Holdaway H line: profile and upper lip
- Nerve
- Highlighted area
Quick facts
- Definition
- Line tangent to the soft tissue pogonion and the most anterior point of the upper lip, seen in profile.
- H angle
- Angle between the H line and the soft tissue facial line, which runs from the soft tissue nasion to the soft tissue pogonion.
- Origin
- Soft tissue cephalometric analysis described by the orthodontist Reed Holdaway.
- Use
- Assess the position of the lips and chin relative to the profile and the balance of the lower third.
- Relevance in orofacial harmonization (HOF)
- Helps decide whether the profile calls for volume in the chin, the lips, or neither.
The Holdaway H line is a line drawn on the profile, tangent to the soft tissue pogonion (the most anterior point of the chin) and the most anterior point of the upper lip. The angle it forms with the soft tissue facial line, which runs from the soft tissue nasion to the soft tissue pogonion, is the H angle. The reference was described by the orthodontist Reed Holdaway in soft tissue cephalometric analysis and helps assess whether the lips and chin are balanced in the facial profile.
How are the H line and H angle drawn?
| Element | How it is defined |
|---|---|
| H line | From the soft tissue pogonion to the most anterior point of the upper lip |
| Soft tissue facial line | From the soft tissue nasion to the soft tissue pogonion |
| H angle | Angle between the two lines |
| Lower lip | In the original analysis, it generally sits on the H line or close to it |
| Nose | The distance from the nasal tip to the H line is also observed |
Measurement requires a standardized profile photo, with the head in the Frankfurt plane, lips relaxed, and teeth in occlusion. Tilting the head or tensing the lips changes the angle.
How to interpret the result
In Holdaway's proposal, the reference range of the H angle is around 7 to 15 degrees, with about 10 degrees considered balanced when the skeletal bases are well related. A larger angle usually indicates a more projected upper lip or a more recessed chin. A smaller angle suggests a retruded lip or a chin that sits further forward. Values change with age, sex, and ethnicity, and Holdaway himself treated the analysis as an individual guide.
Why does it matter in orofacial harmonization (HOF)?
- Lips or chin? An increased H angle can come from a large lip or a short chin. Enlarging the lip in a profile with a recessed chin tends to worsen the imbalance, whereas volume in the chin can improve the relationship. The topic is covered in retrognathic profile: assessment.
- Comparison with other lines: the Steiner S line and the Ricketts E line use other points and give complementary readings. The E line depends on nose size; the H line, less so.
- Limit of injectables: large changes in the angle tied to retrogenia (a recessed chin) or to an imbalance between maxilla and mandible may have an orthodontic or surgical indication. It is worth discussing the case with those specialties.
How does it show up in the assessment?
- Profile at rest: lips without contraction and teeth touching.
- Mentolabial and nasolabial angles: complete the reading of the lower third.
- Frontal analysis: the profile alone does not show asymmetries or width.
Also called: Holdaway line, H angle, Holdaway harmony line.
Frequently asked questions
What is the ideal value of the Holdaway H angle?
In the original proposal, the reference range is around 7 to 15 degrees, with a value close to 10 degrees considered balanced in profiles with well-related skeletal bases. Values vary with age, sex, and ethnicity and serve as a guide, not a goal.
What is the difference between the H line, E line, and S line?
The H line runs from the chin to the upper lip and produces the H angle. The Ricketts E line runs from the tip of the nose to the chin. The Steiner S line runs from the chin to the middle of the columella. All assess lip position in profile, with different starting points.