Journal of Cranio-Maxillo-Facial Surgery 45 (2017) 741e747

Contents lists available at ScienceDirect

Journal of Cranio-Maxillo-Facial Surgery

journal homepage: www.jcmfs.com

Neoclassical canons of facial beauty: Do we see the deviations?

Andrej Pavlic*, Magda Trinajstic Zrinski, Visnja Katic, Stjepan Spalj
Department of Orthodontics (Head: Prof. Stjepan Spalj), School of Medicine, University of Rijeka, Kresimirova 40, 51000 Rijeka, Croatia

a r t i c l e i n f o a b s t r a c t

Article history: Aim: To explore the presence of neoclassical canons of facial beauty among young people in Croatia and
Paper received 19 July 2016 to question possible psychosocial repercussions occurring in those who demonstrate deviations in
Accepted 26 January 2017 relation to canons.
Available online 6 February 2017
Subjects and methods: The study was cross-sectional and the sample included 249 subjects (60% female)
aged 12e39 (median 20). Their en face and profile photographs were taken in Natural Head Position.
Keywords:
Photogrammetry included analysis of nine neoclassical canons of facial beauty originating from the
Aesthetics
Renaissance. Psychosocial issues were assessed using the Self-Esteem Scale, Big Five Inventory and three
Psychometrics
Personality tests
domains of Orthognathic Quality of Life Questionnaire.
Results: Significant deviations from neoclassical facial beauty canons were observed in 55e65% of ad-
olescents and young adults. Gender and age showed no relation to deviations. The deviations from
canons that influenced the quality of life were mainly those related to vertical facial proportions and
demonstrated increased facial aesthetics concern and social impact, and higher self-reported treatment
need (p < 0.05). Deviations from canons were not related to self-esteem but a decrease in openness,
agreeableness and neuroticism was observed.
Conclusion: Neoclassical canons were not valid for the majority of adolescents and young adults in
Croatia. Only deviations from some canons appear to provoke mild psychosocial repercussions.
© 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights
reserved.

1. Introduction Although the scientific field is nowadays becoming more ori-

Canons of human beauty in general, including particularly facial
features, originate from the period of ancient Egypt and Greece.
They represented standardized proportions for human sculptures.
However, it was not until the Renaissance era that canons regained
their importance for artists (Kusugal et al., 2015). Great people of
science, art and innovation, such as Da Vinci, Vitruvius, Bergmüller,
Albrecht Dürer, profoundly revisited and applied canons in their
work (Jayaratne et al., 2012). Most of the canons assessed in this
study were actually first described by Da Vinci. Therefore, the term
“neoclassical” is used. These canons represent assumed occurrence
of constant ratios between different parameters in a harmonious
human face (Vegter and Hage, 2000).
Parameters of facial aesthetics are of importance in the fields of
orthognathic and aesthetic surgery and orthodontics in planning
and setting treatment goals (Naini and Gill, 2008).
* Corresponding author. Fax: þ385 51345650.
E-mail address: pavlic.andrej@yahoo.com (A. Pavlic).
ented towards other conventions such as the averageness theory,
neoclassical canons are still widely used in anatomy, art and
medicine (Al-Sebaei, 2015). In recent decades researchers have
commenced to ask themselves whether these canons still demon-
strate validity. A complex issue emerged since the human face did
not exhibit major changes over the last two millenniums, meaning
other factors might have led to canons becoming less applicable in
modern time. It is known that cultural aspects such as beauty
standards alter over time periods, so it is entirely plausible that
what was attractive and pleasant a few decades, not to mention
centuries ago, is not considered as such nowadays.
Previous studies have questioned the presence of canons,
however did not put them in possible relation with one's percep-
tion of his/her attractiveness (Borman et al., 1999; Farkas et al.,
2000).
Other rules and concepts, such as the divine ratio, have been
formed throughout the history of humankind as scientists and
artists sought mathematical calculations of facial aesthetics
(Jahanbin et al., 2008). They are, however, without disregarding
their importance, beyond the scope of this research.

http://dx.doi.org/10.1016/j.jcms.2017.01.029
1010-5182/© 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
742 A. Pavlic et al. / Journal of Cranio-Maxillo-Facial Surgery 45 (2017) 741e747
Quality of life (QoL) represents the complex product resulting
from health conditions, appearance, social and contextual factors
(Litner et al., 2008; Kosowski et al., 2009). If neoclassical canons do
represent facial beauty, deviations could provoke an alteration of
QoL.
Presence of malocclusion appears to influence self-perceived
QoL (Kragt et al., 2015; Lukez et al., 2015). However, it remains
questionable to what extent laypeople notice the parameters of
mini and micro smile aesthetics. It seems people tend not to notice
details in smile but altered relations between facial elements could
bother them more and provoke psychosocial repercussions (Lukez
et al., 2015; Paula et al., 2011).
Therefore, the aim of this study was to explore the prevalence of
canons in today's faces and to investigate the self-perceived psy-
chosocial issues caused by the deviations from canons. The hy-
pothesis of this study was that significant deviations from canons
could influence the perception of oneself and induce some QoL
impairing psychosocial effects. Furthermore, the assessment of
potential correlation with one's personality traits was to be
inspected, given that personality traits are almost 50% under
environmental influence (Bouchard and Loehlin, 2001).
Personality traits demonstrate stability in children, and become
more coherent during their somatic and psychological develop-
ment. Therefore, adolescents were included in the examination
(Measelle et al., 2005; Soto et al., 2008).
2. Subjects and methods
The study was cross-sectional and the sample included 249
subjects (60% female) aged 12e39 (median 20, interquartile range
16e22 years). Participants were pupils and students from local
schools and University in Rijeka, invited to participate on a volun-
tary basis, and subjects visiting the University Dental Clinic in
Rijeka, Croatia for an annual dental check-up, consultation or any
kind of dental treatment. The group comprised 83 adolescents
(under 18) and 166 adults (over 18).
The sample size was calculated under the presumption that the
differences in dimensions of self-perceived aesthetics impairment
between those with significant and nonsignificant deviations from
neoclassical canons would not be great and would amount to 2
scalar points with high dispersal of data, i.e. standard deviation of 5
scalar points in both groups. The power of 80% and significance
level 0.05, and the presumption of equal group sizes led to a min-
imum of 198 examinees (99 per group). Given the ratio of groups
sizes is 1:2, the required number of examinees would be 222 (74
and 184 per group). Taking into account a drop-out rate of 20%, 270
examinees were recruited. These calculations were performed in
the statistical software MedCalc 14.8.1 (MedCalc Software bvba,
Ostend, Belgium), and based on previously published data
(Cunningham et al., 2002).
Facial photographs of each subject, en face at rest and profile
view, were taken in Natural Head Position (NHP) with a calibration
gauge. Photogrammetric analysis evaluated presence of 9 neo-
classical canons defined 5 centuries ago; relations in proportions
between eyes, nose, lips and face widths, ear and nose heights and
height of head portions and facial portions (Torsello et al., 2010)
(Figs. 1 and 2).
Canons that were analysed are listed below:
1. Orbitonasal canon: endocanthion e endocanthion
(en e en) ¼ alare e alare (al e al)
2a. Orbital canon: endocanthion e endocanthion
(en e en) ¼ right exocanthion e right endocanthion (ex
R e en R)
2b. en e en ¼ ex L e en L
3. Naso-oral canon: cheilion e cheilion (ch e ch) ¼ 1.5
alare e alare (al e al)
4. Nose to face canon: alare e alare (al e al) ¼ 4
zygion e zygion (zy e zy)
5. Lower face in 3 equal portions canon: subnasale e stomion
(sn e stom) ¼ stomion e mentolabial sulcus (stom e
mls) ¼ mentolabial sulcus e menton (mls e me)
5a. sn e stom to sn e me ratio
5b. stom e mls to sn e me ratio
5c. mls-me to sn e me ratio
6. Two portion facial profile canon: vertex e endocanthion
(v e en) ¼ endocanthion e gnathion (en e gn)
7. Three portion facial profile canon: trichion e nasion
(tr e n) ¼ nasion e subnasale (n e sn) ¼ subnasale e
gnathion (sn e gn)
7a. tr e n to tr e gn ratio
7b. n e sn to tr e gn ratio
7c. sn e gn to tr e gn ratio
8. Four portion facial profile canon: vertex e trichion
(v e tr) ¼ trichion e glabella (tr e gl) ¼ glabella e subnasale
(gl e sn) ¼ sn e gn (subnasale e gnathion)
8a. v e tr to v e gn ratio
8b. tr e gl to v e gn ratio
8c. gl e sn to v e gn ratio
8d. sn e gn to v e gn ratio
9. Naso-aural canon: nasion e subnasale (n e sn) ¼
supra-aurale e subaurale (sa e sba)
All analyses were performed in the software AudaxCeph (Audax,
Ljubljana, Slovenia).
Orthognathic Quality of Life Questionnaire (OQoLQ) domains;
Social Aspect of Dentofacial Aesthetics, Facial Aesthetics Concern
and Awareness of Dentofacial Aesthetics were used for the
assessment of self-perceived impairment of QoL in relation to
altered facial aesthetics (Cunningham et al., 2002). OQLQ had not
been used in Croatia previously, therefore a forwardebackward
translation was done by four experts, Croatian dentists and stu-
dents of English language, proficient in both Croatian and English
(two of them independently performed the forward translation and
other two the backward), one of which had had experience using
Quality of Life (QoL) instruments. A panel of four dental experts
checked the meaning of the original, translated and back-translated
items and made consensus of the Croatian version. Internal con-
sistency of domains was verified by average inter-item correlations
and Cronbach alpha. The questionnaire was supplemented with
two questions: “How satisfied are you with the appearance of your
face?” (5 point Likert scale with cut-off points 0 ¼ not at all,
4 ¼ very much) and “Do you think you need some intervention to
change the appearance of your face?” (0 ¼ not at all, 4 ¼ very
much).
Validated Croatian versions of the Rosenberg Self-Esteem scale
and the Big Five Inventory were employed (Schmitt et al., 2007;
Rammstedt and John, 2007).
Big Five personality traits include openness, agreeableness,
conscientiousness, extraversion and neuroticism.
In order to classify examinees into two groups (one group with
significant deviations from theoretical concepts of neoclassical
canons and one group with examinees close to theoretical concept)
z values of deviations were calculated for each examinee according
to formula:
z ¼ [personal (r  4)  mean of the sample (r  4)]/SD of the
sample where r was the ratio of particular canon in an examinee, 4
theoretical concept of canons of facial aesthetics, and SD standard
deviation. Then the z-scores were dichotomised to reduce the effect
of outliers and to classify proportions into 2 groups based on the
A. Pavlic et al. / Journal of Cranio-Maxillo-Facial Surgery 45 (2017) 741e747 743

Fig. 1. Canons evaluated on en face photographs.

Fig. 2. Canons evaluated on profile photographs.

744 A. Pavlic et al. / Journal of Cranio-Maxillo-Facial Surgery 45 (2017) 741e747

range of 1 standard deviation from theoretical concept, 0 ¼ do not
demonstrate significant deviation from theoretical concept
(0.5  z  0.5) and 1 ¼ demonstrate significant deviation from
theoretical concept (0.5 < z > 0.5) (Kiekens et al., 2008). Awareness
of dental aesthetics, reported problems with facial aesthetics and
social aspect of aesthetics, satisfaction with facial appearance,
perception of treatment need and personality traits were compared
between these two defined groups (0 ¼ insignificant deviations
from canons and 1 ¼ significant deviations from canons). Pearson
correlation and independent samples t-test were used in statistical
analyses performed in the commercial statistical software IBM SPSS
22 (IBM Corp, Armonk, NY, USA). Correlations were interpreted as
significant when r > 0.25.
The study was approved by the Local Ethical Committee under the
number 2170-24-01-3-10-02. Informed consents were obtained from
examinees and from their parents when examinees were underage.
3. Results
Original dimensions of OQLQ demonstrated good internal con-
sistency (a ¼ 0.71e0.84) and moderate inter-item correlation
(Table 1).
Dimensions of social aspect and facial aesthetics correlate to
some extent with constructs of facial satisfaction and self-perceived
need for procedures on the face and self-esteem (r ¼ 0.296e0.500),
however, the awareness of dentofacial aesthetics is not associated
with those constructs (Table 2). No correlation was found between
OQLQ dimensions and the Big Five personality traits.
Significant deviations from neoclassical canons of facial aes-
thetics were present in 55e65% adolescents and young adults.
Deviations did not correlate neither to gender nor to age.
Most of the deviations from canons that affected examinees' QoL
were the ones related to proportions of facial thirds or quarters. In
view of that observation, deviation in upper face height (glabella e
subnasale) was correlated to significantly higher social aspect (4.8
vs. 3.2; p < 0.05), deviation in stomion e mentolabial sulcus portion
of canon of three equal portions in lower face led to a significant
increase in facial aesthetics concern and higher treatment need (5.5
vs. 4.5 and 0.8 vs. 0.5; p < 0.05). Deviation in subnasale e stomion
portion of canons of three equal portions in lower face and vertex e
trichion portion of four section facial profile canon led to higher
self-reported treatment need (both 0.8 vs. 0.5; p < 0.05; Fig. 3).
Significant deviation in the naso-oral canon was related to less
awareness of DFE (mouth width ¼ 1.5  nose width (4.9 vs. 5.8;
p < 0.05; Fig. 3)).
Significant deviations from canons were not related to self-
esteem but they induced a decrease in openness, agreeableness
and neuroticism (Fig. 4).
4. Discussion
It appears that more than half of adolescents and young adults
demonstrate significant deviations in craniofacial features from
neoclassical canons. However, these deviations seem to have a mild
effect on the self-perceived aesthetics and do not raise many psy-
chosocial issues.
The data of prevalence found in the present study are in
agreement with previous studies that have shown deviations from
canons in the majority of the population (Farkas et al., 1985;
Zacharopoulos et al., 2012; Cvicelova et al., 2007). The presence
of neoclassical canons has been verified on several races, demon-
strating that the canons are more applicable in some cultures and

Table 1
Internal consistency for the OQLQ subscales.

Subscale Internal consistency

Mean ± SD Range a Average inter-item correlation with range

Social aspect (8 items) 4.2 ± 4.8 0e27 0.84 0.40 (0.25e0.67)

Awareness of dentofacial aesthetics (4 items) 5.3 ± 3.7 0e16 0.74 0.42 (0.20e0.79)
Facial aesthetics (5 items) 5.1 ± 3.8 0e19 0.71 0.32 (0.10e0.75)

Table 2
Pearson correlations.

SA FA AW SFA FTN SE E A C N O

Social aspect (SA) r 1.000 0.555** 0.218** 0.364** 0.318** 0.500** 0.221** 0.017 0.140* 0.117 0.003
p <0.001 0.001 <0.001 <0.001 <0.001 <0.001 0.796 0.027 0.066 0.969
Facial aesthetics (FA) r 0.555** 1.000 0.264** 0.446** 0.296** 0.417** 0.178** 0.077 0.188** 0.121 0.058
p <0.001 <0.001 <0.001 <0.001 <0.001 0.005 0.229 0.003 0.056 0.362
Awareness of facial aesthetics (AW) r 0.218** 0.264** 1.000 0.045 0.003 0.068 0.021 0.231** 0.006 0.157* 0.054
p 0.001 <0.001 0.480 0.958 0.288 0.746 <0.001 0.920 0.013 0.399
Satisfaction with facial appearance (SFA) r 0.364** 0.446** 0.045 1.000 0.442** 0.417** 0.186** 0.030 0.184** 0.101 0.008
p <0.001 <0.001 0.480 <0.001 <0.001 0.003 0.635 0.004 0.115 0.899
Facial treatment need (FTN) r 0.318** 0.296** 0.003 0.442** 1.000 0.198** 0.028 0.068 0.034 0.046 0.052
p <0.001 <0.001 0.958 <0.001 0.002 0.667 0.291 0.601 0.477 0.418
Self-esteem (SE) r 0.500** 0.417** 0.068 0.417** 0.198** 1.000 0.311** 0.123 0.319** 0.250** 0.151*
p <0.001 <0.001 0.288 <0.001 0.002 <0.001 0.054 <0.001 <0.001 0.018
Extraversion (E) r 0.221** 0.178** 0.021 0.186** 0.028 0.311** 1.000 0.067 0.214** 0.041 0.030
p <0.001 0.005 0.746 0.003 0.667 <0.001 0.293 0.001 0.519 0.633
Agreeableness (A) r 0.017 0.077 0.231** 0.030 0.068 0.123 0.067 1.000 0.115 0.176** 0.153*
p 0.796 0.229 <0.001 0.635 0.291 0.054 0.293 0.071 0.005 0.016
Conscientiousness (C) r 0.140* 0.188** 0.006 0.184** 0.034 0.319** 0.214** 0.115 1.000 0.018 0.122
p 0.027 0.003 0.920 0.004 0.601 <0.001 0.001 0.071 0.773 0.056
Neuroticism (N) r 0.117 0.121 0.157* 0.101 0.046 0.250** 0.041 0.176** 0.018 1.000 0.030
p 0.066 0.056 0.013 0.115 0.477 <0.001 0.519 0.005 0.773 0.643
Openness (O) r 0.003 0.058 0.054 0.008 0.052 0.151* 0.030 0.153* 0.122 0.030 1.000
p 0.969 0.362 0.399 0.899 0.418 0.018 0.633 0.016 0.056 0.643

*p < 0.05 **p < 0.005, r e correlation coefficient, p e level of statistical significance.
 A. Pavlic et al. / Journal of Cranio-Maxillo-Facial Surgery 45 (2017) 741e747
Fig. 3. Psychosocial repercussions and presence of canons, * ¼ statistically significant ¼ p < 0.05.
less in others (Al-Sebaei, 2015). It seems that neoclassical canons
are more applicable to the people of Caucasian background rather
than to ones of Chinese, Arabian or Afro-American descent. Studies
done on Arabian and Chinese people demonstrate elusion of canons
(Farkas et al., 2000; Jayaratne et al., 2012; Bozkir et al., 2004).
Although it is obvious that the canons are not omnipresent and
cannot be observed on all faces, a more interesting issue emerges.
Do they describe the aesthetically pleasant face and could they be
used for treatment planning? An interesting study from Italy
(Torsello et al., 2010) found deviations from canons among adult
female participants of a beauty contest, which could imply that not
all deviations could be considered aesthetically unpleasing. The
study analysis demonstrated reduction in the lower third,
enlargement of eyes and mouth width in relation to canons among
contestants. With regard to the abovementioned evidence, treat-
ment planning based on neoclassical canons could be performed
but with caution in view of an individual approach to patients,
especially patients of various ethnic background. No relation of age
and gender with deviations from canons was observed in this
study, although the contrary has been reported previously (Farkas
et al., 1985; Zacharopoulos et al., 2012).
This study found most frequent deviations in canons relating to
the width of the face and the width of the nose and in the four
section facial profile canon with most deviations found in the
height of the calvaria. Similar findings have also been reported
(Borman et al., 1999; Torsello et al., 2010).
Generally, it appears that deviations from neoclassical facial
canons are not considered unpleasant. Similar studies report only
partial presence of neoclassical canons in today's faces with some
even declaring them inappropriate for treatment planning and
setting goals for aesthetic surgery, maxillofacial surgery or ortho-
dontics (Jayaratne et al., 2012; Kusugal et al., 2015). Even so, de-
viations from some canons seem to raise more psychosocial
concerns than others. People with altered lower facial height seem
to have an increased demand for aesthetic corrective procedures on
745
the face, while those with altered upper facial third demonstrate
higher social issues. It seems the symmetries related to eyes or
distance between the eyes are not noticed nor considered
aesthetically unpleasant. It could be that these proportions are not
very relevant to the aesthetics of today. On the other hand, it is
sensible that one is more affected by alterations of facial thirds, as
these could be more visible to oneself and to others. Furthermore,
these alterations can be seen en face and in profile view as well,
meaning one observes them more often. These findings are of
peculiar interest to dentists, namely prosthodontists and ortho-
dontists, and maxillofacial surgeons whose treatment has impact
on the dimensions of the lower face.
Psychologists tend to differentiate several usages of the term
self-esteem. Our study focuses on global self-esteem, which per-
tains to the way people feel about themselves (Brown et al., 2001).
Deviations from canons did not relate to self-esteem. It may be
concluded that self-esteem is a complex entity that cannot be
altered by these disproportions to a large extent, bearing also in
mind that these proportions cannot be strictly related to beauty in
modern societies. Previous research has also shown little influence
of facial characteristics on self-esteem (Gavric et al., 2015).
A relationship between deviations from canons and some per-
sonality traits, namely agreeableness, extraversion and neuroti-
cism, has been found. No correlation was observed between the Big
Five personality traits and the OQLQ dimensions. Previous research
suggests that some personality traits can act as moderators on the
relation between dentofacial aesthetics and psychosocial impacts
(Spalj et al., 2016). Moderators are variables that interact with the
cause potentially affecting the cause and effect relationships.
However, no moderating effect was noticed on the above-
mentioned relation. Mediators alter the cause and effect relation
explaining the cause-effect path. Put in another way, a moderator
influences the strength of a relationship between two other vari-
ables, while mediators explain the relationship (Baron and Kenny,
1986; Fairchild and MacKinnon, 2009).
746 A. Pavlic et al. / Journal of Cranio-Maxillo-Facial Surgery 45 (2017) 741e747

Personality traits are constructs that derive almost equally from

both genetic and environmental factors and as such could be
affected by deviations from aesthetic ideals (Jang et al., 1996).
People with deviations from canons seem to have lower agree-
ableness, neuroticism and openness. It can be postulated that long-
term issues with deviations from ideal facial aesthetics could lead
to one being more antagonistic toward others and develop a more
introverted personality. Even so, the differences observed, although
statistically significant, are minimal, and one could doubt their real-
life significance.

5. Conclusion

The majority of the population demonstrates deviations from

canons. However, these changes do not seem to provoke many
psychosocial issues.

Acknowledgement

Preliminary data were presented at the 91th Congress of the

Fig. 4. Personality traits and presence of canons, * ¼ statistically significant ¼ p < 0.05.

European Orthodontic Society in June of 2015 in Venice as a poster

presentation.

References

Al-Sebaei MO: The validity of three neo-classical facial canons in young adults
originating from the Arabian Peninsula. Head Face Med 13: 11e14. http://
dx.doi.org/10.1186/s13005-015-0064-y, 2015
Baron RM, Kenny DA: The moderator-mediator variable distinction in social psy-
chological research: conceptual, strategic, and statistical considerations. J Pers
Soc Psychol 51: 1173e1182, 1986
Borman H, Ozgür F, Gürsu G: Evaluation of soft-tissue morphology of the face in
1,050 young adults. Ann Plast Surg 42: 280e288, 1999
Bouchard Jr TJ, Loehlin JC: Genes, evolution, and personality. Behav Genet 31:
243e273, 2001
Bozkir MG, Karakas P, Oguz O: Vertical and horizontal neoclassical facial canons in
Turkish young adults. Surg Radiol Anat 26: 212e219, 2004
Brown JD, Dutton KA, Cook KE: From the top down: self-esteem and self-evaluation.
Cogn Emot 15: 615e631, 2001
Cunningham SJ, Garratt AM, Hunt NP: Development of a condition-specific quality
of life measure for patients with dentofacial deformity: II. Validity and
responsiveness testing. Community Dent Oral Epidemiol 30: 81e90, 2002
Cvicelova M, Benus R, Lysakova L, Molnarova A, Borovska Z: Occurrence of neo-
classical facial canons in Caucasian primary school pupils and university stu-
dents. Bratisl Lek Listy 108: 480e485, 2007
Fairchild AJ, MacKinnon DP: A general model for testing mediation and moderation
effects. Prev Sci 10: 87e99, 2009
Farkas LG, Hreczko TA, Kolar JC, Munro IR: Vertical and horizontal proportions of
the face in young adult North American Caucasians: revision of neoclassical
canons. Plast Reconstr Surg 75: 328e338, 1985
Farkas LG, Forrest CR, Litsas L: Revision of neoclassical facial canons in young adult
Afro-Americans. Aesthetic Plast Surg 24: 179e184, 2000
Gavric A, Mirceta D, Jakobovic M, Pavlic A, Zrinski MT, Spalj S: Craniodentofacial
characteristics, dental esthetics-related quality of life, and self-esteem. Am J
Orthod Dentofacial Orthop 147: 711e718. http://dx.doi.org/10.1016/
j.ajodo.2015.01.027, 2015
Jahanbin A, Basafa M, Alizadeh Y: Evaluation of the Divine Proportion in the facial
profile of young females. Indian J Dent Res 19: 292e296, 2008
Jang KL, Livesley WJ, Vernon PA: Heritability of the big five personality dimensions
and their facets: a twin study. J Pers 64: 577e591, 1996
Jayaratne YS, Deutsch CK, McGrath CP, Zwahlen RA: Are neoclassical canons valid
for southern Chinese faces? PLoS One 7: e52593. http://dx.doi.org/10.1371/
journal.pone.0052593, 2012 [Epub 2012 Dec 28]
Kiekens RM, Kuijpers-Jagtman AM, van 't Hof MA, van 't Hof BE, Maltha JC: Putative
golden proportions as predictors of facial esthetics in adolescents. Am J Orthod
Dentofacial Orthop 134: 480e483, 2008
Kosowski TR, McCarthy C, Reavey PL, Scott AM, Wilkins EG, Cano SJ, et al:
A systematic review of patient-reported outcome measures after facial cosmetic
surgery and/or nonsurgical facial rejuvenation. Plast Reconstr Surg 123:
1819e1827. http://dx.doi.org/10.1097/PRS.0b013e3181a3f361, 2009
Kragt L, Dhamo B, Wolvius EB, Ongkosuwito EM: The impact of malocclusions on
oral health-related quality of life in children-a systematic review and meta-
analysis. Clin Oral Investig 20: 1881e1894, 2015
Kusugal P, Ruttonji Z, Gowda R, Rajpurohit L, Lad P: Ritu: three-dimensional facial
analyses of Indian and Malaysian women. Contemp Clin Dent 6: 332e336.
http://dx.doi.org/10.4103/0976-237X.161872, 2015
 A. Pavlic et al. / Journal of Cranio-Maxillo-Facial Surgery 45 (2017) 741e747
Litner JA, Rotenberg BW, Dennis M, Adamson PA: Impact of cosmetic facial surgery
on satisfaction with appearance and quality of life. Arch Facial Plast Surg 10:
79e83. http://dx.doi.org/10.1001/archfaci.10.2.79, 2008
Lukez A, Pavlic A, Trinajstic Zrinski M, Spalj S: The unique contribution of elements
of smile aesthetics to psychosocial well-being. J Oral Rehabil 42: 275e281.
http://dx.doi.org/10.1111/joor.12250, 2015 [Epub 2014 Oct 23]
Measelle JR, John OP, Ablow JC, Cowan PA, Cowan CP: Can children provide
coherent, stable, and valid self-reports on the big five dimensions? A longitu-
dinal study from ages 5 to 7. J Pers Soc Psychol 89: 90e106, 2005
Naini FB, Gill DS: Facial aesthetics: 1. Concepts and canons. Dent Update 35:
102e104, 2008

Campos AC, Nun
Paula Jr DF, Silva ET, ~ ez MO, Leles CR: Effect of anterior teeth display
during smiling on the self-perceived impacts of malocclusion in adolescents.
Angle Orthod 81: 540e545. http://dx.doi.org/10.2319/051710-263.1, 2011 [Epub
2011 Jan 24]
Rammstedt B, John OP: Measuring personality in one minute or less: a 10-item
short version of the Big Five Inventory in English and German. J Res Pers 41:
203e212, 2007
747
Schmitt DP, Allik J, McCrae RR, Bevet-Martinez V: The geographic distribution of Big
Five personality traits: patterns and profiles of human self-description across
56 nations. J Cross-Cult Psychol 38: 173e212, 2007
Soto CJ, John OP, Gosling SD, Potter J: The developmental psychometrics of big five
self-reports: acquiescence, factor structure, coherence, and differentiation from
ages 10 to 20. J Pers Soc Psychol 94: 718e737, 2008
Spalj S, Novsak A, Bilobrk P, Katic V, Zrinski MT, Pavlic A: Mediation and moderation
effect of the big five personality traits on the relationship between self-perceived
malocclusion and psychosocial impact of dental esthetics. Angle Orthod 86:
413e420. http://dx.doi.org/10.2319/032315-187.1, 2016 [Epub 2015 Aug 7]
Torsello F, Mirigliani L, D'Alessio R, Deli R: Do the neoclassical canons still describe the
beauty of faces? An anthropometric study on 50 Caucasian models. Prog Orthod
11: 13e19. http://dx.doi.org/10.1016/j.pio.2010.04.003, 2010 [Epub 2010 May 11]
Vegter F, Hage JJ: Clinical anthropometry and canons of the face in historical
perspective. Plast Reconstr Surg 106: 1090e1096, 2000
Zacharopoulos GV, Manios A, De Bree E, Kau CH, Petousis M, Zacharopoulou I, et al:
Neoclassical facial canons in young adults. J Craniofac Surg 23: 1693e1698.
http://dx.doi.org/10.1097/SCS.0b013e31826b816b, 2012