Farkas et al [3] were the first investigators to test the applicability of neoclassical facial canons, studying samples of 6, 12, and 18-year old North American Caucasians. Subsequently the applicability of these canons was also tested on several other ethnic groups including African-Americans [4], Turkish [5], Vietnamese [2], Thai [2] and Chinese individuals [2], [6]. These studies were performed with manual anthropometry in which measurements were directly obtained using anthropometric tools, e.g., spreading and sliding calipers. There are few studies [7], [8], [9] which have used two-dimensional (2-D) photographs to validate the applicability of these canons. However, use of such 2-D techniques for quantification of the 3-D morphology of the face has inherent methodologic limitations. [10]
Post-natal craniofacial growth and development is characterized by an increase in the width and length of both the face and the skull, as well as by a significant change in the proportions of these, resulting in morphological variations in the three planes of space (vertical, transverse and antero-posterior), until skeletal maturity is reached [1]. To assess both the head and the face, measurements can be conducted that yield cranial and facial classification, using indices associated with growth patterns, which make orthopedic and/or orthodontic diagnosis and treatment planning easier.
Anthropometry of soft- tissue using a measurement instrument (anthropometer) is considered a direct quantitative method. Advantages of this technique include its non-invasive nature and its allowance to access to areas covered by hair (e.g., head circumference, width, length and height) or to areas that, otherwise, would be observed distorted through indirect anthropometry (e.g., face depth in photography) [4].
Early in his career as a surgeon, Leslie Farkas was dissatisfied with the determination of the morphologic changes in the head and face by visual assessment. Therefore, he began to explore the use of classic anthropometric methods for quantitative analysis of faces, pre and postoperatively, and thus establish the differences between direct and indirect measurement methods with clinical assessment [5, 6].
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