The Lip-Philtrum Guides (2004) are 5-point pictorial rulers that are used by the FAS DPN to accurately measure philtrum smoothness and upper lip thinness.
The Rank 5 picture represents the typical expression of the smooth philtrum and thin upper lip seen in individuals with FAS. The Rank 1 picture is an example of an individual with a very deep philtrum and full upper lip. As you advance up the Guide from picture #1 to #5, the upper lip becomes thinner and the philtrum becomes smoother.
The Lip-Philtrum Guide reflects the full range (or 'normal' distribution) of lip thickness and philtrum depth one would see in a population. The Rank 3 picture reflects the mean (or 50th percentile). Ranks 1 and 5 reflect the extreme ends of the normal curve (< 2.5th percentile and > 97.5th percentile).
The Lip-Philtrum Guides are intended for use by medical professionals.
Lip-Philtrum Guide 1 is for use with Caucasian patients. This Guide is available in English and Russian translation.
Lip-Philtrum Guide 2 is for use with African American patients.
For patients of mixed race or other races, select the Guide that best matches the phenotypic profile of the patient's race(s).
The laminated Guides are eight inches by two inches in size and are held next to the patient's face to measure the philtrum and lip. The back side of the guides provides the face and height-weight tables from the FASD Diagnostic Guide (2004).
To order the Lip-Philtrum Guides, click here for an Order Form.
Physician using Lip-Philtrum Guide. Illustration of a physician aligned in the patient's frankfort horizontal plane while using the Lip-Philtrum Guide to rank upper lip thinness and philtrum smoothness. The frankfort horizontal plane is defined by a line (green line) that passes through the patient's external auditory canal and the lowest border of the bony orbital rim (orbitale). The physician's eyes (or camera lens) should be directly in line with this plane. If the physician stood above this plane looking down on the patient, the patient's upper lip could appear thinner than it truly is. Click here to see an animation demonstrating how to align yourself in the patient's frankfort horizontal plane.
Copyright: Please do not use these Lip-Philtrum Guide images without written permission from Susan Astley, Ph.D.
Click here to view instructional photos for how to correctly identify Rank 4 and Rank 5 philtrums.
Click here to see the Lip-Philtrum Guide Tables printed on the backside of each Guide.
A Smile Can Distort the Lip and Philtrum
It is important that the patient have a relaxed facial expression (no smile, lips gently closed). A smile can alter lip thinness and philtrum smoothness.
This is the same person with and without a smile. Note that without a smile, the lip and philtrum would both receive a correct Likert Rank of #2 on the Caucasian Lip-Philtrum Guide. With a smile, the lip and philtrum would both receive an incorrect Likert Rank of #5.