Anthropometric Analysis of Indian Faces: A Systematic Review

Abstract

Objective

Facial anthropometric data vary significantly within the Indian population due to the racial, ethnic and geographic diversity. The anthropometric data of a given ethnic community may not match the other due to diverse ethnic variations, and hence, this study is intended to review the facial anthropometric data pertaining to the diverse Indian populace through a systematic literature survey.

Materials and Method

An electronic search done on Medline, Embase and Central databases was utilized to conduct a systematic review of literature. The available data were analyzed based on the various esthetic subunits of the face. The following inclusion criteria were considered: (1) studies depicting the anthropometric data of any ethnic group identified as belonging to India, (2) studies originating from Indian subcontinent, (3) studies which included data of male and female subjects separately and (4) articles in English language only. The following exclusion criteria were considered: (1) atudies conducted on participants with severe malocclusion, developmental craniofacial anomalies, post-traumatic facial deformities or with a history of previous craniofacial or cosmetic surgery, (2) studies which did not specify the anthropometric landmarks used to obtain the measurements, (3) studies in which the statistical analysis was not provided, or if data were grouped across genders and (4) editorials, commentaries, case reports, systematic reviews, meta-analyses and articles not available in English language.

Results

Twenty-one articles met the inclusion criteria. Majority of the Indians, particularly men, seem to have a mesoproscopic facial phenotype. The vertical and horizontal facial dimensions of the Indian male are comparably larger than the Indian female. There is sexual dimorphism among the Indian population with regard to the upper and lower thirds of the face, with little or no gender difference as regards the middle third of the face. It was observed that the nasal dimensions of the Indian race were not compatible with that of the occidental, oriental or the western race. The overall facial structure and the upper half of the face were critical in determining facial attractiveness in Indian males while the lower half of the face and the mandibular contour were critical in determining facial attractiveness in females.

Conclusion

It is observed that there is a paucity of facial anthropometric data for the Indian population considering the ethnic, racial and geographic diversity. Since the prevalence of craniofacial anomalies and dentofacial deformities in India is high and thus the scope for corrective surgery, it is important to compile baseline facial anthropometric data based on the ethnic diversity of the Indian population.

Introduction

In as much as cephalometry and cephalometric analysis is important to an orthodontist in planning orthodontic treatment, anthropometry and anthropometric data are absolutely essential for an oral and maxillofacial surgeon in the pursuit of treating craniomaxillofacial deformities [1, 2]. Numerous studies in the past have shown significant differences in the anthropometric analysis of various faces between races and between ethnic groups [3]. Hence, it is imperative to establish facial anthropometric norms for a given race and perhaps relook and reestablish facial anthropometric norms given the ethnic diversity of patients that we encounter in the current clinical scenario [4, 5].

India is a vast country with a population of 1.41 billion people and is the fastest growing nation in the world [6]. In addition to this, India has a huge ethnic, racial and geographic diversity, which mandates a thorough understanding of the facial anthropometric norms [7, 8]. Therefore, this systematic review is intended to evaluate the current literature on facial anthropometrics of the Indian population and provide guidelines for future clinical use.

Materials and Method

This systematic review was conducted by following the reporting checklist of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). For this study, a comprehensive literature search was undertaken to identify papers published until the end of May 2023 in dental, oral and maxillofacial surgery and anthropometry journals. A protocol was developed in advance to document the analysis method and inclusion criteria. We utilized Scopus, Google Scholar, PubMed and in some cases the website of the journals to search for articles published in the selected journals containing the terms “anthropometric study,” “Indian face” and “Indian race” in their titles, abstracts and/or keywords with only English being the preferred language.

The title, abstract, keywords, authors names and affiliations, journal name and year of publication of the identified records were exported to an MS Excel spreadsheet. Two independent authors screened the titles and abstracts of the records independently, and those articles clearly not specific to the topic were discarded. Then, the two authors performed eligibility assessment by carefully screening the full texts of the remaining papers independently. During this phase, disagreements between the authors were discussed and resolved by consensus. If no agreement could be reached, the views of a third author were taken into consideration.

The MS Excel spreadsheet was modified by adding the items for which data were sought for data management. More specifically, the bibliographic details of the included studies, the essential items of PRISMA checklist with some extensions and an item to address reporting the PRISMA flowchart were added to the data management spreadsheet. One author extracted the data from the included papers, and the second author checked the extracted data. Disagreements were resolved by discussion between the two reviewers. Subsequently, all the included papers were carefully reviewed to extract and code the data.

The following inclusion criteria were considered: (1) studies depicting the anthropometric data of any ethnic group identified as belonging to India, (2) studies originating from Indian subcontinent, (3) studies which included data of male and female subjects separately and (4) articles in English language only. The following exclusion criteria were considered: (1) studies conducted on participants with severe malocclusion, developmental craniofacial anomalies, post-traumatic facial deformities or with a history of previous craniofacial or cosmetic surgery, (2) studies which did not specify the anthropometric landmarks used to obtain the measurements, (3) studies in which the statistical analysis was not provided, or if data were grouped across genders and (4) editorials, commentaries, case reports, systematic reviews, meta-analyses and articles not available in English language.

The main intention of this study is to evaluate the current literature on facial anthropometrics of the Indian population and provide guidelines for future clinical use. Descriptive data from all the carefully chosen articles were selected and tabulated. Data pertaining to facial anthropometry were categorized based on various esthetic subunits of the face and assessed separately. The studies were thoroughly reviewed to identify the facial anthropometric parameters that were measured, and the landmarks used to obtain these measurements. The following qualitative outcomes were extracted: ethnic group, sample size, gender, age, method of evaluation, instrumentation used and general findings. Following qualitative analysis, all reported inferences pertaining to anthropometric analysis of an Indian face based on ethnicity, gender and geographic location were extracted. Table 1 depicts the facial anthropometric inferences presented in these studies.

Table 1.

Qualitative data extracted from studies conducted in India

S. No	Author (year)	Ethnic group	Sample size Demographic data	Esthetic zone analyzed	Instrument used	General findings
1	Kunjur et al. [20]	Indian origin	13 subjects 18—25 years	Eye	Digital photography	Eyebrow is bow or arc-shaped in both genders. Position of the highest point between the lateral canthus and the lateral limbus in females, but in men, it is 1–2 mm lateral to the lateral canthus
2	Mane et al. [11]	Indian origin	100 Subjects 19—35 years 50 males 50 females	Facial shapes	Digital Vernier’s caliper	Hyperleptoprosopic facial phenotype with oval shape face: Vertical and horizontal dimensions were more in males than in females. Sexual dimorphism exists among the Indian population in both the upper and lower third of face, but the middle third of face revealed less gender difference
3	Shetti et al. [12]	Manipal	100 subjects 66 males 34 females	Facial index	Spreading calipers	Mesoprosopic facial phenotype: Vertical and horizontal measurements were greater in males than in females
4	Mani [13]	Rajasthan	100 subjects 18—35 years 100 males	Facial index	Spreading calipers	Hyperleptoprosopic facial phenotype: They have a longer and broader face. Facial index is not comparable to any other Indian groups, but it is comparable to North Europeans and Nigerians
5	Vasanthakumar et al. [21]	South Indian origin	200 subject 18—26 years 100 males 100 females	Eye	Digital photography	The palpebral fissure width, palpebral fissure inclination, outer canthal distance and interpupillary distance were more in males than females. There was no significant difference in the inter canthal distance between the two genders
6	Chandra et al. [18]	Mangalore	100 subjects 18—25 years 50 males 50 females	Facial proportions	Digital Vernier’s	Indian faces have a wider lower face while North American Caucasians have wider mid face. Indian faces had overall greater values of proportional indices than North American Caucasian population
7	Prasanna et al. [16]	North India South India	200 subjects Older than 18 years of age 100 males 100 females	Facial index	Spreading calipers	North Indian males and females had highest facial height and upper facial height. Facial width of South Indians was more as compared to that of North Indians in both sexes
8	Kalra et al. [19]	Uttar Pradesh	30 female subjects	Facial proportions	Digital photography	Upper face–face height index, nose mouth width index and nasal index were close to golden proportions whereas vermillion-cutaneous upper lip height index and mandibular face width index were close to silver proportion. Mandibulo lower face height index, upper lip mandible height index and mouth face width index were found to be comparable to Caucasian females
9	Duggal et al. [7]	North India	150 subject 18—24 years 75 males 75 females	Esthetic subunits	Digital photography	The overall facial shape and upper facial shape were critical in determining facial attractiveness in Indian males while mandibular contour and shape were critical for females
10	Packiriswamy et al. [41]	South India	375 Subject 18—35 years 375 females	Nose	Digital photography	South Indian women had a significantly wider nose, nose root and nasal base than the North American white women. The nasal length and nasal dorsal length indicate that nose is shorter in South Indian women. The nasal tip projection of South Indian women was similar to North American white women
11	Verma et al. [28]	North East and North West subpopulation of India	80 subjects 18—25 years 33 males 47 females	Ear	Digital Vernier’s caliper	The mean total ear length and breadth, concha length and breadth, lobule height and width were noted more in males on both sides. The ear index was noted more in males whereas lobule index was more in females
12	Shinde et al. [38]	Indian origin	150 subjects 18—28 years 75 males 75 females	Facial proportions	Digital Vernier’s caliper	Males had wider and taller face heights than females. Intercanthal width and binocular width were larger in males, whereas eye fissure length was similar in males and females and eye fissure height was larger in females. Males had a wider noses with increased nose height than females
13	Saurabh et al. [9]	Central India	200 subjects 18—25 years 64 males 136 females	Facial proportions	Digital photography	Significant difference between facial proportions of Indian population and the ideal ratio. They showed significant difference from the Japanese and Caucasian population
14	Mehta et al. [39]	North India South India West India Central India Himalayan	1000 subjects 20—60 years 500 males 500 females	Nose	Digital photography	North Indians had the longest but narrowest nose. South Indians had the broadest noses whereas subjects from Himalayan region had shortest nose
15	Parab et al. [36]	North India South India East India West India	221 subjects 18—25 years 110 males 111 females	Nose	Digital photography	Nasal measurements of the Indians are different from European, Chinese and American noses. Hence, the parameters obtained from western and eastern countries should not be applied for Indian Nose
16	Gupta et al. [8]	Haryana	300 subjects 17—30 years 150 males 150 females	Facial forms	Digital Vernier’s caliper	Mesoprosopic facial phenotype. Males have a greater lower facial height, width of mouth, intercanthal distance, width of face, physiognomic facial length and facial length than females
17	Kumar et al. [14]	Haryana & Himachal Pradesh	200 subjects 18—40 years 100 males 100 females	Facial form	Spreading vernier caliper	Facial height of Haryanvi males was more than Himachali males. The predominant face type for both populations was Hypereuryproscopic phenotype
18	Prasanna et al. [15]	Andhra Pradesh	291 subjects 17—23 years 143 males 148 females	Facial index	Digital Vernier’s caliper	The dominant facial phenotype is mesoproscopic and hypereuryproscopic in males and females, respectively
19	Chitta et al. [17]	Kerala	250 subjects 18—40 years 144 males 106 females	Facial forms	Digital photography	Face is wider and rounder than other Indian face with respect to the upper facial, lower facial, nasal and intercommissural widths. Midface of females is longer compared to other Indian female
20	Bandari et al. [35]	North India	500 subjects 18—35 years 387 males 113 females	Nose	Both digital photography and digital vernier’s caliper	The male nose is longer, wider, with more tip protrusion, longer columella with a wider columellar base and wider nostril floor as compared to the female nose. The Indian nose was found to be in between the North American White nose and Korean nose
21	Agarwal et al. [6]	Mumbai	200 subjects 16—35 years 100 males 100 females	Facial proportions	Digital photography	The physiognomic facial height and facial width were greater in males than females. Males significantly deviate from the ideal golden ratio as compared to females

Results

The current study reviewed 21 articles. The study selection process has been summarized in Figs. 1 and 2. Although the literature search against the databases and search engines resulted in 1108 records, 906 were screened and 703 were eliminated and 203 articles were assessed for eligibility. Systematic reviews, articles involving cephalometrics, articles not from Indian origin and articles whose full texts were not available were excluded. The full texts of the remaining 203 articles were carefully evaluated, and eventually only 21 articles involving studies conducted for anthropometric analysis on the Indian population were considered for the collation of anthropometric norms for an Indian face.

Fig. 1.

The PRISMA flow diagram

Fig. 2.

Flow chart of study selection process

There was a large variation noted in sample size, age, racial, ethnic and geographic diversity among all the studies that were included. Also, the methods used to perform facial anthropometric analysis were variable in the form of digital photographic evaluation and the use of manual or digital vernier’s calipers. Following a thorough literature survey, it was evident that a vast ethnic, racial and geographic diversity exists among the Indian population.

Majority of the Indians, particularly men seem to have a mesoproscopic facial phenotype whereas women were hypereuryproscopic phenotype. The vertical and horizontal facial dimensions of the Indian male are comparably larger than the Indian female. There is sexual dimorphism among the Indian population with regard to the upper and lower thirds of the face, with little or no gender difference as regards the middle third of the face. It was observed that the nasal dimensions of the Indian race were not compatible with that of the occidental, oriental or the western race. The overall facial structure and the upper half of the face were critical in determining facial attractiveness in Indian males while the lower half of the face and the mandibular contour were critical in determining facial attractiveness in females (Table 2).

Table 2.

Inferences of the systematic literature survey

S. No.	Parameter	Indian population	Indian population compared to the Caucasians
1	Facial form and proportions	Facial height and facial width were greater in males than females	Facial proportions of the Indian population are lesser than the Caucasians
		Males had a longer faces while females had a rounded face
2	Eyes	Indian males had a wider palpebral fissure than Indian females	Indians have a smaller intercanthi distance, face width, outer intercanthi distance and frontal angle of the nose than the Caucasians
		The interpupillary distance was greater in males compared to females
3	Ears	Indian males had larger ears than females with ear length and breadth and lobule height and width being greater in males than females	No data available
		The length and width of the ear was higher in the north-west followed by the north east and central Indian population
4	Nose	Indian males had a longer and wider nose with more tip protrusion, longer columella with a wider columellar base and wider nostril floor as compared to the female nose	The Indian nose should be considered as a different entity in comparison to Caucasians There were numerous variations noted
		Northern and Western India population had the longest noses followed by people from Southern India
		The nasofrontal angle in males was narrower as compared to females perhaps due to an increase in the projection of the frontal bone
5	Upper and lower lip	The vertical height of the upper lip is more among Indian males than females	The vertical height of the upper lip, the width of the Cupid’s bow and the width of the oral commisure in Caucasians were greater than the Indians
		The Indian males have a wider oral commissure compared to females

Discussion

A thorough literature survey was done from the available articles of Indian origin, and the data were interpreted as per the esthetic sub units of the face in addition to drawing comparisons with the Caucasians, Chinese and the African races.

Facial Form and Proportions

It is a well-known fact that the face is the most attractive part of the human body responsible for visual appraisal and recognition [9]. The beauty of a human face is quantified by the harmony of proportions [10]. Literature review has revealed that the overall facial structure and the upper half of the face were critical in determining facial attractiveness in Indian males while the lower half of the face and the mandibular contour were critical in determining facial attractiveness in females [11]. It was observed that among the Indian population, the physiognomic facial height and facial width were greater in males than females. [10, 12] Indian males significantly deviated from the ideal golden ratio as compared to Indian females [10, 13]. A recent study stated that 2.80 to 12.08% deviation can be noticed from ideal values in the transverse and vertical planes for the Indian population with the variation being minimal in North Indian and maximum in South Indians [14]. Literature reveals that majority of the Indian population had a mesoproscopic facial phenotype followed by hyperleptoproscopic facial phenotype with oval shaped faces [11, 15–19]. The vertical and horizontal dimensions were greater in males than in females [11, 15–19]. It has been observed that sexual dimorphism exists among the Indian population in both the upper and lower thirds of the face; however, the middle thirds of the face revealed less gender differences [11, 15, 16].

The north Indian males were found to have longer faces as compared to females whereas the females had a tendency toward long to round faces. The South Indian males again had longer faces as compared to females, and the females had a more round to broad faces as compared to the North Indian females [20, 21]. This could be attributed to the fact that the North Indians live in colder climates as compared to the South Indians which could have led to an increase in the length of the nose and as a result, an increase in midfacial height [20]. The facial proportions of Indians showed significant differences from the Japanese and Caucasian populations [13, 22, 23]. Literature reveals that the variations in facial morphology are a result of the environmental, socioeconomic status and nutritional conditions [4, 13]. Hence, it is essential to understand that although the golden proportion is a widely accepted concept in facial esthetics, it is not the only method by which human beauty can be quantified.

Eyes

Anthropometric studies from the western world reveal that the medial brow should begin on the same vertical plane as the lateral extent of the ala and the inner canthus and should end laterally at an oblique line drawn from the most lateral point of the ala through the lateral canthus [24]. The medial and lateral ends of the brow should lie roughly at the same horizontal level with the apex lying on a vertical line directly above the lateral limbus. However, anthropometric studies on Indian races reveal that the eyebrow is arch or bow shaped. In the Indian female, the apex of the brow lies between the lateral canthus and the lateral limbus, but in the Indian men, it was noted about 1–2 mm lateral to the lateral canthus [24]. The mean distance from the upper lid crease to the lower margin of the brow ranged from 7 to 12 mm compared to 10 to 15 mm in Caucasians.

It was observed from previous studies that Indian males had a wider palpebral fissure than Indian females [23, 24]. This may be attributed to the larger and wider faces of men as compared to women. Previous studies have shown that the American and Caucasian males have a wider palpebral fissure than Indian males [25, 26]. Adler suggested that the eyes look esthetically pleasing if both medial and lateral canthi are at the same level [27]. According to western esthetic norms, the lateral canthus should lie slightly higher than the medial canthus. Vasanthakumar et al. in a study on the Indian population observed more obliquity of palpebral fissure in females than in males while Kunjur et al. in a study on adult Indians observed that the palpebral fissure inclination in males is more oblique than in females [24, 25]. However, there was no difference between the obliquity of the palpebral fissures in the Indian population. A mongoloid type of palpebral fissure was seen in Indian ethnic adults [25]. The obliquity of the palpebral fissure was relatively higher in the Indian population as compared to the Chinese and the North Americans. A recent study established normative data of facial anthropometry required for designing a spectacle frame for the Indian population and stated that the Indians have a smaller intercanthi distance, face width, outer intercanthi distance and frontal angle of the nose than the Chinese [28].

With regard to the interpupillary distance, it was noticed that these values were higher in males compared to females and they follow the Caucasian norms [25]. However, there is no gender difference with regard to the intercanthal distance similar to the Caucasian norms [24, 25]. As compared to the previous studies, it was observed that significant differences were noticed in the dimensions and in the inclination of the palpebral fissure in addition to the eyebrow shape and the position of its apex in Indians, Chinese and the North Americanss [26, 29, 30]. The Indian population revealed bigger eyes and a larger iris area as compared to the Chinese which are perhaps due to the comparatively greater intercanthal and eye-to-eyebrow distances with higher percentage of iris coverage in the Chinese [31, 32].

Ears

A recent study on the morphological variations and biometrics of the ear stated that 65% of the North Indian population have attached ear lobes and 35% have free ear lobes [33, 34]. An oval ear shape was most commonly noted followed by a triangular, rectangular and round shapes in the Indian population [33]. It was observed that the ears were larger in males than females with ear length and breadth and lobule height and width being greater in males than females contributing to the overall increase in the dimensions in males as compared to the females [33–35]. The tragus length was more or less equal in dimension for both the genders. The ear index was observed to be more in males while the lobule index was more in females [33, 35]. It was observed from previous studies that the length and width of the ear were higher in the north-west followed by the north-east and central Indian population which could be attributed to the variations in ethnic and genetic background [33–37]. A recent study also found that 82.9% of the Indian population had the Darwin’s tubercle [34]. However, this frequency is as low as 40% in the population belonging to central India [38]. A rolled helix is more common than flat a helix in the Indian population [34, 39].

Nose

It was observed that among the Indian population, the males had a longer and wider nose with more tip protrusion, longer columella with a wider columellar base and wider nostril floor as compared to the female nose [40–43]. Hence, this increase in nasal length may contribute to the increased midfacial height noticed in males thus contributing to the overall increase in facial height. Also, the vertical height of the upper lip as measured from the columellar base to the tip of the cupids bow was more in males than in females [40]. A recent study noted that subjects from North India and Western India had the longest noses followed by people from South India [44]. South Indians had the broadest nose whereas North Indians had the narrowest nose [44].

The nasofrontal angle in males was narrower as compared to females perhaps due to an increase in the projection of the frontal bone [41]. The Himalayan population had the widest nasofrontal angle which can be attributed to the flatter nasal bones. The nasolabial angle irrespective of the geographic location is always narrower in Indian male than in Indian female which could be attributed to the projection of the nasal tip and the upper lip posture [44]. Previous studies have shown that populations adapted to dry environments tend to have large protruding external noses, downwardly directed nostrils and narrower skeletal apertures which would induce turbulence to nasal airflow thereby maximizing filtration and humidification of air within the nasal passages. Conversely, those with smaller, flatter external noses, more anteriorly directed nares and shorter pyriform apertures are better adapted to humid environments [45].

A recent study comparing South Indian women with North American white women showed a significant difference in nasal dimensions and morphology with the South Indian nose being shortest and the widest in all dimensions. However, the nasal tip projection of South Indian women was similar to North American white women. [46] An ideal characteristic of the Caucasian nose is considered to be the columella, which is twice the length of the infratip lobule [47]. The Chinese nose resembled the Indian nose only in nasal length [48]. Hence, considering all the above mentioned factors, the Indian nose should be considered as a different entity in comparison with the North American white population, Africans, Koreans and Chinese [40, 41].

Upper and Lower Lip

The length of the upper lip as viewed in the profile is almost similar to the extent of nasal tip protrusion in the North American white population, and this proportion is identical to Caucasians. However, the lip length in the Indian population was relatively less than the nasal tip protrusion and was found to be comparable to the Korean population [49]. It was observed that the vertical height of the upper lip is more among Indian males than females [26, 50]. The vertical height of the upper lip in Caucasians was the longest followed by the Africans whereas it was shortest among the Indians [50]. The width of the Cupid’s bow was lesser compared to the Caucasians and the Africans; however, no gender difference was observed in the Indian population [50].

It was observed among the Indian population that the upper lip vermilion is thinner than the lower lip vermilion in both the genders [51]. The length of the upper lip is lesser than the length of the lower lip in both genders [51, 52]. It was observed that the Indian males have a wider oral commissure compared to females. However, the oral commissure was narrower in the Indian population when compared to the Caucasian and the African races [50]. The Indian upper and lower lips differ significantly in certain parameters from Caucasians, Africans and White North Americans [51].

Conclusion

It was observed from the current systematic literature survey that majority of the Indian population had a mesoproscopic facial phenotype. The facial proportions of Indians showed significant differences from the Caucasians. The Indians have a smaller intercanthi distance, face width, outer intercanthi distance and frontal angle of the nose than the Caucasians and the Chinese. An oval ear shape was most commonly noted in the Indian population with the ear index more in males and the lobule index more in females. The Northern and Western Indian population had the longest noses followed by Southern India. The nasolabial angle irrespective of the geographic location is always narrower in Indian male than in Indian female. The vertical height of the upper lip and the width of the oral commissure were greater in the Caucasians than the Indians.

Previous studies conducted to obtain anthropometric values for different races of the Indian population have had limitations. This could be due to the low sample size, studies being restricted to a specific race, lack of comparative studies or variations in the method of values obtained based on photographs as against direct measurements from the face. It is observed from the current systematic literature survey that there is a paucity of facial anthropometric data for the Indian population considering the ethnic, racial and geographic diversity. Since the prevalence of dentofacial deformities in India is high and thus the scope for corrective surgery, it necessitates the need to compile baseline facial anthropometric data based on the ethnic diversity of the Indian population.

Author Contributions

Uday Kiran Uppada, David P. Tauro and KP Senthilnathan were involved in design of study, data acquisition, data analysis and manuscript preparation.

Funding

Self-funded.

Declarations

Conflict of interest

None.

Consent to Participate

Patient consent not required taken.

Ethical Approval

Institutional ethical clearance not required.