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Anthropometric Evaluation of Periorbital Region and Facial Projection Using Three-Dimensional Photogrammetry

Jodeh, Diana S., MD*; Curtis, Heather, MD; Cray, James J., PhD; Ford, Jonathan, PhD§; Decker, Summer, PhD§; Rottgers, S. Alex, MD*

doi: 10.1097/SCS.0000000000004761
Original Articles

Introduction: Direct anthropometric and three-dimensional (3D) photogrammetry measurements have been used extensively in cleft/craniofacial surgery to assess morphological changes and surgical outcomes. Craniofacial procedures alter the sagittal projection of periorbital bony prominences. Mulliken described a method of measuring their projection relative to the corneal plane but is impractical in clinical practice. Three-dimensional photogrammetry may offer a solution; however, the cornea is not visualized on this. The authors propose to develop new normative measurements of facial projection relative to the pupil.

Methods: Five 3D photographs were taken of 5 individuals using Vectra M5 camera. Facial projection measurements were taken of the sagittal projection of the bilateral periorbital landmarks and nasal radix relative to the pupil using Mirror 3D analysis. Standard deviations (SD) were determined for each subject and laterality. Chi-square tests confirmed all SD <1 mm. Intra and inter-rater reliability were confirmed with an intraclass correlation coefficient assessment.

Results: Three male and 2 female subjects were photographed with 5 unique images. Standard deviations of repeat measures of all landmarks were <0.5 mm. Chi-square tests confirmed with statistical significance that SD for all values except for the radix was <1 mm (P<0.05). Intrarater reliability was high for all landmarks (intraclass correlation coefficient coefficients 0.93–0.99). Inter-rater reliability was good for the lateral canthi and excellent for all others.

Conclusion: This technique demonstrates repeatability with high reliability on serial photographs and is applicable to measuring surgery effects and growth on facial projection. Establishment of age-specific normative values for landmark projection will refine usage applicability in operative planning.

*Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg

Department of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL

Departments of Oral Health Sciences and Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC

§Department of Radiology, University of South Florida, Morsani College of Medicine, Tampa, FL.

Address correspondence and reprint requests to S. Alex Rottgers, MD, Assistant Professor of Plastic Reconstructive Surgery, Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, 601 Fifth Street South, Suite 306, St. Petersburg, FL; E-mail:

Received 1 February, 2018

Accepted 23 May, 2018

The authors report no conflicts of interest.

© 2018 by Mutaz B. Habal, MD.