Frankfurt plane: standardizing head position in photos
- Nerve
- Highlighted area
Quick facts
- Definition
- Horizontal plane passing through the porion and the orbitale, used as a reference for head position.
- Porion
- Highest point of the external ear canal; on the skin, the practical reference is the top of the tragus.
- Orbitale
- Lowest point of the lower border of the orbit.
- Use
- Anthropometry, cephalometry and standardization of facial photographs.
- Relevance in HOF
- Keeps the head in the same position in the before and the after, so the photo compares the procedure and not the posture.
The Frankfurt plane, or Frankfurt horizontal plane, is the plane that passes through the porion, the highest point of the ear canal, and the orbitale, the lowest point of the lower border of the orbit. When this plane is parallel to the floor, the head is in the position considered neutral for measuring and photographing the face. The name comes from the anthropology congress in Frankfurt, in the late 19th century, at which the reference was adopted as the standard.
Which points define the Frankfurt plane?
| Point | Anatomical definition | Practical reference on the skin |
|---|---|---|
| Porion | Highest point of the external ear canal | Top of the tragus, the small bump in front of the ear |
| Orbitale | Lowest point of the infraorbital border | Palpable on the lower orbital rim, below the center of the eye |
On a lateral radiograph, the points are bony. In photography, the skin version is used, drawing the line from the top of the tragus to the lowest point of the orbital rim. The skin version is an approximation, but it is enough to standardize photos.
Why does head position change the photo so much?
Small tilts alter what appears to be anatomy. That is why, without standardization, the before and after compare postures, not procedures.
| Positioning error | What appears to change |
|---|---|
| Head tilted down | More evident double chin, more open cervicomental angle, shorter lower third, larger forehead |
| Head tilted up | More defined jaw, longer neck, more visible nostrils, longer lower third |
| Face turned to one side | Apparent asymmetry and one side of the face looking wider |
| Head tilted sideways | Eyes and eyebrows at different heights |
Why does it matter in HOF?
- Honest before and afters: the same position in every photo is the basis for a fair comparison. The full routine is in standardized clinical photography.
- Profile analyses: the Holdaway H line, the Ricketts E-line and the Steiner S line are only comparable with the head in the Frankfurt plane.
- Lower third and double chin: assessment of the double chin and the jawline contour is the most sensitive to head tilt.
How does it show up in the assessment?
- Frontal photo: eyes at the same height and the tragus-to-orbit line horizontal.
- Profile photo: same reference, seen from the side, with the lips relaxed.
- Follow-up: repeat position, distance, lens and lighting of the first photo.
Also known as: Frankfurt horizontal plane, FH plane, Frankfurt horizontal, auriculo-orbital plane.
Frequently asked questions
How do I position the head in the Frankfurt plane for the photo?
Ask the patient to look straight ahead and adjust the tilt until the line between the top of the tragus and the lower border of the orbit is parallel to the floor. Repeat the same position in every follow-up photo.