Protruding or concealed: Defining ideal cranioauricular angle via a morphometric analysis in Asians.

Introduction: The frontal appearance of ears, usually overlooked in facial aesthetics, has gained increasing attention among Asians. However, a consensus on the ideal cranioauricular angle is currently lacking. This study aims to investigate the ideal cranioauricular angle as perceived by the Asian population through a questionnaire-based survey.

Methods: A survey was conducted among a diverse population of varying backgrounds by distributing questionnaires manually. The participants were requested to evaluate a series of images depicting typical Asian facial features, with ears digitally manipulated to demonstrate distinct cranioauricular angles. Demographic information, including age, gender, occupation, their own face and ear type, and history or interest in otoplasty for aesthetic purposes, was recorded.

Results: A total of 632 responses were recorded. The cranioauricular angle of 30 degrees received the highest scores from respondents, regardless of gender and face shape (P<0.0001), which corresponded to an upper width facial ratio of 0.79-0.82 and a lower facial width ratio of 0.67-0.70. Subgroup analysis revealed ideal angle lies between 30 and 40 degrees, with slight differences when stratified by age, gender, or occupation. Auricles that are excessively protruded or concealed were not preferred. Among respondents with a slender face, 20.5% expressed interest in otoplasty, compared to 15.27% among those with a broader face.

Conclusion: This study provides an in-depth insight into the optimal cranioauricular angle based on gender and facial shape. The ear with a cranioauricular angle of 30 degrees is the preferred option among participants in the survey. These findings offer valuable guidance for surgical planning and outcome assessment in cosmetic otoplasty.