Frontal analysis starts by assessing the transverse and vertical facial dimensions and general symmetry. The relationship between the bitemporal, bizygomatic, bigonial, and mental widths, also in comparison with facial heights, determines the facial form, which varies from wide to narrow, from long to short, and from square to triangular (Fig. 5.2). The grade of angularity and skeletonization of the facial form should also be noted.

Symmetry is always checked. Many patients are unaware of minor facial asymmetries, and if they discover these in the postoperative period, it will lead to patient dissatisfaction and misunderstanding. My preferred way to document and show all the facial asymmetries to the patient requires the marking of the midline skin points, using a fine-tip surgical skin marker and taking the frontal, basal, and facedown views again (Fig. 5.3). If the facial asymmetry is located in a lateral structure and not in the midline, as in the case of unilateral upper lid ptosis, a simple picture taken in frontal view is the best way to communicate this to the patient.

My attention is almost always focused on the central oval of the face. This extended facial region, described by Oscar Ramirez in his articles on facial rejuvenation, is also of interest in every basic facial analysis [7]. The central oval of the face comprises the eyes, the eyebrows, the zygoma, the nose, the mouth, and the chin, as depicted in Fig. 5.4.

The basal views offer an additional check in the evaluation of general facial symmetry. The shape of the nasal base, the projection of the nasal tip and eye globes, and the shape of the zygomatic arches and chin are all evaluated and judged utilizing the basal view (Fig. 5.5).

There are multiple oblique views because, from the pure frontal to the pure profile views, we can find 89 different head positions to the right and 89 different head positions to the left by making small intermediate rotations of 1°. When we try to document a nose with a dorsal deformity, the best oblique view is quite different with the oblique view we need to judge the spatial position of the malar eminence, as depicted in Fig. 5.6.

As recommended in Chap. 3, in every clinical case, I prefer to take at least three different right and left oblique views, changing the camera position and maintaining the position of the subject, with the lighting system fixed.

Ideally, an oblique view should be considered as being composed of two distinct components, which need to be analyzed separately.

The first one (Fig. 5.7) is the half of the face that is facing the camera (or the eyes of the observer) and is a great aid in the evaluation of the lateral components of the face such as the temporal, zygomatic, orbital, cheek, paranasal, preauricular, and mandibular angle. This component is usually familiar to the patient, as is the frontal view, so it is utilized extensively during communication with her.

The second component (Fig. 5.8) is the profile of the opposite side of the face that emerges on the background panel. In a youthful subject, it is composed of a series of gentle curves, which resembles the outline of an ogee. Here is how J. William Little describes these curves: “the youthful facial ogee typically arises from a high, subtle lid–cheek interface and rises gradually and gracefully to a broad, uniform convexity that peaks near or above the nasal tip. It then continues as a descending convex curve to the level of the upper lip, where it rapidly reverses itself through the occlusal plane, entering a limited concavity that rises slightly at the mandibular border before curving acutely around that structure into the neck” [4].