The Goode index: a 1984 paper that still defines nose aesthetics

If you have ever sat in a rhinoplasty consult and heard a surgeon talk about "projection," they were almost certainly referencing the Goode index. The parameter was defined by Richard Goode in a 1984 paper on nasal aesthetic analysis and has barely moved since.

Who Richard Goode was

Goode was an American facial plastic surgeon and professor at Stanford. The 1984 paper proposed a small set of geometric ratios that could be computed from a profile photograph and used to assess nasal projection. The simplest of those ratios, the projection-to-length ratio, became known as the Goode index.

What the Goode index measures

On a strict profile view, two landmarks are identified:

• Nasal tip (the most projected point of the nose).
• Alar crease (the junction of the nasal alar base with the cheek).

A line is drawn from the alar crease through the tip, and another from the alar crease to the nasion (the deepest point of the nasal root, between the brows). The Goode index is the ratio of the first line to the second: nasal projection divided by nasal length.

The aesthetic "ideal" range Goode proposed was 0.55 to 0.6. Higher values indicate over-projection (a nose that pokes too far forward of the face). Lower values indicate under-projection (a nose that reads as flat in profile).

Why it has held up

Forty-plus years is a long time for an aesthetic parameter to remain in use. The reasons are mostly practical:

• It requires only one photograph and two clearly identifiable landmarks.
• It produces a unitless ratio, which means it works regardless of face size or photo distance.
• It maps to a clinical decision: "the patient is over-projected, recommend tip de-projection" vs "under-projected, recommend a graft." The math has direct consequences.
• The 0.55 to 0.6 range has held up across multiple replication studies as a reasonable aesthetic norm in Caucasian populations, with caveats for other groups.

What it does not capture

The Goode index is a projection ratio. It says nothing about:

• Nasal width (the frontal-view alar-to-face-width ratio).
• Nasal symmetry.
• Dorsal hump or scoop.
• Tip rotation (the nasolabial angle).
• Skin thickness, which dramatically changes how all of the above read.

A full nasal aesthetic analysis includes multiple parameters, of which the Goode index is one. Surgeons who reference only Goode are doing a fast read; surgeons doing serious planning will measure five or six.

How Facet handles it

The Goode index requires a profile photo. The current version of Facet calculates it when a profile photo is provided, and defers the parameter (flagged in the module) when only a frontal photo is supplied. Frontal-only scans still produce a nasal score based on width ratio and symmetry, with Goode marked as "requires profile photo" in the breakdown.