This study evaluates six different techniques with respect to their ability
to quantitatively describe facial asymmetry in three dimensions. Three-dim
ensional facial images were acquired using a Cyberware 3030RGB laser surfac
e scanner. Image processing was performed on a Silicon Graphics Indigo comp
uter workstation. The following techniques for facial asymmetry analysis we
re developed: asymmetry in the location of anthropometric landmarks, Euclid
ean distance matrix analysis (EDMA), scalar measurement of the lower ciliar
y margin and palpebral fissure area, clearance vector mapping, and determin
ation of the volume of asymmetry. Techniques were applied and validated in
three anthropometric models: a perfectly symmetrical plastic head model and
a plaster head model with and without a unilateral cheek augmentation. In
each of the anthropometric test models, each analytical technique was valid
ated by means of static anthropometric facial models and was evaluated for
intraobserver and interobserver reliability. Asymmetries in the location of
anthropometric landmarks can be accurately determined to within 2 mm in x,
y, and z directions of the Cartesian space. EDMA is a useful technique in
describing both size and shape changes of discrete areas of the face. Measu
rement of the lower ciliary margin and palpebral fissure area is reliable.
Clearance vector mapping is especially useful in quantifying facial surface
asymmetries in facial areas where anthropometric landmarks are scarce. Vol
ume of asymmetry is potentially useful in those patients for whom the use o
f injections or implants of known volume may be helpful in correcting unila
teral facial deficiencies.