What Is Holdaway Analysis?
Developed by Ray A. Holdaway in the 1950s and refined through subsequent publications, Holdaway soft tissue analysis was one of the first systematic attempts to evaluate facial aesthetics through measurable cephalometric parameters rather than subjective impression. Where most classical analyses — Steiner, Ricketts, Downs — focus primarily on skeletal and dental relationships, Holdaway's method centres on the soft tissue profile: the lips, nose, and chin as they actually appear to the patient and clinician.
The central construct of the analysis is the H line — a line drawn from the soft tissue chin (soft tissue Pogonion) to the most prominent point of the upper lip. The angle this line forms with the NB line (Nasion to bony Pogonion) constitutes the H angle, the primary indicator of lip protrusion or retrusion relative to the facial profile. A series of additional measurements then describe the relationship of the upper lip, lower lip, nose, and chin to this reference line.
In contemporary practice, Holdaway analysis is most valuable when interpreted alongside skeletal analyses. It helps answer the clinical question that patients actually care about: How will this treatment change the appearance of my face? It is particularly useful in extraction versus non-extraction decision-making, in planning orthognathic surgery, and in evaluating soft tissue response to dentoalveolar changes. BCeph includes full Holdaway analysis alongside Ricketts, McNamara, and the full suite of skeletal analyses in a single free browser-based session.
Holdaway Measurements and Norms
Holdaway analysis comprises six principal measurements. Norms are based on Holdaway's original white North American sample. Clinicians should apply population-appropriate reference values where available.
| Measurement | Norm | Acceptable Range | High (↑) | Low (↓) |
|---|---|---|---|---|
| H Angle (H-NB) | 10° | 7° – 15° | Lip protrusion / full profile | Lip retrusion / flat profile |
| Upper Lip to H Line | 0 mm | −1 to +1 mm | Upper lip protrusive | Upper lip retrusive |
| Lower Lip to H Line | 0 mm | −1 to +1 mm | Lower lip protrusive / lip strain | Lower lip retrusive |
| Nose Prominence (Pn to H Line) | 9 mm | 7 – 14 mm | Prominent / projecting nose | Flat / deficient nasal projection |
| Skeletal Profile Convexity (A to NB) | 2 mm | 0 – 4 mm | Skeletal convexity / Class II tendency | Skeletal concavity / Class III tendency |
| Soft Tissue Chin Thickness (Pog to Pog') | 10 mm | 8 – 14 mm | Thick soft tissue chin | Thin soft tissue chin |
Norms from Holdaway (1983). Values may vary by sex, age, and population group. Soft tissue chin thickness of ≥10 mm may mask a skeletal chin deficiency; clinicians should compare Pog' position with underlying bony Pogonion.
The H Line and H Angle: Construction
The H line is drawn from soft tissue Pogonion (Pog') to the most prominent soft tissue point of the upper lip. The angle it subtends against the NB line (hard tissue Nasion to bony Pogonion) is the H angle. Critically, the construction of the H line depends on upper lip prominence — meaning the H angle and upper lip-to-H-line measurement are interrelated. A more protrusive upper lip produces a larger H angle and simultaneously places the upper lip at or near 0 mm on the H line by definition. This self-referential aspect is important: the H angle is most informative when read alongside nose prominence and lower lip position, not in isolation.
Landmarks Required for Holdaway Analysis
Holdaway analysis requires both hard tissue and soft tissue landmarks. Accurate tracing of the soft tissue outline is essential — errors in identifying the upper lip, lower lip, nasal tip, or soft tissue chin will directly affect all measurements.
Clinical Interpretation of Holdaway Findings
H Angle: Profile Fullness and Lip Protrusion
The H angle is the primary descriptor of overall lip prominence relative to the chin. An H angle of 7–15° is considered harmonious. Values above 15° indicate a convex soft tissue profile with prominent lips — often seen in Class II division 1 cases with protrusive upper incisors, or in untreated bimaxillary protrusion. Values below 7° indicate a flatter or retrusive lip profile, which may be appropriate in some skeletal patterns but can become aesthetically problematic if extraction treatment or orthognathic surgery creates excessive retraction.
Holdaway observed that the ideal H angle tends to increase slightly with age as the nose grows and the lips become relatively more retrusive. Clinicians treating adolescent patients should account for this in long-range treatment planning.
Lip Position and Lip Strain
The upper lip should ideally lie at 0 mm to the H line — exactly on it. A lower lip that sits more than 1–2 mm anterior to the H line typically indicates lip strain: the lower lip is working to achieve lip seal against a protrusive upper lip or upper incisors. This finding should correlate with other indicators of upper incisor proclination in the Steiner or Ricketts analyses. Following treatment, lower lip position is expected to move posteriorly as upper incisor retraction reduces the demand for lip strain.
Nose Prominence and Profile Balance
Nose prominence (Pronasale to H line) of approximately 9 mm represents a well-projected nose that contributes to a balanced profile. Clinicians planning maxillary impaction or orthognathic advancement should consider the effect on apparent nasal projection — maxillary advancement tends to reduce the relative prominence of the nose tip, while posterior movement can increase apparent nasal projection. These relationships are also reflected in E-line analysis, which uses Pronasale as a reference anchor.
Soft Tissue Chin Thickness
Soft tissue chin thickness (Pog to Pog') of approximately 10 mm is average. Importantly, a thick soft tissue chin can mask a deficient bony pogonion — a clinically significant finding when planning genioplasty or orthognathic surgery. Conversely, a patient with a skeletal Class III jaw relationship may still present with a well-projected soft tissue chin if the soft tissue pad is thick. Always compare bony and soft tissue pogonion positions explicitly rather than relying on one landmark alone.
Relationship to Other Analyses
Holdaway findings should always be read in context. An elevated skeletal convexity (A to NB >4 mm) correlating with a large H angle and lip strain creates a consistent picture of a Class II soft tissue pattern. By contrast, a large H angle in a patient with a flat or concave skeletal profile may indicate bimaxillary dentoalveolar protrusion with a normal or mild skeletal discrepancy — a pattern better addressed with extraction than with skeletal correction. Cross-referencing with the Wits appraisal, ANB angle, and McNamara maxillary position will guide the final treatment plan.
Run Holdaway Analysis Free in BCeph
BCeph includes complete Holdaway soft tissue analysis at no cost, with no installation and no cloud upload. You place soft tissue landmarks — upper lip, lower lip, Pronasale, soft tissue Pogonion — directly on your uploaded cephalogram, and BCeph calculates all six Holdaway measurements in real time against the published norms.
Data Stays Local
Your cephalogram never leaves the browser. No cloud processing, no external server, no BAA required. HIPAA-aligned by architecture.
Full Soft Tissue Suite
H angle, lip positions, nose prominence, skeletal convexity, and chin thickness — all six measurements with norm comparison and colour-coded deviation indicators.
Combined Analyses
Run Holdaway alongside Steiner, Ricketts, McNamara, and 6+ other analyses in one session. One landmark set, all analyses, one exportable PDF report.
Any Device, No Install
BCeph runs in any modern browser — Windows, macOS, iPad, or Chromebook. No download, no licence key, no IT approval needed.
BCeph is free for all users — residents, educators, and practitioners. There is no feature gating, no per-case fee, and no paywall on any analysis module. See how BCeph compares to WebCeph, CephX, and Dolphin Imaging for a full breakdown of what you get for free versus what paid platforms charge.