Rating nasolabial aesthetics in unilateral cleft lip and palate patients: Cropped versus full-face images

Roderic M.F. Schwirtz, Frans J. Mulder, David G.M. Mosmuller, Robin A. Tan, Thomas J. Maal, Charlotte Prahl, Henrica C.W. de Vet, J. Peter W. Don Griot

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10 Citations (Scopus)


Objective: To determine if cropping facial images affects nasolabial aesthetics assessments in unilateral cleft lip patients and to evaluate the effect of facial attractiveness on nasolabial evaluation. Design: Two cleft surgeons and one cleft orthodontist assessed standardized frontal photographs 4 times; nasolabial aesthetics were rated on cropped and full-face images using the Cleft Aesthetic Rating Scale, and total facial attractiveness was rated on fullface images with and without the nasolabial area blurred using a 5-point Likert scale. Setting: Cleft Palate Craniofacial Unit of a University Medical Center. Patients: Inclusion criteria: nonsyndromic unilateral cleft lip and an available frontal view photograph around 10 years of age. Exclusion criteria: a history of facial trauma and an incomplete cleft. Eighty-one photographs were available for assessment. Main Outcome Measures: Differences in mean CARS scores between cropped versus full-face photographs and attractive versus unattractive rated patients were evaluated by paired t test. Results: Nasolabial aesthetics are scored more negatively on full-face photographs compared to cropped photographs, regardless of facial attractiveness. (Mean CARS score, nose: cropped = 2.8, full-face = 3.0, P <.001; lip: cropped = 2.4, full-face = 2.7, P <.001; nose and lip: cropped = 2.6, full-face = 2.8, P <.001). Conclusion: Aesthetic outcomes of the nasolabial area are assessed significantly more positively when using cropped images compared to full-face images. For this reason, cropping images, revealing the nasolabial area only, is recommended for aesthetical assessments.

Original languageEnglish
Pages (from-to)747-752
Number of pages6
JournalCleft palate-craniofacial journal
Issue number5
Publication statusPublished - 1 May 2018


  • Cleft lip and palate
  • Cropping photographs
  • Full-face images
  • Nasolabial appearance

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