The Atractive Lip

Journal of Plastic, Reconstructive & Aesthetic Surgery (2015) 68, 920e929
The attractive lip: A photomorphometric

analysis
V. Penna*,1, A. Fricke 1, N. Iblher, S.U. Eisenhardt, G.B. Stark
Department of Plastic and Hand Surgery, University Medical Center Freiburg, Freiburg, Germany
Received 7 October 2014; accepted 8 March 2015
KEYWORDS Summary Background: Throughout literature, there are different parameters defining the
Photomorphometry; ideal shape of the lip and lower third of the face. This study was conducted to clarify what
Lip aesthetics; it is that makes lips attractive e and whether there are gender-related differences of an
Attractiveness; attractive lip and lower third of the face.
Perioral region Patients and methods: Pictures of the lip and chin region of 176 patients were photographed in
a standardised way and evaluated by 250 voluntary judges through an internet presentation by
means of an analogue Likert scaling system.
Results: We found a significant higher ratio of upper vermillion height/mouth-nose distance in
frontal-view images of attractive compared to unattractive female (p < 0.001) and male
(p < 0.05) perioral regions. Furthermore, the ratio of upper vermillion height/chin-nose dis-
tance was significantly higher in attractive than in unattractive female (p < 0.005) and male
(p < 0.05) lip and chin regions. The nasolabial angle was significantly sharper in attractive
compared to unattractive female perioral regions (p < 0.001). Moreover, attractive female
lip and chin regions showed a wider mentolabial angle compared to unattractive female lip
and chin regions (p < 0.05). Comparing men and women, we found that attractive female peri-
oral regions showed a higher ratio of lower vermillion height/chin-mouth distance (p < 0.05)
and lower vermillion height/chin-nose distance than attractive male perioral regions
(p < 0.05).
Conclusion: We were able to define certain parameters of the lip and lower third of the face
that seem to add to the attractivity of female and male individuals and prove that there are
gender-related differences in form and shape of an attractive lower third of the face.
ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by
Elsevier Ltd. All rights reserved.
* Corresponding author.
E-mail address: vincenzo.penna@uniklinik-freiburg.de (V. Penna).
1
The first two authors contributed equally to this manuscript.
http://dx.doi.org/10.1016/j.bjps.2015.03.013
1748-6815/ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
A photomorphometric analysis 921
Introduction shape of lips. Nevertheless, there are certain features

which are generally considered attractive in both men and
In 1984, Farkas et al. defined proportion standards by using women, such as full lips, as Sforza et al.12 showed in their
classical anthropometric landmarks in the upper lipelower study about facial morphometry of male and female
lipechin area of young adults,1 however not referring to adolescents.
attractive new proportions in particular but rather to The goal of our study was to emphasise what makes
average proportion standards. certain lips appealing and to analyse gender differences in
Recently, several studies have been conducted analysing certain proportions and angles of attractive and unattrac-
ideal facial proportions2,3 and symmetry of the face.4 Be- tive lips and perioral regions.
sides, a broad range of studies have identified different
attractive aspects of the eye5e7 and nose.8e10 Likewise, it
has been suggested that a certain scheme of childlike Patients and methods
characteristics combined with aspects of maturity and
expression make a female face appear explicitly attrac- The perioral region of 176 healthy Caucasians (18e30 years,
tive.11 However, little is known about ‘ideal’ features of 88 female, 88 male) was photographed in a standardised
the lower third of the face and especially the ‘perfect’ way (frontal and lateral view) and evaluated by 250
voluntary jurors through an Internet presentation by means
Figure 1 A. Likert 1/2, Male, Frontal view. B. Likert 1/2, Female, Lateral view. C. Likert 6/7, Male, Lateral view. D. Likert 6/7,
Female, Frontal view. Black line Z Mouth width. Turquoise line Z mouthenose distance. Purple line Z chinemouth distance.
Turquoise line and purple line Z chinenose distance. Red line Z upper vermillion height. Orange line Z Lower vermillion height.
Angle between yellow lines Z Nasolabial angle. Angle between green lines Z Mentolabial angle. ‘Nose’ refers to the nasal/
columellar base.
922 V. Penna et al.
Figure 2 Ratio of upper vermillion height/mouthenose dis- Figure 4 Ratio of upper vermillion height/chinenose dis-
tance in attractive (Likert 1/2) compared to unattractive fe- tance in attractive (Likert 1/2) compared to unattractive fe-
male perioral regions (Likert 6/7). *** Z p < 0.001. Frontal male perioral regions (Likert 6/7). ** Z p < 0.005. Frontal
view. view.
of an analogue Likert scaling system (scaling 1e7, chinenose distance (turquoise and purple line), ratio of
1 Z absolutely attractive, 7 Z absolutely unattractive). A lower vermillion height (orange line)/chinenose distance
photomorphometric analysis was performed on the frontal (turquoise and purple line), ratio of mouth width (black
and lateral view of the perioral region of each subject to line)/chinenose distance (turquoise and purple line), ratio
obtain angle and proportion measurements of the pictures of mouthenose distance (turquoise line)/chinemouth dis-
with highest and lowest Likert scores using an image anal- tance (purple line), nasolabial angle (angle between yellow
ysis software. Differences between the two groups were lines) and mentolabial angle (angle between green lines)
compared with 95% significance using the Student’s t-test (Figure 1 A and B). All distance measurements including the
for independent samples. P-values were rounded to four term ‘nose’ refer to the nasal/columellar base while the
significant digits. The following proportion and angle mea- term ‘mouth’ refers to the median point of the oral slit
surements were obtained: Ratio of upper vermillion height when the oral cavity is closed (stomion) (Figures 2e11,
(red line)/mouthenose distance (turquoise line), ratio of Tables 1e4).
lower vermillion height (orange line)/chinemouth distance
(purple line), ratio of upper vermillion height (red line)/
Figure 3 Ratio of upper vermillion height/mouthenose dis- Figure 5 Ratio of upper vermillion height/chinenose dis-
tance in attractive (Likert 1/2) compared to unattractive fe- tance in attractive (Likert 1/2) compared to unattractive fe-
male perioral regions (Likert 6/7). * Z p < 0.05. Lateral view. male perioral regions (Likert 6/7). * Z p < 0.05. Lateral view.
Figure 6 Ratio of upper vermillion height/mouthenose dis-

tance in attractive (Likert 1/2) compared to unattractive male
perioral regions (Likert 6/7). * Z p < 0.05. Frontal view. Figure 8 Nasolabial angle in attractive (Likert 1/2)
compared to unattractive female perioral regions (Likert 6/7).
*** Z p < 0.001. Lateral view.
Results
We found significant differences in the ratio of upper images (Figure 5). In both frontal-view images (p < 0.005)
vermillion height/mouthenose distance in attractive (Lik- and lateral-view images (p < 0.05), the ratio of upper
ert 1/2) compared to unattractive female perioral regions vermillion height/chinenose distance was significantly
(Likert 6/7), performing analysis on frontal- (Figure 2) as higher in attractive compared to unattractive female per-
well as on lateral-view images (Figure 3). In both frontal- ioral regions.
view images (p < 0.001) and lateral-view images In male perioral regions, we also found a significant
(p < 0.05), the ratio of upper vermillion height/mouth- higher ratio of upper vermillion height/mouthenose dis-
enose distance was significantly higher in attractive tance (p < 0.05) (Figure 6) and of upper vermillion height/
compared to unattractive female lip and chin regions. chinenose distance (p < 0.05) (Figure 7) in frontal-view
Furthermore, significant differences in the ratio of upper images of the attractive (Likert 1/2) compared to the un-
vermillion height/chinenose distance in the attractive attractive group (Likert 6/7).
compared to the unattractive female group could be
shown, analysing frontal- (Figure 4) as well as lateral-view
Figure 7 Ratio of upper vermillion height/chinenose dis- Figure 9 Mentolabial angle in attractive (Likert 1/2)
tance in attractive (Likert 1/2) compared to unattractive male compared to unattractive female perioral regions (Likert 6/7).
perioral regions (Likert 6/7). * Z p < 0.05. Frontal view. * Z p < 0.05. Lateral view.
924 V. Penna et al.
unattractive male perioral regions did not show any dif-

ferences in the nasolabial and mentolabial angles (Table 2).
Comparing male and female lip and chin regions in both
the attractive (Likert 1/2) and the unattractive (Likert 6/7)
group, we found that attractive female perioral regions
showed a significant higher ratio of lower vermillion height/
chinemouth distance than attractive male perioral regions
(p < 0.05) (Figure 10), whereas no such difference could be
shown comparing unattractive male and female perioral
regions (Table 4). Furthermore, the attractive female group
showed a significant higher ratio of lower vermillion height/
chinenose distance than the attractive male group
(p < 0.05) (Figure 11) e a difference that could also not be
found comparing unattractive male and female perioral
regions (Table 4). These findings are summarised in Tables
5e7. The ratio of mouth width/chinenose distance and of
mouthenose distance/chinemouth distance (Figure 1A and
B) did not show any significant difference of attractive
compared to unattractive perioral regions or of attractive/
unattractive female perioral regions compared to attrac-
tive/unattractive male perioral regions (Tables 1e4).
Figures 12 and 13 show exemplary images of attractive and
unattractive female and male perioral regions in frontal
Figure 10 Ratio of lower vermillion height/chinemouth and lateral views, respectively.
distance in attractive (Likert 1/2) female compared to
attractive male (Likert 1/2) perioral regions. * Z p < 0.05.
Lateral view. Discussion
The nasolabial angle was significantly sharper in the In our study, we found that there are various features of the
attractive (Likert 1/2) compared to the unattractive (Likert lips and the lower third of the face that are judged as
6/7) female group (p < 0.001) (Figure 8). Moreover, particularly appealing. Thus, we found that there are sig-
attractive female lip and chin regions showed a significantly nificant differences between certain features of male and
wider mentolabial angle compared to unattractive female female perioral regions which are rated as very attractive
lip and chin regions (p < 0.05) (Figure 9). Attractive and (Likert 1/2) and male and female perioral regions which are
rated as particularly unattractive (Likert 6/7). For
example, both the ratio of upper vermillion height/
mouthenose distance and the ratio of upper vermillion
height/chinenose distance in frontal- and lateral-view im-
ages of female lip and chin regions (Figures 2e5) and
frontal-view images of male lip and chin regions (Figures 6
and 7) proved to be significantly higher in the attractive
than in the unattractive group, which shows that a full
upper lip certainly is an important feature of both feminine
and masculine attractiveness. Interestingly, we also found
significant differences of the nasolabial and mentolabial
angles between the attractive and unattractive female
groups, with the nasolabial angle being reduced (Figure 8)
and the mentolabial angle being increased (Figure 9) in very
appealing female lip and chin regions. The mean values of
the nasolabial angle of 98.0 in attractive and 118.0 in
unattractive female perioral regions (Table 1, Figure 8)
might indicate that protruding upper lips are judged as
appealing. However, it might also lead to the assumption
that droopy noses, resulting in sharp nasolabial angles, are
generally perceived as more appealing than snub noses,
resulting in wide nasolabial angles. Clearly, when analysing
the nasolabial angle, one has to take into account the nasal
shape as well as the protrusion of the upper lip. Therefore,
one cannot conclude that sharp nasolabial angles are
Figure 11 Ratio of lower vermillion height/chinenose dis- necessarily always judged as appealing.
tance in attractive (Likert 1/2) female compared to attractive Furthermore, the increased mentolabial angles in the
male (Likert 1/2) perioral regions. * Z p < 0.05. Lateral view. attractive female group might indicate that attractive
Table 1 Mean values, p-value and indication of corresponding figure (if present) of different parameters of attractive (Likert
1/2) and unattractive (Likert 6/7) female perioral regions, evaluated in frontal- and lateral-view images.
Female perioral regions Mean Likert 1/2 Mean Likert 6/7 p-value Figure
Frontal-view images
Upper vermillion height/mouthenose distance 0.28 0.18 0.0009 2
Lower vermillion height/chin-mouth distance 0.22 0.17 0.0872
Upper vermillion height/chinenose distance 0.09 0.06 0.0012 4
Lower vermillion height/chinenose distance 0.14 0.11 0.0547
Mouth width/chinenose distance 0.73 0.71 0.6311
Mouthenose distance/chinemouth distance 0.51 0.53 0.7313
Lateral-view images
Lower vermillion height/chinemouth distance 0.27 0.22 0.1378
Mouth-nose distance/chinemouth distance 0.49 0.50 0.5753
Nasolabial angle (degrees) 98.00 118.00 0.0001 8
Mentolabial angle (degrees) 130.50 114.67 0.0287 9
women show a less prominent chin and less protruding lower in the attractive male group than in the attractive
lower lips compared to unattractive women. female group, thus showing that a full lower lip might imply
No difference in naso- and mentolabial angles could be feminine attractiveness, but does, as well as the naso- and
found between the attractive and unattractive male mentolabial angles, not play an important role in masculine
groups, which indicates that nasolabial and mentolabial appeal. However, differences in the height of the lower
angles may not be of major importance when determining vermillion in relation to the chinemouth distance and the
attractive male facial features. Additionally, one can chinenose distance did not show to be significantly
deduct that a prominent chin, often considered as a key different in attractive compared to unattractive perioral
future of masculinity,13 is not necessarily always perceived regions of both the female (Table 1) and the male groups
as attractive. However, our study did not include volunteers (Table 2).
showing abnormal anterior or posterior positioning of the Furthermore, the ratio of mouth width/chinenose dis-
maxilla or mandible, which could have clearly affected the tance did not show any significant difference in attractive
outcomes of mentolabial angles in attractive and unat- compared to unattractive male and female perioral regions
tractive perioral regions. or in attractive female perioral regions compared to
Moreover, our results clearly show that there are certain attractive male perioral regions (Tables 1e4), indicating
features that vary in attractive male and female perioral that a larger mouth does not necessarily add to an in-
regions, such as the height of the lower vermillion, which, dividual’s appeal, as it has previously been pointed out by
in relation to the chinemouth distance (Figure 10) and the Sforza et al.14 No differences could be shown in the ratio of
chinenose distance (Figure 11), appears to be significantly mouthenose distance/chinemouth distance between
1/2) and unattractive (Likert 6/7) male perioral regions, evaluated in frontal- and lateral-view images.
Male perioral regions Mean Likert 1/2 Mean Likert 6/7 p-value Figure
Frontal-view images
Lateral-view images
Upper vermillion height/mouthenose distance 0.39 0.30 0.1396
Upper vermillion height/chinenose distance 0.13 0.10 0.1574
Mouth-nose distance/chinemouth distance 0.50 0.53 0.3930
Nasolabial angle (degrees) 101.17 115.50 0.0718
Mentolabial angle (degrees) 124.17 112.33 0.1922
926 V. Penna et al.
1/2) male and female perioral regions, evaluated in frontal- and lateral-view images.
Male versus female perioral regions (Likert 1/2) Mean Female (Likert 1/2) Mean Male (Likert 1/2) p-value Figure
Frontal-view images
Lateral-view images
Lower vermillion height/chinemouth distance 0.27 0.22 0.0276 10
Lower vermillion height/chinenose distance 0.18 0.15 0.0354 11
Table 4 Mean values, p-value and indication of corresponding figure (if present) of different parameters of unattractive
(Likert 6/7) male and female perioral regions, evaluated in frontal- and lateral-view images.
Male versus female perioral regions (Likert 6/7) Mean Female (Likert 6/7) Mean Male (Likert 6/7) p-value Figure
Frontal-view images
Lateral-view images
attractive and unattractive perioral regions, which makes it

clear that there are certainly more important facial fea-
tures that make the lip and chin area of an individual look
Table 5 Summary of results: Main differences in female appealing than mere facial proportion standards, such as
attractive and unattractive perioral regions. those defined by Farkas et al.1
Table 6 Summary of results: Main differences in male

attractive and unattractive perioral regions.
facial region, being dependent on ethnic, demographic, or

Table 7 Summary of results: Main differences in female
even occupational factors, is subjective,15,16 which is why
vs. male attractive perioral regions.
this study may be specific for a central European popula-
tion. Furthermore, one might perceive certain facial
structures that remind one of a loved person as particularly
beautiful, thus leading to a slightly biased evaluation of
shown image material. It has, for example, been shown
that transcranial current stimulation of the left dorsolat-
eral prefrontal cortex enhances aesthetic appreciation,17
which points out that perception of beauty can clearly be
altered by different mechanisms. Thus, it seems that
beauty does not only lie in the eyes but also in the brain of
the beholder.
Even though a series of significant differences between
attractive and unattractive male and female perioral re-
gions and between attractive male and female perioral Conclusion
regions have been found in this study, there might have
been several confounding factors being of considerable
Perception of beauty certainly varies depending on cultural
importance while evaluating image material using the Lik-
and ethnic influences. However, we were able to define
ert scoring system. First, one must consider that to a
certain parameters of the lips and lower third of the face
certain extent, one’s perception of the beauty of a face or
that seem to add to the attractiveness of female and male
Figure 12 Exemplary images of female(A,B) and male (C,D) attractive and unattractive perioral regions. Frontal view.
928 V. Penna et al.
Figure 13 Exemplary images of female(A,B) and male (C,D) attractive and unattractive perioral regions. Lateral view.
individuals. Furthermore, we were able to prove that there Ethical approval

are gender-related differences in shape and proportions of
attractive lips and an attractive lower third of the face. N/A.
This scientific approach to the appeal of different shapes of
lips, as well as being helpful in preoperative patient’s
consultation, can serve as a helping tool in aesthetic lip
surgery. However, the influence of different cultural and
ethnic backgrounds on the perception of attractiveness and
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Journal of Plastic, Reconstructive & Aesthetic Surgery (2015) 68, 920e929

The attractive lip: A photomorphometric

Received 7 October 2014; accepted 8 March 2015

Introduction shape of lips. Nevertheless, there are certain features

Figure 6 Ratio of upper vermillion height/mouthenose dis-

unattractive male perioral regions did not show any dif-

attractive and unattractive perioral regions, which makes it

Table 6 Summary of results: Main differences in male

facial region, being dependent on ethnic, demographic, or

individuals. Furthermore, we were able to prove that there Ethical approval

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