Pg’ and
the esthetic line, and Z-angle (Table II). The same
ranges were recorded for the dental students in
Table III.
For men rated by both the orthodontists and the
dental students, the most-favored lip protrusion values
relative to Sn-Pg’ ranged from 3.4 to 5.4 mm for the
upper lip and from 2.7 to 4.7 mm for the lower lip. The
most-favored lip protrusion range relative to the es-
thetic line was from –5.5 to –3.5 mm for the upper lip
and –2.0 to 0 mm for the lower lip. The range of
most-favored Z-angle values was 72.0° to 75.0°.
For women rated by the orthodontists, the ranges of
the most-favored lip protrusion values relative to
Sn-Pg’ were 3.5 to 5.5 mm for the upper lip and 3.4 to
5.4 mm for the lower lip. The most-favored lip protru-
sion range relative to the esthetic line was – 4.0 to –2.0
mm for the upper lip and –1.0 to 1.0 mm for the lower
lip. The range of most-favored Z-angle values was
72.0° to 74.0°.
208 Ioi et al American Journal of Orthodontics and Dentofacial Orthopedics
August 2005

Table I. Mean and SD of Japanese soft tissue measurements

Men Women

Variables Mean SD Mean SD

Facial form
Angle of nasal prominence (°) 31.3 2.4 30.3 4.0
Collumellar length angle (°) 22.3 1.8 21.2 2.0
Nasal tip angle (°) 75.7 8.4 83.6 7.3
Facial convexity (G=-Sn-Pg=) (°) 11.5 2.9 13.2 4.9
Vertical height ratio (G=-Sn/Sn-Me=) 0.95 0.05 0.92 0.09
Lip position
Nasolabial angle (Cm-Sn-Ls) (°) 93.8 11.3 99.8 8.5
Upper lip protrusion (Ls to Sn-Pg=) (mm) 6.4 1.6 6.5 1.5
Lower lip protrusion (Li to Sn-Pg=) (mm) 5.7 1.9 6.4 1.9
Inferior labial sulcus angle (°) 129.6 13.7 140.5 13.8
Z-angle (chin/lip line to FH plane) (°) 69.0 5.4 66.6 7.1

Fig 2. Series of 13 profiles rated by orthodontists and dental students for men (upper row) and
women (lower row).

For women rated by dental students, the ranges of DISCUSSION

the most-favored lip protrusion values relative to
Sn-Pg’ were 2.5 to 4.5 mm for the upper lip and 2.4 to
4.4 mm for the lower lip. The most-favored lip protru-
sion ranges relative to the esthetic line were – 4.5 to
–2.5 mm for the upper lip and –1.5 to 0.5 mm for the
lower lip. The range of most-favored Z-angle values
was 73.0° to 75.0°.
The objectives of orthodontic treatment are to
achieve facial balance, by stabilizing the dentition, and
pleasing facial and dental esthetics.18 Therefore, it is
important to identify and define the characteristics of a
pleasing, well-balanced face, as well as those of a
functioning occlusion. Our predecessors, including phi-
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 128, Number 2
Fig 3. Distribution of most-favored profiles. A, orthodontists rating men; B, orthodontists rating
women; C, dental students rating men; D, dental students rating women.
Table II. Range of preferred Japanese lip protrusion
values by orthodontists
Range
Variables Men Women
Lip position
Upper lip protrusion (Ls to Sn-Pg=) (mm) 3.4 - 5.4 3.5 - 5.5
Lower lip protrusion (Li to Sn-Pg=) (mm) 2.7 - 4.7 3.4 - 5.4
Upper lip to E-line (Ls to E-line) (mm) –5.5 - –3.5 –4.0 - –2.0
Lower lip to E-line (Li to E-line) (mm) –2.0 - 0 –1.0 - 1.0
Z-angle (chin/lip line to FH plane) (°) 72.0 - 75.0 72.0 - 74.0
losophers and artists, attempted to define beauty. How-
ever, it was difficult to determine the standards of
beauty, because of tremendous variations among peo-
ple in different racial groups.18 There are many studies
on the norms of the well-balanced Japanese face,3-14
but most were performed between 1950 and 1970 .3-10
To date, only a few studies have attempted to
quantify soft tissue lip positions of well-balanced Jap-
anese subjects.8,10,11 Because the perception of beauty
might have changed with time, it appears reasonable to
reevaluate the perception of the well-balanced, pleasing
Japanese face in the 21st century. Worldwide commu-
nications through the media, such as the Internet,
Ioi et al 209
Table III.
Range of preferred Japanese lip protrusion
values by dental students
Range
Variables Men Women
Lip position
Upper lip protrusion (Ls to Sn-Pg=) (mm) 3.4 - 5.4 2.5 - 4.5
Lower lip protrusion (Li to Sn-Pg=) (mm) 2.7 - 4.7 2.4 - 4.4
Upper lip to E-line (Ls to E-line) (mm) –5.5 - –3.5 –4.5 - –2.5
Lower lip to E-line (Li to E-line) (mm) –2.0 - 0 –1.5 - 0.5
Z-angle (chin/lip line to FH plane) (°) 72.0 - 75.0 73.0 - 75.0
television, movies, and magazines, have expanded in
recent years. People who are potential candidates for
orthodontic treatment are likely to be profoundly influ-
enced by these media. Our hypothesis is that the
perception of beauty might have changed because of an
increase in worldwide access to variations in pleasing
facial profiles. The objective of this study was to
determine, assess, and compare the range of values of
well-balanced, facial profiles by Japanese orthodontists
and dental students.
The orthodontists rated the most-favored Japanese
profiles as slightly more retruded than the average for
both men and women. If the raters in this study chose
210 Ioi et al
the average profile as the well-balanced one, they
should have selected 7; 6 was considered most favored
for men and 5 for women. The tendency was to prefer
a slightly more retruded lip position than the average lip
position for women. The dental students regarded 5 as
the best profile for men and 3 as the best for women.
The dental students favored a slightly more retruded lip
position for men and women than did the orthodontists.
Therefore, it is important to consider the perceptions of
young adults or nonorthodontists in determining well-
balanced facial profiles. The same tendency of Japanese
to prefer a flatter profile was reported in previous
articles.12,14 These authors described the Japanese as
favoring a flatter profile, as did white people, even
though their profiles were characterized by convex
features.12 These results might imply that a perception
regarding beauty has been established around each
racial norm. The least-favored profile was consistently
the most protrusive for both rater groups. This finding
might suggest that orthodontic patients with protrusive
lips seek straighter profiles through orthodontic treat-
ment.
For men, orthodontists and dental students pre-
ferred the same ranges of the favored lip protrusion
relative to Ls to Sn-Pg’, Li to Sn-Pg’, Ls to E-line, Li
to E-line, and Z-angle, respectively. For women, the
dental students preferred a slightly more retruded lip
position than the orthodontists, differing by 0.5 to 1.0
mm.
A slightly more retruded lip position was favored
by the dental students relative to Sn-Pg’ and the esthetic
line. Similar findings were reported by Alcalde et al,14
who compared the differences in lip position between a
normal Japanese group and a supernormal pleasant
Japanese group. He stated that the lip protrusion rela-
tive to Sn-Pg’ for the pleasant Japanese norm was 4.6
mm at the upper lip and 3.1 mm at the lower lip,
including men and women. Nezu et al19 reported that
normal lower lip protrusion to the esthetic line was 2.0
mm in Japanese people and –2.0 mm in white people.
These findings indicated that the flatter, white profile
was favored for Japanese men and women. In some
Western countries, a common perception is that more
protrusive lips are more desirable in women than
men.18 Although both men and women favored a more
retruded lip position than the mean values for each sex,
a similar tendency was preferred for women compared
with men, when observed by Japanese raters.
In this study, the mean values of Z-angle for the
Japanese male and female subjects were 69.0° and
66.6°, respectively. Iwasawa et al20 reported that
Z-angles for Japanese men and women were 69.7° and
71.8°, respectively. We found slightly larger Z-angle
American Journal of Orthodontics and Dentofacial Orthopedics
August 2005
values in the most-favored profiles compared with these
mean values. This result might also show that the
Japanese prefer a straight profile over a convex one.
Because the mean value of Z-angle for white people21
is 80.2°, there is still considerable difference between
the Japanese-favored Z-angle and the white norm. This
might be due to the more retruded chin and generally
protruding mandibular incisors inherent in the Japanese
population.
In this study, we established a range of soft tissue
lip-position values for the most-favored Japanese pro-
file. We should not treat our patients to all look alike.
Some patients might not want their facial features
altered to those considered to be well balanced. Differ-
ent racial groups have different perceptions of what is
attractive.18
CONCLUSIONS
1. Both the orthodontists and the dental students
tended to prefer a slightly more retruded lip posi-
tion than the average silhouette.
2. In the estimation of both the orthodontists and the
dental students for men, the ranges of the favored
lip protrusion relative to Sn-Pg’ were 3.4 to 5.4 mm
at the upper lip and 2.7 to 4.7 mm at the lower lip,
respectively. In the estimation of the orthodontists
for women, the ranges of the favored lip protrusion
relative to Sn-Pg’ were 3.5 to 5.5 mm at the upper
lip and 3.4 to 5.4 mm at the lower lip, respectively.
A slightly more retruded position was favored by
the dental students.
3. For men rated by both the orthodontists and the
dental students, the range of most-favored Z-angle
values was 72.0° to 75.0°. On the other hand, for
women, the ranges of most-favored Z-angle values
were 72.0° to 74.0° and 73.0° to 75.0° rated by the
orthodontists and the dental students, respectively.
Additional research, on the issue of the hard tissue
analysis for most-favored profiles in young Japanese
adults, appears to be warranted.1,21
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